Limits of breathing control to manage breathlessness

Breathing control (aka relaxed basal breathing, diaphragmatic and abdominal breathing) is a technique used in physiotherapy to manage breathlessness.

Researchers from the University of South Australia in Adelaide reviewed 57 studies to determine the state of the art.

What it is.

  • Breathing control is breathing using the lower chest with relaxation of the upper chest and shoulders.
  • Patients are encouraged to move their abdominal wall during inspiration while simultaneously reducing upper rib cage motion and accessory muscle use.

Treatment goals.

  • Correct abnormal chest motion.
  • Reduce the work of breathing and sensation of shortness of breath.
  • Improve the efficiency of breathing.
  • Alter the distribution of ventilation (air movement in the lungs).

Here’s what they found in their review of the published studies.

  • Despite being advocated as a technique to manage breathlessness in people with chronic lung disease, there is insufficient high-level evidence to recommend breathing control alone to treat shortness of breath (dyspnea).
    • This doesn’t mean it is a failure. Just that there is insufficient supporting evidence.

What breathing control does/does not accomplish.

  • There is a significant short-term effect on breathing (rate of breathing, tidal volume [air passing in and out of the lung], arterial oxygen saturation [efficiency of breathing]).
  • It doesn’t alter the distribution of air ventilating the lungs or oxygen consumption.
  • Long-term training of breathing control doesn’t result in significant improvements in physiological or clinical outcomes.

The bottom line?
“This review,” according to the authors, “clearly indicates that breathing control is likely to have a detrimental effect on dyspnea and work of breathing in people with severe COPD [chronic obstructive pulmonary disease].”

“Healthcare professionals planning to use breathing control as a short-term strategy to affect outcomes related to the mechanism … or physiological outcomes in people with severe airflow obstruction should proceed cautiously and monitor dyspnea and work of breathing.”

3/4/08 10:32 JR

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.