purse lip breathing technique

[skate4life]

While doing some reading in my respiratory textbook, I found a reason for why it is said to breathe out slowly when doing purse lip breathing. It is not uncommon for people, especially when anxious or having severe shortness of breath, to inhale/exhale quickly. They exhale forcefully. Even our rehab Director used to do this, apparently thinking that just pursing the lips created enough back pressure to keep the small air sacs open longer to exchange the gases. But apparently due to airway pressures at the smallest level, the air sacs will stay open until certain pressures are reached and then the walls collapse. So I gather that you could still be exhaling forcefully but the walls will have already collapsed and effect is lost.

So I interpret this to mean you need to purse your lips and just let the air out (exhale) slowly by itself, try to do for as long as possible before the next breath. At first, when very SOB, don't try to inhale to maximum the first couple of times, but do try to let air out for a count of 2-3. If possible focus on thinking about sucking your tummy in toward your spine and pushing it up toward your chest. Then try to increase inhalation to count of 2 even if not maximum, and exhale slowly to count of 3, later try count of 4. Gradually you will find you can take deeper and deeper breaths in and be able to slowly exhale longer and longer. Try this as an exercise when you are relaxed so you know how it feels. I think Nancy Wilson has a youtube about this and showed it on a webinar with Noah Greenspan.

I try to never stop learning about this disease......and this textbook could be wrong. I'm always willing to be corrected.

[zellie]

Did you mean Donna Wilson Lung Exercises on youtube? Yes, she has many good exercises for COPD.

[skate4life]

Thanks Zellie - you are indeed right. It is Donna Wilson. Did you see the webinar? She was great and had information on hints not found on her youtube.

Hi Zellie - hope you will post more often. Are you still in NY? I'm in CT, 71, very severe copd, 95% housebound mainly because getting my rolator back into the car has wrenched my back several times I've only been here a couple of years and they are such warm & caring people.

[zellie]

Yes, I am still in NY and also in the very severe stage at 71. I am pretty much home bound at this stage. I only go out for Dr. appointments.
I watched most of Noah's programs. Donna has many helpful videos.

[jarca]

thanks for the explanation, skate, i always thought it was to force the leftover CO2 out, so probably not doing it right. 
I also thought a person was supposed to exhale twice as long as inhale.
boy, i need to remember what i used to know

[skate4life]

Yes Jarca, you do exhale longer than inhale (just rechecked my initial post and while I did not give a ratio per se, I did say with each breath to try and exhale longer - count to 2, then try counting to 3, etc.) The goal is to exhale CO2 to keep your body in balance (not let CO2 rise beyond normal.)

I didn't say it completely right - I was trying to say that due to a pressure change, don't forcefully blow out/exhale, but let the air go out only by the help of sucking in your tummy. Perhaps that is why I don't like the analogy of 'blow out the candle.' Some people interpret this to 'quickly blow out all the candles on the cake with one big breath.'

Donna gave a good description of how to handle the times when you get acutely short of breath, when you feel you are gasping for air...can't get air in or out.....focus on not trying to take such a deep breath but take a partial inhale and then exhaling. If it helps you to mentally say '1-1000, 2-1000..' before inhaling again, then do so. What ever works for you. It does take several breaths to gain control, but just tell yourself that you can do this, you have done it before, and it will get better with each breath. The goal is to exhale enough gas to make room for more to come in. The longer you exhale, the more room you make for the next breath, you'll find you can inhale deeper and get more oxygen to come in.

I sincerely apologize if I have confused you!