Pursed+Lip+Breathing

Patients with COPD have affected swallowing due to the disruption between their respiratory cycle and swallow (Shaker //et al.//, 1992). A rehabilitative technique to assist breathing is using pursed-lip breathing (PLB). PLB is a breathing technique where the client is asked to breath out while pursing the lips. This action creats a resistance for the air to pass through (Spahija, Marchie, & Grassino, 2005). PLB uses diaphragmatic breathing which allows the lung to increase its capacity. This is thought to be beneficial for reducing breathing rates and controlling dyspnea (Jantarakupt & Porock, 2005). This slower rate of breathing has a reported effect on diminishing breathlessness (Spahija //et al.//, 2005). Patients are asked to breathe in for two seconds followed by breathing out for four (Mount Nittany Medical Centre, 2010). The outgoing breath must be longer than the inhale (Refer to Figure 1 and 2).  Patients of COPD tend to inhale after swallowing whereas a normal swallow will be followed by exhaling (Gross, Atwood, Ross, Olszewski, & Eichhorn, 2009) Using a pulmonary technique to regulate this disruption will be beneficial. However, it appears that PLB may not be successful at controlling breathing for some patients with COPD (Spahija //et al.//, 2005). Like all management of patients with dysphagia treatments need to be tailored to meet their individual needs. If a patient is able to use pulmonary techniques to control their rate of breathing then PLB may be beneficial with assisting them with their dysphagia needs.
 * Pursed Lip Breathing**

**References:** Gross, R., Atwood, C., Ross, S., Olszewski, J., & Eichhorn, K. (2009). The coordination of breathing and swallowing in Chronic Obstructive Pulmonary Disease. //American Journal of Respiratory and Critical Care Medicine, 179, 559-565.// Jantarakupt, P. & Porock, D. (2005). Dypsnea management in lung cancer: Applying the evidence from Chronic Obstructive Pulmonary Disease. //Oncology Nursing Forum, 32(4), 785-797.// Mount Nittany Medical Centre. (2010). //Pursed-Lip Breathing.// Retrieved from []. Shaker, R., Ren, Q., Townsend, W., Dodds, W., Martin, B., Kern, M., & Rynders, A. (1992). Coordination of deglutition and phases of respirtation: effect of aging, tachypnea, bolus volume, and chronic obstructive pulmonary disease. //American Journal of Physiology, 263(26), G750-755.//

Spahija, J., Marchie, M., & Grassino, A. (2005). Effects of imposed pursed-lips breathing on respiratory mechanics and dyspnea at rest and during exercise in COPD. //Chest, 128, 640-650.//