Which breathing techniques help with COVID-19?

Breathing techniques or exercises are being recommended to help people get air right into the bases of their lungs if they are suffering from COVID-19, the disease caused by the new coronavirus (SARS-CoV-2). The breathing techniques won’t cure COVID-19, but they may help to alleviate some of the respiratory symptoms by helping to clear mucus or secretions from the lungs. Shortness of breath, or dyspena, is a common respiratory symptom associated with COVID-19.

Why are breathing techniques being recommended for COVID-19?

Breathing techniques gained attention after UK author J.K. Rowling tweeted that the techniques advised by Dr Sarfaraz Munshi from Queen's Hospital in Romford, UK, helped her recover from a suspected case of COVID-19.

Are these breathing techniques new or specific to COVID-19 patients?

The breathing techniques that are recommended are already used by people who have breathing difficulties or are at increased risk of lung infections. The techniques will already be familiar to many people with breathing difficulties caused by cystic fibrosis, chronic obstructive pulmonary disease (chronic bronchitis and emphysema) and chronic asthma.

Which breathing techniques might help my COVID-19 respiratory symptoms?

The breathing technique covered by Dr Munshi is part of a process better known as Active Cycle of Breathing Technique (ACBT), which he advises should be used in conjunction with lying on your stomach with a pillow. This may help with draining mucus and secretions from your lungs (postural drainage). Don’t forget to check with your doctor or physiotherapist if these techniques are suitable for you.

ACBT guidelines recommend that you follow a 3 step process:

1. Breathing control

Breathing control is focused on breathing gently with as little effort as possible.

• Sit in a comfortable position.
• Place your hands on the rib cage or the top of your stomach. Feel your ribs or stomach rise and fall as you breathe.
• Breathe in through your nose and out through your nose of mouth.
• Breathe at a comfortable rate.

2. Deep breathing exercises

Deep breathing exercises help to loosen secretions.

• Take 3 to 5 deep breaths in through your nose. Make sure they are long and slow.
• Hold your breath, or ‘pause’ at the end of each breath, for 2-3 seconds before breathing out again. Keep your shoulders and chest relaxed and breathe out as though you are sighing.

Repeat steps 1 and 2 several times before beginning step

3. Huffing

Huffing is when you breathe out (exhale) forcefully through your mouth without coughing.

• To move secretions from your lower airways perform a medium volume huff. Breathe in normally and then breathe out actively for as long as you can until your lungs feel empty.
• To remove secretions from your upper airways take a deep breath in, then open your mouth nice and wide and huff out quickly.
• To avoid a tight feeling in your chest only do 1-2 huffs together.
• If you hear crackling noises when you huff then a cough can help clear secretions, but take care to avoid excessive coughing.

These techniques can be carried out twice a day for 10-15 minutes at a time. They can also be carried out more depending on your symptoms. Don’t forget to contact your doctor for advice, however, if your symptoms aren’t improving or are getting worse.

What about postural drainage?

Dr Munshi recommended lying on your stomach with a pillow for 10 minutes after completing your breathing techniques. This can also help to shift any secretions out of your lungs, but check with your doctor first before trying this out because it may not be suitable for everyone. Postural drainage can also be carried out while lying on your sides and back to help drain other areas of your lungs.

• Postural drainage is best done on an empty stomach.
• You can lie on your back, sides and front to help drain different areas.
• Back (drains front of lungs) - lie on your back with a pillow under your head and with your chest lower than your hips. You can prop your hips up above your chest by placing 2-3 pillows under your bent knees. With your arms by your side breathe in through your nose and out through your mouth. Try to breathe out for longer than you breathe in.
• Sides (drains sides of lungs) - lie on your side with 2-3 pillows under your stomach and drape yourself over them so that your chest is lower than your hips. Once again breathe in through your nose and out through your mouth. Don’t forget to change sides.
• Front (drains the back of your lungs) - lie on your front with 2-3 pillows under your stomach to raise it above your chest. Rest your arms by your head and breathe in through your nose and out through your mouth.

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