Anxiety and Panic Attacks In Emphysema/ Chronic Obstructive Pulmonary Diseases (COPD)

Vijai P. Sharma, Ph.D., psychologist

Chapter 9

Correct Breathing

  • Signs of Irregular Breathing
  • Breathing Pattern Disorder
  • Signs of Regular and Relaxed Breathing
  • Potential Benefits of Breathing Training
  • Correct Process of Breathing
  • Check and Improve Your Own Breathing
  • Form the Habit of Conscious Breathing
  • How to do "Diaphragmatic Breathing" or "Lower Ribs Breathing"
  • Pursed-Lip Breathing (PLB)

Learn correct breathing and relaxed breathing. Avoid incorrect breathing. Correct breathing and physical and mental relaxation, the two master skills which can make a big difference in your quality of life. Make sure you also read the section on Physical and Mental Relaxation for a more enjoyable and relaxed life.

Signs of Irregular Breathing

When you are not exerting and you still experience any of the following:

  • Neck and shoulders moving while breathing
  • Shallow breathing (chest breathing)
  • Jerky breathing (like sobbing or sighing)
  • Rapid breathing
  • Uneven breathing
  • Mouth breathing even when the nostrils are not blocked
  • Too long a pause from one breath to the next
  • Loud and noisy breathing unless there is a medical reason for that

    Negative effects of chronic hyperventilation (over breathing)
    Chronic hyperventilation sometimes can cause one or more of the following:
    Breathlessness and/or difficulty breathing
    Tingling sensation
    Chest pains
    Frequent yawning
    Feelings of dizziness or faintness

    Breathing Pattern Disorder (BPD)

    A faulty or incorrect breathing pattern such as habitual over breathing, breath holding or shallow breathing may be may be genetically acquired, learned or affected by physical or psycho-emotional factors.

    Here are some of the factors associated with BPD:
    Habitual mouth breathing due to such problems as chronic sinus blockage or malocclusion of teeth.
    Chronically tight chest
    Poor posture such as "forward head," raised shoulders, tilted head or hunch back (excessive kyphosis)
    Weak or restricted diaphragm
    Habitually tense chest, shoulders or neck muscles.
    "Emotional breathing," influenced by such chronic negative emotions as anxiety, depression or anger.

    Potential Benefits of Breathing training

    • Increased sense of control over breathlessness
    • Increased sense of personal well-being
    • Increased self-confidence
    • Better quality of sleep
    • Improved posture
    • Exercise endurance
    • Reduction in anxiety and depression

    Therefore, if possible seek breathing training.

    Many (not all) teachers of eastern exercise systems such as Yoga, Tai Chi, Qui Gong provide breathing training.

    Find a teacher who has some experience of working with a person with COPD.

    Tips For Correcting Breathing

    • Slow Your Breathing
      If you breathe more than 20 breaths per minutes, you will likely be using your upper chest, neck and shoulder muscles during breathing resulting in shallow and anxious breathing.
    • Make the Diaphragmatic Muscle and Ribcage Flexible
      Depending on the flexibility of the diaphragmatic muscle, the movement of the diaphragm varies from individual to individual. For example, in a person with extreme rigidity of the diaphragmatic muscle and the lower ribs, the movement may be only 1 cm. But in a person with great flexibility of diaphragmatic muscle and the lower ribs, the movement of the diaphragmatic muscle may be as much as 10 cm.
      • Do upper and lower body exercises.
      • Stretch the whole body
      • Move your spine in every which direction. Practice gentle forward bending, backward bending, side ways bending, spine elongation and spinal twists
      • Learn and practice gentle yoga

    Signs of regular and relaxed breathing

    The following tend to relax the body and the mind:

    • Neck and shoulders relaxed
    • Belly breathing
    • Slow breathing
    • Smooth and rhythmical breathing
    • Quiet breathing
    • No long pauses between breaths
    • Exhalation is equal or longer than inhalation.

    Helpful Tips

    • Practice relaxed breathing several times a day for a few minutes at a time
    • Schedule several one minute "relaxed breathing moment" during the day, when you quickly relax, focus on your belly or forehead and trigger relaxed breathing
    • Learn physical and mental relaxation technique from the chapter "Physical and Mental Relaxation which would also facilitate relaxed breathing

    Correct Process of Breathing


    Neck and shoulders remain relaxed. As the breath goes downward, the chest expands, the rib cage elevates, diaphragm goes down and the belly comes out. The area between sternum, navel and perineum stretches. The upper back widens and the lumbar arch slightly deepens.


    Neck and shoulders remain relaxed. Diaphragm relaxes, chest and ribcage retract to their pre-inhalation size and position, the belly goes in, navel slightly pulled in towards the back and the lumbar arch in the low back slightly flattens.

    Helpful Hints

    • Do upper and lower body exercises.
    • Stretch the whole body
    • Move your spine in every which direction. Practice gentle forward bending, backward bending, side ways bending, spine elongation and spinal twists
    • Learn at least one technique of physical and mental relaxation and practice it at least three times a day
    • Manage and temper your emotions because they can compromise your breathing.
    • Reduce and manage your stress because your breathing is affected during stressful moments
    • Learn and practice gentle yoga

    Check and Improve Your Own Breathing

    Use the "Hand Technique"

    Sit in a quiet place and just settle down for a minute or two. Put your hand, horizontally, about one inch above your navel. Close your eyes. Breathe normally without trying to influence your breathing one way or the other. Observe how your belly moves every time you breathe in and breathe out. If you are breathing correctly, you should find that the hand over the tummy moves as you breathe in and out.

    This is called "abdominal breathing." Abdominal breathing is good but don't deliberately puff your belly out, let the belly be relaxed. Also, if upper chest and/or shoulder and neck go up and down as you breathe in and out, let your neck and shoulder relax.

    Belly Movement

    Having checked yourself for the abdominal breathing, you may now check if your belly is moving in the right pattern.

    Close your eyes again and track your hand on the belly.

    Belly should bulge OUT when you breathe IN

    Belly should pull IN when you breathe OUT.

    Tips for Correcting Belly Movement

    If the belly does not move correctly as for example, belly moves in when you inhale, you need to correct it. Here is how to:

    "Take a slow, deep breath in and breathe out slowly and steadily. The next breath will come in automatically, that is without your effort. Your tummy will move outward as you breathe in and move inward as you breathe out."

    If your tummy begins to move incorrectly or not move at all or only chest moves but not belly, relax and reestablish correct breathing. Take a deep, slow, easy breath and blow it out, slowly and steadily. Do it as many times as you need to. It will get better.

    Form the Habit of Conscious Breathing

    As you begin to pay steady attention to your breathing, it will be easier for you to monitor your breathing. Any time you find yourself holding your breath or having a jerky breath, breathing irregular or faster, go back to belly breathing

    Pay attention to your breathing. While inhaling move your attention downward and follow the lungs filling, chest expanding horizontally and vertically and the belly bulging out. While exhaling, move your attention upward from abdomen to chest, notice the belly and solar plexus slightly contracting and the breath finally exiting through the nostrils.

    Make it a habit to breathe consciously. Conscious breathing can be very beneficial. Develop positive and relaxed awareness of your breathing.

    While driving, even when you use the cruise, you continue to monitor the road conditions all the time. Likewise, you should monitor your breathing. When you monitor the breath, you can decide when you want to leave your breathing on the "automatic pilot" and when to take charge and regulate your breath with awareness

    Beneficial for COPD, anxiety and depression

    Belly Breathing

    One of the most beneficial breathing techniques for people with COPD is belly breathing.

    When you breathe in, abdomen should expand and protrude.

    When you breathe out, abdomen should go in towards the back.

    While breathing in, the focus should be on the descending diaphragm and expanding lower ribs and abdomen

    During exhalation, attention should be on the diaphragm ascending, the lower ribs squeezing and the belly contracting.

    Pay gentle attention to this process and not get frustrated if the lower ribs don't move at all.

    In light of the relatively flattened diaphragm and shortened intercostals in the case of many people with COPD, when you gently contract the abdomen and lower ribs during exhalation, you are assisting your diaphragm to move upward and empty the lungs.

    During inhalation, simply allow the expansion of the belly and lower ribs during so the diaphragm moves down,.

    How to Do "Diaphragmatic Breathing" or "Lower Ribs Breathing"

    "Diaphragmatic breathing" which is also called "lower ribs breathing" may be done in a seated position or lying down position.

    Some people with COPD experience aggravation of their breathing problem when lying down. They have a hard time mobilizing the diaphragm in that position. They should practice breathing technique in comfortable seated position.

    Those who don't have this problem can practice diaphragm breathing in a prone position. Lying down with a sandbag, bag of rice, beanbag or a book weighing one or two pounds on the abdomen while practicing diaphragm breathing for 5 to 15 minutes strengthens the diaphragm and also promotes relaxation. Later the weight can be increased to 5 or 10 pounds. After the sandbag method is mastered, they can practice diaphragm breathing in the sitting and standing positions and then while walking.

    Walking is a highly beneficial exercise for people with COPD, and if they can do diaphragm breathing while walking, the benefits are likely to be even greater. One should learn both techniques of diaphragm breathing: (1) abdominal breathing--pressing the belly in for exhalation and expanding the belly for inhalation and (2) side rib breathing--squeezing the side ribs with the hands while exhaling and releasing them while inhaling.

    Pursed-Lip Breathing (PLB) for Shortness of Breath

    Pursed -Lip Breathing (PLB) is one of the most helpful things you can do when you are feeling breathless. Pursed lips help to keep the breathing tubes (bronchi) open and maintain right pressure in those tiny, tiny air sacs. Mouth is closer to lungs than the nose is, so it's easier to blow the breath out through the mouth.

    Benefits of PLB
    1. Reduces breathlessness
    2. Slows the breathing rate
    3. Lengthens the exhalation
    4. Helps to empty the stale air out of the lungs
    5. Increases the size of your breath volume

    Instructions for PLB

    Lean slightly forward and s-l-o-w-l-y blow out through pursed lips as if gently blowing a kiss at someone or cooling hot soup in a bowl.

    You may breathe in through the nose, if possible, and breathe out through the pursed lips. The action of leaning slightly forward and blowing out against pursed lips encourages the contraction of abdominal muscles, thereby forcing the diaphragm upward to empty the lungs more completely. People with COPD tend to cut short exhalation and rush to swallow more air, making breathlessness even worse.

    Pursed-lip breathing slows down exhalation and assists with the action of emptying the lungs and may also help strengthen the breathing muscles.

    Lengthen your exhalation. Silently counting while exhaling and inhaling can help. At first they should inhale for a count of three or four and exhale for the same count.

    Over time, you may aim to increase the exhalation to a count of perhaps six or eight. An ideal ratio for the length of inhalation to exhalation is 1:2.

    10 Steps of PLB
    1."Imagine you are smelling a rose (Inhaling slowly) blowing at the candle like you are bending or flickering the flame but not so forcefully as to put out the candle. Imagine blowing softly, gently and slowly."
    2. "Relax your shoulders and neck."
    3. "Pucker your lips as if you were going to whistle or kiss a baby."
    "Softly, VERY GENTLY, and s-l-o-o-w-w-ly breathe out through the pursed lips.
    If possible, through both sides of the lips."
    4. "Breathe in slowly through your nose."
    5. "Do not force air out of your lungs. Blow out the breath softly."
    6. "Exhalation should be longer than inhalation. However, increase the length of exhalation gradually. Exhaling longer than your capacity could make the next breath jerky. If your breathing gets agitated, take a break.
    7. Count in your head as you inhale and exhale so you can keep track of the length of breath. Always breathe slowly and softly.
    8. As much as possible, breathe in through the nose and breathe out through the pursed lips.
    9. Gradually learn to exhale twice longer than inhale. For example, if possible, inhale to a count of 5 and exhale to a count of 10. Never inhale longer than exhale.
    10. Over time, lengthen your exhale and inhale maintaining the same ratio. For example, at present, if you exhale to a count of 8 and inhale 4, over time, perhaps several month, lengthen your exhale to a count of 10 or 12 and inhalation to a count of 5 or 6.

    Remember about the length of inhalation and exhalation
    It is generally better to exhale longer than inhale
    However, if you must, you may exhale and inhale for equal length
    But, do not inhale longer than you exhale.

    Continue to Chapter 10

    Return to Chapter 8

    Copyright 2008, Mind Publications 
    Posted December 2008


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