BREATHING EXERCISES

By
Dr. Hari Narayan Saini (PT)
Associate Professor
NIMS College of Physiotherapy & Occupatinal Therapy
 Positive Expiratory Pressure Breathing

Positive expiratory pressure breathing is a technique in which resistance

to airflow is applied during exhalation, similar to what occurs during
pursed-lip breathing, except that the patient breathes through a
specially designed mouthpiece or mask that controls resistance to
airflow.
This breathing technique is used to hold airways open during exhalation to
mobilize accumulated secretions and improve their clearance. Positive
expiratory pressure breathing provides an alternative or adjunct to
postural drainage which a patient can perform independently.
 Procedure

Positive expiratory pressure breathing is performed in an upright position,

preferably seated with the elbows resting on a table. The procedure can be
performed against low or high pressure. A low pressure technique involves
tidal inspiration and active, but not forced, expiration through a mouthpiece
or mask.
The patient inhales, holds the inspiration for 2 to 3 seconds, and then exhales,
repeating the sequence for approximately 10 to 15 cycles. The patient removes
the mouthpiece or mask, takes several “huffs” and then coughs to clear the
mobilized secretions from the airways. The breathing sequence typically is
repeated four to six times with a total treatment session lasting about 15
minutes.
 COUGHING

An effective cough is necessary to eliminate respiratory obstructions and

keep the lungs clear. Airway clearance is an important part of management of
patients with acute or chronic respiratory conditions.

The Normal Cough Pump:-

A cough may be reflexive or voluntary. When a person coughs, a series of
actions occurs. Under normal conditions, the cough pump is effective to the
seventh generation of bronchi.
Ciliated epithelial cells are present up to the terminal bronchiole and raise
secretions from the smaller to the larger airways in the absence of pathology.
 Coughing or Huffing

Coughing is difficult because of incisional pain. An alternative is huffing.

A huff is an outward breath caused by the upper abdominals contracting
up and in against the diaphragm to push air out of the lungs.
The abdominals are pulled up and in, rather than pushed out, causing
decreased pressure in the abdominal cavity and less strain on the
incision. Huffing must be done quickly to generate sufficient force to
expel mucus. Instruct the patient to support the incision with a pillow or
the hands and say “ha” forcefully and repetitively while contracting the
abdominal muscles.
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