BREATHING TECHNIQUES for BREATHLESS MANAGEMENT in CHRONIC RESPIRATORY CONDITIONS AIM To be able to safely and effectively teach and supervise a service user undertaking techniques to minimise breathlessness at rest and post exertion. BACKGROUND Various techniques are available to help a service user with chronic respiratory disease to manage their breathlessness when well. This can be at rest to find a pattern that is the most ergonomically efficient or during and post exercise to increase activity levels and minimise anxiety and panic. Breathing control at rest Pursed lips breathing during exertion Exhalation on effort (blow as you go) Paced breathing on exertion Procedure 1. Check plan for length of treatment and any variations (e.g. position). Identify whether any observations are needed to be taken prior or during the techniques. 2. Check the Service User s breathing pattern before commencing. e.g. what is normal for them, are they well and stable enough to be able to control their breathlessness? warning if service user is emphysematous or has air trapping they may not be able to use their diaphragm. 3. Explain the reason for the technique: e.g. this is to help you establish an easy, normal breathing pattern or this is to help you to increase activity with decreased levels of breathlessness. 4. Position of Service User: check plan. Usually sitting, or walking. If doing breathing control in sitting ensure they are well supported, with service user s hands on their tummy, or in forward lean sitting. (Be aware that the service user may have a preferred relaxed breathing positions the principles are the same).
5. Position of Rehabilitation Assistant: in front and to the side of the service user, so you can clearly observe their face and respiratory action throughout. 6. Explain how to perform the technique i) At Rest Breathing Control in sitting, place your hands on your tummy. Keep your shoulders, arms and upper chest loose and relaxed. Take a normal breath in through your nose and feel your tummy expand slightly. Breathe out slowly through your mouth and feel your tummy fall slightly. If you keep repeating this it will help you develop a calm controlled breathing pattern. You can then use the technique any time you feel your breathing is difficult or rapid. When breathless you can use the technique with different positions to help get control of your breathing. These positions let your tummy relax which makes it easier to breathe in with the lower part of your chest (e.g. forward lean sitting or high side lying). Some people find a fan is helpful to relieve symptoms. Caution: Diaphragmatic Breathing should not be taught routinely in service user s with severe COPD with hyperinflation and air trapping ii) When Walking Your breathing will increase this is normal. You may go from breathing through your nose to your mouth. When breathing out you can try and force out the air called blow as you go or force your breath out with your lips pursed together. See if either help reduce your breathlessness. If you use the paced breathing control method during walking you can keep your breathing under control. Breathe in and out through your mouth if you need to and try breathing with your walking steps e.g. in for 1step and out for 2 steps. You might need to experiment to find a rhythm that suits you Caution: Do not encourage holding the breath Passively fixing the shoulder girdle can help breathlessness by optimising ventilator muscle efficiency - consider the use of thumbs in pockets; across the shoulder handbag; hands on hips or use of walking frame/rollator. 7. On completion seek feedback from service user re how they found the technique. Ensure the service user is comfortable and not in distress. 8. Document in the service user s notes 9. Feedback clearly to the registered practitioner who delegated the task. References: Bott J, Blumenthal S, Buxton M et al 2009 Guidelines for the Physiotherapy management of the adult, spontaneously breathing patient Thorax 64;suppl 1.
SUPERVISED TASKS/EXERCISES CARRIED OUT BY REHABILITATION ASSISTANT COMPETENCIES NAME: TAUGHT MODELLED COMPETENT PT64 Breathing Control (sitting) DATE DATE DATE 1 Read plan, identify exercises and any variations 2 Decide where to undertake breathing control (e.g. in sitting, walking, with sputum clearance or with relaxed breathing positions) 3 Appropriate explanation of the reason for the exercise/technique to Service User 4 Start position of Service User 5 Position of Rehab Assistant relative to Service User 6 Verbal explanation & demonstration of how to perform the exercise/technique, including number of repetitions and any warnings 7 Supervision of exercise/technique i Verbal prompts and encouragement (consider speed and volume of own voice) ii Appropriate correction iii Correct timing of repetitions and rest periods iv Appropriate use of touch
PT64 Breathing Control (sitting) DATE DATE DATE 8 Completion of exercise/technique seek feedback from & give appropriate feedback to service user 9 Documentation 10 Feedback to Registered Practitioner Signature of Learner Sign and date when achieved Signature of Assessor Date of Review
SUPERVISED TASKS/EXERCISES CARRIED OUT BY REHABILITATION ASSISTANT COMPETENCIES NAME: TAUGHT MODELLED COMPETENT PT64 Breathing Control (walking) DATE DATE DATE 1 Read plan, identify exercises and any variations 2 Decide where to undertake breathing control (e.g. in sitting, walking, with PD or with relaxed breathing positions) 3 Appropriate explanation of the reason for the exercise/technique to Service User 4 Start position of Service User 5 Position of Rehab Assistant relative to Service User 6 Verbal explanation of how to perform the exercise/technique, including number of repetitions and any warnings 7 Supervision of exercise/technique i Verbal prompts and encouragement able to help service user find best breathing rhythm ii Appropriate correction iii Correct timing of repetitions and rest periods iv Appropriate use of touch v)appropriate recognition of when to stop and seek advice/help
PT64 Breathing Control (walking) DATE DATE DATE 8 Completion of exercise/technique seek feedback from & give appropriate feedback to service user 9 Documentation 10 Feedback to Registered Practitioner Signature of Learner Sign and date when achieved Signature of Assessor Date of Review
SUPERVISED TASKS/EXERCISES CARRIED OUT BY REHABILITATION ASSISTANT COMPETENCIES NAME: TAUGHT MODELLED COMPETENT PT64 Breathing Control (positions when breathless) DATE DATE DATE 1 Read plan, identify exercises and any variations 2 Decide where to undertake breathing control (e.g. in sitting, walking, with PD or with relaxed breathing positions) 3 Appropriate explanation of the reason for the exercise/technique to Service User 4 Start position of Service User 5 Position of Rehab Assistant relative to Service User 6 Verbal explanation and demonstration of how to perform the exercise/technique, including when to use and any warnings 7 Supervision of exercise/technique i Verbal prompts and encouragement ii Appropriate correction iii Correct timing of repetitions and rest periods iv Appropriate use of touch v)appropriate recognition of when to stop and seek advice/help
PT64 Breathing Control (positions when breathless) DATE DATE DATE 8 Completion of exercise/technique seek feedback from & give appropriate feedback to service user 9 Documentation 10 Feedback to Registered Practitioner Signature of Learner Sign and date when achieved Signature of Assessor Date of Review