Breathlessness Management guide

Rectangular breathing

This is a strategy to help you recover from breathlessness, anxiety and panic attacks. It can be combined with techniques such as pursed lip breathing, thumb squeeze and shoulder relaxing.

• Focus your sight on something rectangular, for example a TV, a window, family photograph or relaxing image
• Follow the sides of the rectangle (below) with your eyes clockwise
• Breathe in through your nose on the shorter edges
• Breathe out through your mouth on the longer edges through pursed lips
• Focus on the breath out and slowly make it longer, to slow down and regulate your breathing
• Follow the rectangle round until you feel relaxed and in control of your breathing again.

Thumb squeeze

• Squeezing certain acupressure points can help the nervous system to calm down, may reduce anxiety and help you to relax
• Locate the union valley point in the webbing between your thumb andindex finger. Using those two fingers, apply firm pressure to the webbing between the thumb and the index finger of your other hand, and massage for four to five seconds breathing slowly and deeply.

Fan therapy

Using a handheld fan can make you feel relaxed and ‘getting more air’ by stimulating the nerves around your nose and mouth. The brain then sends a signal to slow down your breathing.

• Make yourself comfortable and hold your fan approximately six inches from your face
• Aim the draft of the air towards the central part of your face so you feel the breeze around the sides of your nose and above your top.

Relaxing your shoulders

Relaxing shoulders would stop using accessory muscles unnecessarily when out of breath. That is an efficient way to optimise the breathing and decrease oxygen demand.

Try to relax your shoulders and support your arms to be in a better position for your breathing muscle-diaphragm to work.

Breathing control – diaphragmatic breathing

This is a more efficient way of breathing and can help you to relax and feel in control. It will help you to implement the correct breathing pattern to your daily routine.

• Place one hand on your upper chest and one hand on your stomach, just below your ribs. If you feel your top hand moves more than your bottom hand it means your breathing is ineffective
• Get in a comfortable, well-supported position, i.e. sitting in an armchair, sitting up in bed. Relax your head, neck, shoulders and upper chest. Keep your hand on your stomach throughout
• Inhale through your nose and then exhale, using your nose or mouth as normal sized breath not a deep breath
  • You should feel your stomach rise as you breathe in and fall as you breathe out.

Pursed lip breathing

Pursed lips breathing can be used at any time to help you control your breathing.

• Breathe in gently through your nose, then purse your lips as though you’re going to blow out a candle
• Blow out with your lips in this pursed position and only for as long as is comfortable – don’t force your lungs to empty.

Blow-as-you-go

Use it while you’re doing something strenuous that makes you breathless. You can use it with pursed lip breathing as you blow out.

Breathe in before you make the effort. Then breathe out while you’re making the effort, ie. when standing up, breathe in before you step or stand up, and then blow out as you stand up.

Calming hand

This technique is used for panic attacks control as well as breathlessness. Do it again when needed. Hand stretching is helpful when having an acute episode of panic.

• Hold your thumb firmly and recognise the symptoms of panic attack. Remind yourself what to do next

• Move to your index finger and breathe out for longer than you breathe in relaxing your shoulders and upper chest

• Hand, relax and stop

• Move to your ring finger and relax whilst breathing out gently

• Holding on your little finger, stretch out your hand, relax and stop.

Positions of ease

Body positions can help relieve breathlessness. Relax your shoulders and support your arms leaning slightly forward. Do not lean too much as this might squash your diaphragm.

Position One: Lean against a wall. Let your head fall forwards and your arms hang loosely by your sides.

Position Two: Sitting forwards, rest your hands or elbows on your lap. Let your head and shoulders relax.

Position Three: Find a wall or window ledge to lean on. Rest your arms and let your head fall forwards.

Our patients matter

Mersey Care NHS Foundation Trust listens and responds to patients and their carers to help improve the services we deliver.

If you have any comments, compliments or concerns you can speak with a member of staff or contact our Patient Advice and LiaisonService (PALS) and Complaints Team.

Telephone: 0151 471 2377 Freephone: 0800 328 2941 Email: palsandcomplaints@merseycare.nhs.uk