Breathlessness and breathing control 

Breathlessness is common and patients often describe having to stop to ‘catch’ their breath when doing a task or activity that they used to be able to do with ease. They may feel that breathing is harder work than normal and that their shoulders are going up and down as they breathe.This is because normally about three-quarters of the work of breathing is done by the diaphragm. 

Diaphragmatic movement may be lessened after illness such as Covid-19, necessitating more use of neck and shoulder muscles in breathing. This in turn results in shallower breathing that uses more energy and thus increases fatigue and breathlessness. A practical tip when this happens is to try wiping a cool wet flannel across the nose and upper cheeks because cooling the face, especially around the nose, can often help reduce the feeling of breathlessness.

Breathing techniques are known to improve breathlessness and one that is recommended by the NHS is ‘breathing control’. This simple measure can easily be explained to patients and will help them to control their breathing when they are moving around and also help recovery after physical activity. The aim is to restore and normalise breathing patterns and to increase the efficiency of the respiratory muscles (including the diaphragm). Energy expenditure becomes lower, there is less airway irritation, fatigue is improved and breathlessness improves too.

The technique helps the patient to breathe gently with the least amount of effort. Breathing control can be used throughout the day, in five to 10-minute bursts (or longer if the patient finds it helpful). Advise the patient as outlined below to practise while they are sitting down in a supported position so they can get used to the technique and gradually master it: 

• Put one hand on your chest and the other on your tummy. Keep your shoulders relaxed
• Slowly breathe in and out through your nose, with your mouth closed. If this is too hard, breathe in through your nose and out through your mouth. If you’re relaxed, the air will reach low in your lungs. Your tummy will move out against your hand. If breathing is controlled, the hand on your chest will hardly move
• When you breathe out, your tummy will fall gently. Imagine all the tension in your body leaving as you let the air out
• Make your out-breaths twice as long as your in-breaths
• With every breath out, try to feel more relaxed and calm. Gradually try to breathe more slowly
• When you are able to do this easily while sitting down, try and then use this technique when you are active.