Managing breathlessness
Last edited: 18/09/2026
What is breathlessness?
All of us, at some time, have experienced breathlessness, whether due to exertion, a chest cold, or feeling anxious or excited.
When you are short of breath, you breathe faster. This causes anxiety, tension and overuse of the muscles in your shoulders and upper chest. This uses up more energy and oxygen, as it is harder work.
Your breathing may also become shallower, which means the lungs do not receive as much oxygen to the small airways at the very bottom and outside the lungs. This can increase the sensation of breathlessness.
What causes breathlessness?
There can be many causes and it is important to seek medical opinion to establish the cause and confirm correct treatment.
Common causes are:
- anaemia – low levels of red blood cells
- anxiety and panic – can alter the natural way of breathing, causing shallow, rapid breathing which reduces effective air exchange
- lung disease – can narrow or block airways
- cancer treatments
- chest infection – swelling or inflammation of lung tissue
- pain
- pleural effusion – build-up of fluid in the lining of the lung
- smoking
- tiredness/weakness
- excess weight
- abdominal ascites – excess fluid in the abdomen
- cardiac problems.
What can I do?
There are breathing control techniques you can learn to help you increase your control over your breathing. There are also some practical tips that may help you to manage your breathing better on a day-to-day basis.
This leaflet will take you through these methods to help you take back some control.
Diaphragmatic breathing
The diaphragm is the most efficient muscle of breathing. It is a large, dome-shaped muscle located at the base of the lungs. Your abdominal muscles help move the diaphragm and give you more power to empty your lungs. But COPD may prevent the diaphragm from working effectively.
What does diaphragmatic breathing do?
Diaphragmatic breathing is intended to help you use the diaphragm correctly while breathing to:
- strengthen the diaphragm
- decrease the work of breathing by slowing your breathing rate
- decrease oxygen demand
- use less effort and energy to breathe.
When should I use this technique?
Use it during your daily activities to help maintain control of your breathing. You can also practise it during a period of quiet, relaxing time that suits you.
Diaphragmatic breathing technique
- sit comfortably with knees bent, shoulders, head and neck relaxed
- place one hand on your upper chest and one just below your ribcage. This allows you to feel the diaphragm as it moves
- as you breathe in, try to fill your lungs under your lower hand. Let your tummy rise up with each breath in
- as you breathe out slowly through your mouth, feel your tummy fall
- practise this for five minutes. It may be tiring at first if breathing in this way does not come naturally to you.
When short of breath
The key points to follow are below and are expanded upon in the next section:
• relax your shoulders
• get into a comfortable position
• practise pursed lip breathing until back in control of breathing
• continue activity.
Relax your shoulders
- excessive tension in your shoulders and neck will use up excess energy and oxygen
- gently roll them and let them relax.
Position
- get into a position to help ease your breathing by allowing your muscles to relax and your diaphragm to expand.
Pursed lip breathing
What does pursed lip breathing do?
- improves ventilation
- releases trapped air in the lungs
- keeps the airways open longer and decreases the work of breathing
- prolongs breathing out to slow the breathing rate
- improves breathing patterns by moving old air out of the lungs and allowing new air to enter the lungs
- relieves shortness of breath
- helps general relaxation.
When should I use this technique?
Use this technique during the difficult part of any activity, such as bending, lifting or climbing stairs. Practise this technique four to five times a day at first so that you can get the correct breathing pattern.
Pursed lip breathing technique
- relax your neck and shoulder muscles
- breathe in slowly for two counts
- pucker or purse your lips as if you were going to blow out a candle
- breathe out slowly and gently through your pursed lips for a count of four.
Coughing
Coughing can be a distressing and frustrating problem. Your cough may be dry or you may cough up phlegm.
Tips to help your cough:
• if your cough is dry, try to increase your oral intake of fluid
• drinking warm honey and water and sucking lozenges may help
• try breathing in steam from hot water
• a cough linctus or suppressant may be prescribed by your doctor.
Clearing phlegm
Increase your oral fluid intake – phlegm will be much easier to clear if you are well hydrated.
Active cycle of breathing technique (ACBT)
This technique helps you to clear sputum from your lungs.
• start with relaxed breathing, which is your normal breathing at rest
• take a slow deep breath in through your nose before gently sighing out through your mouth
• repeat this three to four times, then return to normal breathing
• if you do not feel there is phlegm to be cleared, repeat the deep breathing exercise
• when the phlegm is in the small airways, it can be useful to perform a “huff” to move phlegm to the large airways to be coughed up
• take a breath in, then squeeze the breath out through an open mouth and throat – imagine you are trying to steam up a window
• the breath out should sound soft and should not hurt your throat and should not be prolonged
• cough and spit up any phlegm. If you do not cough up any phlegm with one or two coughs, try to stop coughing
• repeat the cycle until your chest feels clear
Sleeping
Many people with COPD suffer from breathing difficulties during the night. This can be very frightening and increases your anxiety, making your breathlessness worse.
Being prepared can help reassure you when it happens.
- if you wake up breathless, sit up and lean forward. For example, sit at the edge of the bed and lean your arms on a bed table
- keep a fan by your bed and turn it on when you are feeling breathless
- keep your inhalers/medicines by your bed so that they are there when you need them
- try to use your breathing control techniques
- try not to fight your breathlessness. Relax your shoulders as tensing them will only use more energy and make you more breathless.
Anxiety and panic
Anxiety is a normal reaction to situations where we may feel frightened or threatened. This is why it is a common reaction to feeling short of breath.
Common responses to anxiety include:
- fast breathing, chest tightness and shortness of breath
- muscle tension, trembling or shaking
- sweating, cold and clammy hands
- heart pounding/racing and palpitations
- light-headedness and dizziness.
Try to use your breathing control techniques to manage your breathing and anxiety. Try to focus on something to distract you; it could be an image in your mind or something physical in the room.
Remind yourself that the fear will pass and that your breathing will slow and calm.
Calming hand
This is a tool for you to focus on to aid you in relaxing and regaining control of your breathing.
(Burnett and Blagborough, 2010)
Relaxation
If you are prone to becoming anxious, practising relaxation is a good idea to help you maintain control of your breathlessness. Relaxation is a very personal experience and you must find what works for you.
For some people this may be sitting quietly, perhaps with some music on, and practising the diaphragmatic breathing technique. Taking your body through a series of progressive relaxation where you tighten then relax each muscle group in turn can also be helpful.
There are audio CDs that can help with relaxation. Ask your health professional if you need further help.
Acupressure
Acupressure uses the same points as acupuncture. When pressed, they aim to stimulate the body’s self-curative abilities. They are safe self-treatments and can help to reduce anxiety and stress.
Points are easy to locate and should feel tender, like a bruise. Apply firm, steady pressure for one minute with your thumb or middle finger, then release pressure slowly.
Fans
Many people report their breathing is eased by use of a fan. The mechanism by which this helps is not yet fully understood, but it is definitely a simple method worth trying.
Daily activities
Some tips to help you with your everyday activities if these cause you breathlessness:
- take your time getting out of bed. Sit on the edge for a few minutes
- when bathing or showering, avoid having the water too hot and have a window or the door open
- after your bath, use a towelling robe to avoid having to dry yourself straight away
- when dressing, sit down for as much as possible
- avoid clothes covering your face by taking your arms out of sleeves first, then pulling them over your head, and vice versa
- try to avoid bending where you can. Use a pick-up stick, sit down to carry out tasks or work at waist level
- organise your house so items you use frequently are within easy reach.
Ensure beds and chairs are easy to get on and off – ask your therapist for equipment that may help.
- use a shopping trolley or rucksack if having to carry shopping to distribute weight comfortably
- have a hand-held fan with you to help ease your breathlessness while you are out and about
- use the pursed lip breathing technique to tackle stairs and slopes if you know these will make you breathless.
Exercise
When you are breathless, you may start to avoid physical activity which makes you short of breath.
This leaflet aims to give you the skills to manage your breathing in order that you can remain active. This is very important as the less you do, the weaker your muscles will become. This will result in you being able to do less and becoming more breathless, the less you do. This is called deconditioning.
Some basic exercises to maintain strength and mobility are shown in this booklet. Ask your physiotherapist for further advice on staying active.
Basic exercises
These exercises will help to maintain some strength and mobility in your muscles and joints while exercising your lungs.
Start slowly and rest when needed.
1. Slowly raise one knee as high as you can, then return down. Repeat with the other leg. Five times each side.
2. Straighten one leg out in front, hold for five seconds, then slowly lower. Repeat on the other side. Five times each leg.
3. Rotate your ankle anti-clockwise 10 times. Then repeat in a clockwise direction 10 times.
4. You can do this sitting or lying. Raise one hand up towards the ceiling and then slowly back down. Five times. Repeat with the other arm.
5. Lying or sitting with legs fully supported, tighten your thigh muscle and press the back of the knee down onto the bed. Hold for five seconds. Repeat five times. Repeat on the other leg.
6. Lying, slowly bend your knee, bringing your heel towards your bottom, then slowly straighten. Five times each leg.
7. With your legs straight, squeeze your buttocks together tightly and hold for five seconds. Repeat five times.
Notes on exercising
- do not do all the exercises in one go, aim to do two to three in one session
- aim to do some exercise two to three times per day
- your normal walking and daily activities also count as exercise
- if you are tired, rest
- the repetitions stated are just a guide, if you can only do two to three repetitions that is fine
- listen to your body
- you may ache a bit more for the first week, but this will ease
- none of the exercises should cause pain, if any do seek advice from your physiotherapist.
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