Anxiety and 

Pursed Lip Breathing (PLB)   (Part 1)

The following was written by a gentleman living with COPD

©Philip J. Cable 2006 - Permission granted to re-produce For non-profit distribution.

         Anxiety - Why do we become short of breath? In a nutshell and very simplified, in most of us COPD’ers, our DLCO or diffusion rate is compromised so that our lungs are no longer able to efficiently exchange O2 and CO2. The O2 in our blood may drop and the CO2 level increases. Our brain signals our lungs and heart to speed up and try to get our level back in balance. We then become short winded. Then anxiety kicks in. When we become anxious, our body releases adrenaline which causes our heart to beat even faster. The brain then tells the lungs that the heart is working harder and needs more oxygen. So we start to breathe faster and harder. The brain then tells the heart that the lungs need more blood to process, and so the heart starts to beat faster again. And so on, and so on, until we are uncontrollably Short Of Breath. We are then hyperventilating, breathing too fast and too shallow.

Coping with the Symptoms of Anxiety....

(Extracted from a flyer of Capital Health in Nova Scotia Canada, originally adapted from "How to Cope with the Symptoms of Anxiety"  (Westra & Young 1998) .....

After you've been checked out physically to rule out any heart or medical problems, you were diagnosed as having anxiety or panic attacks.  You know that dealing with the symptoms of anxiety can be a challenge.  In turn, feeling these unpleasant symptoms can make your anxiety worse.  You need to break the cycle.

• Breathlessness

Worrying that I will stop breathing.  Breathlessness is a sign that you are getting too much air.  Try to slow down your breathing by taking slow, deep, even breaths.  Take in less air and see what happens to your symptoms.  Breathlessness is not dangerous.  It's jus t a normal body reaction to over breathing so slow down your breathing.  Tell yourself "I will not stop breathing

• Sweating, Dizziness, Chest Pain

Worrying that I am having a heart attack.  Symptoms such as shortness of breath, sweating and dizziness usually happen before one has chest pain from anxiety.  Slow down your breathing by taking slow deep breaths.  The fear you are feeling is also causing the symptoms.  If the symptoms improve, it is anxiety.

• Impending Doom

Worrying that I am going to die.  Fear of the unknown, of what is about to happen and the dread caused by the physical symptoms all contribute to feeling you will die.  No one has ever died of a panic or anxiety attack.  Fainting is the worse thing that can happen and even that is rare.  Tell yourself "I will not die, I have thought I would before and have been wrong."

• Losing Control

Worrying that I'm going to loose control.  When a person feels anxiety,  he/she is actually more in control.  Anxiety makes people more mentally alert and purposeful.  Anxiety protects you from "loosing it".  You will not  do anything out of character if you are anxious or pan iced.  Anxiety does not transform you into someone else.  Worrying about loosing control is evidence that you will not, because you have the mental alertness to ask about it.  Try to do something that takes control to do; like buttoning your shirt to prove you are in control".

Pursed Lip Breathing

©Philip J. Cable 2006 - Permission granted to re-produce For non-profit distribution.

What is Pursed Lip Breathing (PLB)? PLB is the first line of defense used by most COPD’ers when trying to recover from shortness of breath. It involves breathing in, generally through the nose if you're able,  and exhaling with the lips pursed as if you were going to whistle.

How hard do you blow out? I find that blowing out with the same force that you would use to cool hot soup on a spoon to be the perfect force. Blow hard enough to cool it but not hard enough to blow it off the spoon.

Many sites advocate blow like you were blowing out a candle, but I find that if I simulate blowing out a candle, I tend to puff, instead of a slow exhale and I tend to exhale with too much force and find it harder to relax.

How does PLB help? When we PLB properly we create a back pressure in the mouth and throat and this back pressure actually blows the airways open. Now that we can breathe in easier we have to concentrate and breathe out for at least 4 seconds or longer if possible. This helps expel CO2 and trapped air and we begin to breathe easier yet.

 I have been trying something for the last month or so that helps me. It may not help everybody. After I exhale for four seconds or more, I pause and let the body inhale naturally. The reason I pause is two-fold. First of all, it tells me that I am regaining control of my breathing, which allows me to relax easier and secondly, I find that if I consciously try to inhale right away, I will invariably gasp. When I inhale naturally, I make sure I do not try to “top off” the air already in my lungs. “Topping-off” is when we inhale once and then inhale again before we exhale. This will cause you to use your auxiliary breathing muscles in your shoulders and neck. This will in turn cause you to expend more energy and use up more oxygen. Also with the pausing after exhaling, I would suspect that it gives the lungs a little more time to exchange gases.  Now that we are breathing rather easily, the anxiety subsides and all is well in our wonderful little worlds. Practicing these techniques is very important so as to be completely trained on how to recover from being Short Of Breath.

Note:  Pursed Lip Breathing is also VERY useful when experiencing a panic attack.

This Way to More About Pursed Lip Breathing  (Part 2) by  

Mark Mangus, Sr   BSRC, RRT, RPFT, FAARC

This page was last  last updated August 7th, 2011