Breathing Exercises

Question 1

What are the indications for diaphragmatic breathing?

Answer 1

• post-surgical patient with pain in the chest wall or abdomen or restricted mobility
• patient learning active cycle of breathing or autogenic drainage airway clearance techniques
• dyspnea at rest or with minimal activity
• inability to perform ADLs due to dyspnea or inefficient breathing pattern

Question 2

What are the precaution/contraindications for diaphragmatic breathing?

Answer 2

• moderate to severe COPD and marked hyperinflation of the lungs without diaphragmatic movement
• patient with paradoxical breathing patterns, or who demonstrate increased respiratory muscle effort, and increased dyspnea during DB

Question 3

What is the procedure for diaphragmatic breathing?

Answer 3

• semi-fowler’s position is best starting position for most
• sniffing can be used to facilitate contraction of the diaphragm
• have patient place one hand on the upper chest and the other hand below the rib cage
• instruct patient to breathe into the hand below the ribs and try to make sure the hand on the chest does not move and then exhale through pursed lips while keeping the hand on the chest still

Question 4

What are the expected outcomes for diaphragmatic breathing?

Answer 4

• decreased respiratory rate
• decreased use of accessory muscles of inspiration
• increase tidal volume
• decrease respiratory flow rate
• subjective improvement of dyspnea
• improve activity tolerance

Question 5

What is the goal of inspiratory muscle training?

Answer 5

strengthen the diaphragm and intercostal muscles

Question 6

What are the two types of inspiratory muscle training?

Answer 6

flow resistive training (breathing with a mouthpiece that decreases diameter to increase resistance to breathing

threshold breathing which requires a buildup of negative pressure before flow occurs through a valve that opens at critical pressure which provides consistent and specific pressure for IMT

Question 7

What are the indications for inspiratory muscle training?

Answer 7

impaired respiratory muscle strength and/or a ventilatory limitation to exercise performance

Question 8

What are the precautions/contraindications for inspiratory muscle training?

Answer 8

-clinical signs of inspiratory muscle fatigue such as tachypnea, reduced tidal volume, increased PaCO2 and bradypnea

Question 9

What is the procedure for using the threshold respiratory muscle trainer when performing inspiratory muscle training?

Answer 9

• measure patient’s maximum inspiratory pressure with a manometer in order to calculate the training load
• have patient put the mouthpiece in their mouth and inspired with enough force to to open the valve
• begin training at 30-40% of the patient MIP (max insipiratory pressure)
• breath at resting respiratory rate for 5-15 minutes 3 times a day
• resistance can be increased slowly until it is at 40-60% of MIP

Question 10

What is the procedure for using the PFLEX inspiratory muscle trainer when performing inspiratory muscle training?

Answer 10

• measure patient’s maximum inspiratory pressure with a manometer in order to calculate the training load
• have patient place PFLEx in mouth and breathe at tidal volume
• begin training at 30-40% of MIP for 10-15 minutes daily, increasing towards 20-30 minutes for 3-5 days a week
• once a patient can stand 30 mins at one pressure you can increase pressure to next setting

Question 11

What are the expected outcomes for inspiratory muscle training?

Answer 11

• increased respiratory muscle strength and endurance
• decreased dyspnea at rest and during exercise
• increased functional exercise capacity

Question 12

What is the goal for paced breathing and exhale with effort?

Answer 12

paced breathing is a strategy to decrease the work of breathing and prevent dyspnea during activity by allowing anyone who experiences SoB to become less fearful of activity and exercise

exhale with effort is used to prevent a patient from holding their breath by having patient inhale during the less active part of a movement and exhale during the strenuous phase of a movement

Question 13

What are the indications for paced breathing and exhale with effort?

Answer 13

• patients with dyspnea at rest or with minimal activity
• inability to perform activities due to pulmonary limitation
• inefficient breathing pattern during activity

Question 14

What are the precautions for paced breathing and exhale with effort?

Answer 14

avoid valsalva maneuver during activity

Question 15

When should a patient inhale and exhale when performing exhale with effort?

Answer 15

inhale before or during the easier component of an activity

Exhale during the more vigorous component of the activity

Question 16

When should a patient inhale/exhale when walking if they are performing exhale with effort?

Answer 16

inhale through the nose while walking two steps and then pause; exhale through pursed lips while walking four steps

Question 17

When should a patient inhale/exhale when climbing stairs if they are performing exhale with effort?

Answer 17

• inhale through the nose while standing
• exhale through pursed lips while stepping up or down one or two stairs
• remain on the step until breathing control is restored

Question 18

When should a patient inhale/exhale when lifting objects if they are performing exhale with effort?

Answer 18

• inhale through the nose while standing or sitting; exhale through pursed lips while bending to reach the object
• pause
• inhale through the nose while grabbing the object; exhale through pursed lips while standing up

Question 19

What are the expected outcomes with paced breathing and exhale with effort intervention?

Answer 19

• complete activity without dyspnea

- decrease patient;s fear of becoming short of breath during activity

Question 20

What is the goal of pursed lip breathing?

Answer 20

reduce respiratory rate, dyspnea, and maintain a small positive pressure in the bronchioles to help prevent airway collapse in patients with emphysema

Question 21

What are the indications for pursed lip breathing?

Answer 21

• tachypnea

- dyspnea

Question 22

What is semi-fowler’s position?

Answer 22

patient is reclined to 30-45 degrees in a bed

Question 23

What are the expected outcomes for pursed lips breathing?

Answer 23

• decrease respiratory rate
• relieve dyspnea
• reduce PaCO2
• improve tidal volume
• improve oxygen saturation
• prevent airway collapse in patients with emphysema
• increase activity tolerance

Question 24

What is segmental breathing (thoracic expansion exercise or localized breathing)?

Answer 24

an intervention intended to improve regional ventilation and prevent and treat pulmonary complications after surgery and based on the presumption that inspired air can be directed to a particular area through proper hand placement or cues to either facilitate or inhibit chest wall movement

Question 25

What are the indications for segmental breathing?

Answer 25

• decreased intrathoracic lung volume
• decreased chest wall lung compliance
• increased flow resistance from decreased lung volumes
• ventilation:perfusion (V;P) mismatch

Question 26

What are the contraindications for segmental breathing?

Answer 26

there are none

Question 27

What is the procedure for segmental breathing?

Answer 27

• position patient depending on goals of intervention (sitting for basal atelactasis, sidelying with affected lung area uppermost, or in typical postural drainage positions)
• therapist should apply pressure to area that needs to be expanded
• patient inhales deeply and slowly expands the rib cage under the therapist’s pressure
• therapist should release pressure in hands as patient inhales

Question 28

What are the expected outcomes for segmental breathing?

Answer 28

• increased chest wall mobility
• expand collapsed alveoli via airflow through collateral ventilation channels
• assist with secretion removal

Question 29

What is sustained maximal inhalation?

Answer 29

a technique in which a maximal inspiratory effort is held for 3+ seconds at the point of maximum inspiration before exhalation.

Many airway clearance techniques include SMI to compensate for asynchronous ventilation and to maximize alveolar expansion

Question 30

What is incentive spirometry?

Answer 30

A form of sustained maximal inhalation which uses a device that provides visual or other feedback to encourage patients to take long slow deep inhalations

Question 31

What are the indications for sustained maximal inhalation (with or without incentive spirometry)?

Answer 31

• decreased intrathoracic lung volume
• decreased chest wall lung compliance
• increased flow resistance from decreased lung volume
• V:Q mismatch
• atelactasis or risk of atelactasis due to thoracic surgery

Question 32

What are the precautions/contraindications for sustained maximal inhalation?

Answer 32

• patient unable to perform incentive spirometry properly
• patient unable to deep breathe properly
• patients with moderate to severe COPD with increased respiratory rate and hyperinflation

Question 33

What is the procedure for incentive spirometry?

Answer 33

• hold spirometer in vertical position
• have patient exhale completely then seal lips around mouthpiece
• breathe in slowly and deeply through the mouth to raise the ball of spirometer
• encourage diaphragmatic breathing
• hold breath for at least 3 seconds at the highest level the piston reaches
• perform independently 5-10 times per hour when awake

Question 34

What are the expected outcomes for incentive spirometry/sustained maximal inhalation?

Answer 34

• absence of or improved signs of atelactasis
• decreased respiratory rate
• resolution of fever
• normal pulse rate
• normal chest x-ray
• improved PaO2
• increased forced vital capacity and peak expiratory flows