Pursed Lip Breathing: Pursed Lips Technique and Its Effects
By Dr. Artour Rakhimov, Alternative Health Educator and Author - Medically Reviewed by Naziliya Rakhimova, MD - Last updated on August 9, 2018
Pursed lip breathing has been tested in many clinical trials.
- COPD ( Faager et al, 2008; Zhang et al, 2008; Nield et al, 2007; Puente-Maestu & Stringer,
2006; Garrod et al, 2005; Spahija et al, 2005; Bianchi et al, 2004;
Opdekamp & Sergysels, 2003;
Gigliotti et al, 2003;
Sudo et al, 2002;
Sudo et al, 2001;
Truesdell et al, 2000; Onodera & Yazaki, 1998; Bai, 1991)
- asthma (Lehrer et al, 2006; Tsunezuka et al, 2005; Lehrer et al,
2004; Ritz & Roth 2003; Meyer et al, 1997; Van der Schans et al, 1997)
- asthma in children (Lehrer et al, 2000)
- emphysema (Egli, 1960)
- stroke (Sutbeyaz et al, 2010)
- autonomic failure (Thijs et al, 2007)
- primary hypertension (Reyes del Paso et al, 2006)
- major abdominal surgery (Fagevik et al, 1997)
- cystic fibrosis (Delk et al, 1994).
- myasthenia gravis (Fregonezi et al, 2005)
- myotonic muscular dystrophy (Ugalde et al, 2000)
- autonomic failure (Thijs et al, 2007)
- altitude adaptation (Burtscher, 2009).
Causes or purpose of pursed lips breathing technique
It can be applied:
- as a 3-5 minutes “rescue exercise” or an Emergency Procedure to counteract acute
exacerbations or dyspnea (shortage of air or breathlessness) in COPD and asthma (Nield et al, 2007;
Puente-Maestu & Stringer, 2006; Garrod et al, 2005; Bianchi et al, 2004;
Gigliotti et al, 2003; Truesdell et al, 2000; Van der Schans et al, 1997; Bai, 1991)
- to increase baroreceptor cardiac function in primary hypertension (Reyes
del Paso et al, 2006)
- during physical exercise or walking to improve oxygenation of the arterial blood (Spahija
et al, 2005; Faager et al, 2008)
- as a 10-20 minutes daily systematic respiratory exercise to train
breathing in complex with other rehabilitative activities (Zhang et al,
Lehrer et al, 2006; Tsunezuka et al, 2005;
Fregonezi et al, 2005; Lehrer et al, 2004; Opdekamp & Sergysels, 2003; Ritz & Roth 2003;
Gigliotti et al, 2003;
Sudo et al, 2002;
Sudo et al, 2001; Lehrer et al, 2000; Ugalde et al, 2000; Onodera & Yazaki, 1998;
Fagevik et al, 1997; Meyer et al, 1997; Delk et al, 1994;
In an overwhelming majority of published studies, their authors and
participated patients report that pursed lip breathing is effective for
acute attacks, during physical activity, and as a part of pulmonary rehabilitation programs.
Pursed lip breathing preliminary instructions
1. A quiet place to focus one’s attention on relaxation and
2. Silence (no speaking)
3. Empty stomach, but not hungry Warning.
If you suffer from diabetes and use insulin or other blood
glucose-lowering medication, the pursed lip breathing exercise can increase
your sensitivity to medication. This can make your blood glucose level lower
than usual. You may suffer then from hypoglycemic shock, which is
much more dangerous than high blood sugar. You should have a small snack
immediately after the breathing session.
4. Hydration (drink water any time if you get thirsty)
5. Clean and fresh air or good air quality
6. Good thermoregulation (do not overheat yourself or, for advanced
training, be a little on a cold side)
7. Good posture that allows diaphragmatic breathing (during initial stages
of learning for severe COPD, asthma, emphysema, and bronchitis, the exercise
can be done while sitting in an armchair or on a couch; later, during clinical
remission, it should be done with a straight spine, e.g., while sitting on a
half of a chair and without leaning on the back of this chair).
Warning.Breathing exercises can cause powerful cleansing reactions and can be dangerous for
pregnant women, people with organ transplants, GI problems, and panic attacks, as well as those who take medication
for diabetes, hypertension, hypothyroidism, and other conditions.
Consult your health care provider and follow special guidelines, which can be found
in the Module
Restrictions, limits, and temporary contraindications.
Pursed lip breathing instructions
- Relax all body muscles,
especially your neck and shoulder muscles
- Make your usual inhalation through your nose and from the diaphragm for
about two seconds only while keeping your mouth closed
- Exhale for about four seconds through pursed lips, while applying very
light resistance as if you were going to whistle. Keep in mind that your
exhalation should always be about twice as long as your inhalation.
Note that you should not blow too hard. Hyperventilation will worsen your
symptoms. Blow out with the about same force that you would use to cool hot
soup on a spoon so that you do not blow it off the spoon.
The most common mistake is too much resistance to air flow or
high-pressure breathing. This results in muscular tension and sudden
reduction of oxygen content in the lungs. It is important to reduce or slow
down one's breathing pattern during pursed lip breathing but do it very gradually.
Pursed lip breathing rationale
Confused about getting even more CO2, while people with COPD already have too high arterial CO2. This confusion is common even for doctors and respiratory professionals (!). Here is how Dr. Artour explains why reduced breathing improves blood gases: their arterial CO2 gets lower (closer to the medical norm), while blood oxygenation increases in one breathing session(!).
Since the technique works, it is useful to find causes or its rationale. Most authors base their ideas on mechanical effects of pursed
lip breathing assuming that lungs are influenced, during breath work, by the amplitude of
the respiratory movements, stretching of alveoli, prevention of collapse and
airway obstruction, a reduction of dynamic hyperinflation of the lungs, and so
forth. In reality, the change and improvement in lung tissue function are based on biochemical processes
and the main effect or purpose of pursed lip breathing was suggested in 1987
Lancet article Pursed-lip breathing
reduces hyperventilation-induced bronchoconstriction (Wardlaw et al,
Several research articles have found reduced arterial hypercapnia (excess
of CO2 due to ventilation-perfusion mismatch) and improved oxygenation of
the arterial blood. How is it possible, if patients breathe less during
Alveolar hyperventilation in patients with COPD, asthma,
bronchitis, emphysema, and cystic fibrosis is a proven fact. It leads to alveolar hypocapnia
that causes constrictions of bronchi and bronchioles worsening the
ventilation-perfusion ratio and prevents
lung tissue healing. Pursed lip breathing, when correctly executed, leads to
reversal of alveolar hyperventilation and increased alveolar CO2 tension.
Summary. Physiology of pursed lip breathing. The main
physiological effect of pursed lip breathing is reduction of
hyperventilation and higher CO2 levels in the alveoli during and after
training. Increased CO2 levels
in the functioning parts of the lungs relax and dilate smooth muscles of airways.
Relative alveolar hypercapnia immediately improves
ventilation-perfusion ratio and oxygen levels in the arterial blood.
Additionally, due to healing effects of CO2 on lung damage and lung injury,
gradual breathing normalization leads to clinical remission even in more
severe cases of COPD and other conditions.
There is a Table right below here that provides a practical comparison of several breathing techniques with pursed lip breathing. In addition, there is another page that compares and provides technical details related to pursed lip breathing and other breathing
retraining techniques (including hatha yoga, the Buteyko method, Frolov device, and
Resperate). All these resources are right below here as your bonus content.
Tweet or Share this page to reveal the bonus content.
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