The process that moves air in and out of the lungs called breathing or pulmonary ventilation.  Breathing is only one of the processes that deliver oxygen to where it is needed in the body and remove carbon dioxide. Breathing exercise enhance the respiratory system. Improper breathing can upset the oxygen and carbon dioxide exchange.

1. DR. MEENU VERMA
ASSISTANT PROFESSOR
MMIPR, MMDU, MULLANA
Breathing Exercise and
Spirometer

2. Breathing
The process that moves air in and out of
the lungs called breathing or pulmonary
ventilation.
Breathing is only one of the processes
that deliver oxygen to where it is needed
in the body and remove carbon dioxide.

3. Breathing exercise enhance
the respiratory system by
improving
• Ventilation
• Strengthening respiratory
muscles
• Make breathing more
efficient
• Stress reduction.
Improper breathing can
upset the oxygen and
carbon dioxide exchange
and contribute to
• Anxiety
• Panic attacks
• Fatigue
• Other physical and
emotional disturbances

4. ORGANS THAT INVOLVED IN
BREATHING
 Nose :The beginning of the respiratory tract.
 Function :-Warm, Moisten, Filter fine
particles
 Trachea :Tube like structure.
 Function :- Responsible for transporting air
for respiration from the larynx to the bronchi
 Bronchi
 Bronchioles
 Lungs

5.  Muscles : Diaphragm, Scalene,
Sternocleidomastoid, Serratus anterior,
External intercostal, External oblique,
Rectoabdominal, Internal oblique, Transverse
abdominal
 Diaphragm : Is a sheet of internal skeletal
muscle. It separates the thoracic cavity
containing heart & lungs , from the
abdominal cavity.

6. Normal lung volumes and
capacities

7. Breathing Exercise
Breathing ex
and ventilatory
training are the
fundamental
interventions
for the
prevention of
Acute and chronic
pulmonary
diseases’s patients
with high spinal
cord lesion
Pt withThoracic
and abdominal
surgery
Bedridden
patients.
Breathing
Exercise and
ventilatory
technique is used
to improve the
pulmonary status
and increase
patients overall
endurance.

8.  Improve ventilation
 Increase the effectiveness of cough
 Promote airway clearance
 To prevent post operative pulmonary
complications
 To improve the strength endurance
coordination of the muscles of ventilation
 Maintain and improve chest and thoracic
spine mobility

9.  Promote relaxation and relieve stress
 To teach the patient how to deal with episodes
of dyspnea
 Assisting in removal of secretions.
 Correct abnormal breathing patterns
 Decrease the work of breathing.
 Aid in bronchial hygiene---Prevent accumulation
of pulmonary secretions, mobilization of these
secretions, and improve the cough mechanism.

10. GUIDELINE FOR TEACHING
BREATHING EXERCISES
 Choose a quiet area-to get a proper interaction with
minimal distraction
 Explain the patient about the aim and how it works
for his impairment
 Patient Position: in relaxed position and loosen the
clothes, make him in semi-fowlers position with
head and trunk elevated approx: 45˚ (total support
to the head and trunk and flexing the hip and knees
with pillow support) the abdominal muscle become
relaxed.
 Other positions, such as supine, sitting, or standing,
may be used as the patient progresses during
treatment.

11. Observe and access the patients
 Spontaneous breathing pattern while at rest and
during activity
 Determine whether Rx is indicated or not
 If necessary teach the patient relaxation techniques:
1. Relax the muscles of upper thorax neck and
shoulder to minimize the use of accessory muscle
work.
2. Special attention on sternocleidomastoids, upper
trapezius and levator scapulae.
3. Demonstrate the breathing pattern to the patient
4. Have the patient practice the correct technique in
verity of positions at rest and with activity.

12. PRECUATIONS
 Never allow the patient to force expiration-it may
increase the turbulence in the air way which leads to
bronchospasm and airway resistance.
 Avoid prolonged expiration-it cause the patient to
gasp with the next inspiration and the breathing
pattern become irregular and inefficient.
 Do not allow the patient to initiate inspiration with
accessory muscles and upper chest
 Advise him that upper chest should be quiet during
breathing
 Allow the patient to perform deep breathing only for
3-4 times (inspiration and expirations) to avoid
Hyperventilation.

13. Incentive spirometer
 Incentive spirometer is a handheld medical
device that measures the volume of your breath.
It helps your lungs recover after surgery or lung
illness, keeping them active and free of fluid.
 A piston rises inside the device to measure your
breath volume when you breathe from an
incentive spirometer. A healthcare professional
can set a target breath volume for you to hit.
 Spirometers are commonly used at hospitals
after surgeries or prolonged illnesses that lead to
extended bed rest.

15.  To increase transpulmonary pressure and
inspiratory volumes, improve inspiratory
muscle performance, and re-establish or
simulate the normal pattern of pulmonary
hyperinflation.
 •When the procedure is repeated on a
regular basis, airway patency may be
maintained and lung atelectasis prevented
and reversed Drain.

16. Indications are
 Pre-operative : to obtain a baseline of their inspiratory flow and
volume
 Presence of pulmonary atelectasis
 Conditions predisposing to atelectasis such as:
 Abdominal or thoracic surgery
 Prolonged bed rest
 Surgery in patients with COPD
 Presence thoracic or Abdominal binders.
 Lack of pain control
 Restrictive lung disease associated with a
dysfunctional diaphragm or involving respiratory musculature
 Patients with inspiratory capacity less than 2.5 litres
 Patients with neuromuscular disease or spinal cord injury

17.  After surgery: An incentive spirometer can keep the
lungs active during bed rest.
 Helps to reduce the risk of developing complications
like atelectasis, pneumonia, bronchospasms,
and respiratory failure.
 Pneumonia.
 Chronic obstructive pulmonary disease (COPD).
 Cystic fibrosis: lower the chance of central airway
collapse.
 Other conditions: sickle cell anaemia, asthma,
or atelectasis.

18. Contraindications
 Fatigue
 Patients who are heavily sedated or
comatose

19. How to use
 •The patient is instructed to hold the
spirometer in an upright position, exhale
normally, and then place the lips tightly
around the mouthpiece.
 •The next step is a slow inhalation to raise
the ball (flow-oriented) or the volume-
oriented in the chamber to the set target.
 At maximum inhalation, followed by a
breath-hold and normal exhalation.

20. FREQUENCY:
 •Ten breaths every one to two hours while
awake
 •Ten breaths, 5 times a day
 • Fifteen breaths every 4 hours

21. Types of breathing exercise
Deep Breathing Exercise.
Diaphragmatic Breathing Exercise.
Glossopharangeal Breathing Exercise.
Pursed lip Breathing Exercise.
Segmental Breathing Exercise.
Lateral Coastal Expansion Exercise.

22. Deep Breathing
 Deep breathing helps to relieve
 shortness of breath
 feel more relaxed and centred.

23. Technique
 While standing or sitting, draw elbows back
slightly to allow your chest to expand.
 Take a deep inhalation through the nose.
 Retain your breath for a count of 5.
 Slowly release your breath by exhaling
through the nose

24. Diaphragmatic Breathing
 PROCEDURE : Prepare the patient in relaxed and
comfortable position in which the gravity assist the
diaphragm such as semi- fowlers position
 If you notice any accessory muscle activation stop
him and do relaxation techniques (shoulder roll or
shrugs coupled with relaxation)
 Place your hands over the rectus abdominis just
below the ant: costal margin ask the patient to
breath slowly and deeply via nose by keeping the
shoulder relaxed and upper chest quiet allowing the
abdominal to rise now ask him/her to slowly let all
the air out using controlled expiration through
mouth.

26. Glossophryngeal breathing
 It is a means of increasing a patients inspiratory
capacity when there is a severe weakness of the
muscle of inspiration
 It is taught to patients who have difficulty in
deep breathing.
 This type of breathing pattern was originally
developed to assist post polio patients with
severe muscle weakness
 PROCEDURE : Patient take several gulp of air by
closing the mouth the tongue pushes the air
back and trap it in the pharynx the air is then
forced to lungs when the glottis is opened.

28. PURSED LIP BREATHING
 It helps to Improves ventilation and Releases trapped air in
the lungs
 Keeps the airways open longer and Prolong exhalation slow
the breathing rate
 It moves old air out of the lungs and allow new air to enter
the lungs
 PROCEDURE: Patient in a comfortable position and
relaxed, explain the patient about the expiration phase (it
should be relaxed)
 abdominal muscle contraction must be avoided (therapist
hand over the patients abdominal to check for contraction)
Ask the patient to breathe in slowly and deeply through the
nose and then breathe out gently through lightly pursed
lips (blowing on and bending the flame of a candle ).

30.  It can be applied as a 3-5 minutes “rescue
exercise” or an Emergency Procedure to
counteract acute exacerbations or dyspnoea.

31. SEGMENTAL BREATHING
 It is performed on a segment of lung, or a section
of chest wall that needs increased ventilation or
movement.
 ADVANTAGES OF SEGMENTAL BREATHING
 Prevent accumulation of pleural fluid and
secretions
 Decreases paradoxical breathing
 Decrease panic
 Improve chest mobility

33. Lateral costal expansion
 This is sometimes called lateral basal expansion and may be
done unilaterally or bilaterally.
 The patient may be sitting or in a hook lying position.
 Place your hands along the lateral aspect of the lower ribs
 Ask the patient to breathe out, and feel the rib cage move
downward and inward.
 As the patient breathes out, place firm downward pressure
into the ribs with the palms of your hands.
 Just prior to inspiration, apply a quick downward and
inward stretch to the chest.
 This places a quick stretch on the external intercostals to
facilitate their contraction.These muscles move the ribs
outward and upward during inspiration.

35. Reference
 Lin L, WangY, Cao J, Kong L, An J, ZhangT. 3.0T motion-
corrected single-shot phase sensitive inversion recovery
(PSIR) late gadolinium enhancement (LGE) in free-
breathing patients compared with conventional segmented
breath-held LGE. Journal of Cardiovascular Magnetic
Resonance. 2015 Dec;17(1):1-2.
 Dail CW. “GLOSSOPHARYNGEAL BREATHING” BY
PARALYZED PATIENTS—A Preliminary Report. California
medicine. 1951 Sep;75(3):217.
 Fry DL, Ebert RV, SteadWW, Brown CC.The mechanics of
pulmonary ventilation in normal subjects and in patients
with emphysema.The American journal of medicine. 1954
Jan 1;16(1):80-97.
 ESLINGER MR. Moderate Sedation CertificationClinical
Competency Assessment Program.