For millions of people living with Chronic Obstructive Pulmonary Disease (COPD), the simple act of breathing can be a daily struggle. Among the various breathing techniques taught in pulmonary rehabilitation, pursed lip breathing (PLB) stands out as one of the most effective non-pharmacological interventions. But what does the science tell us about this technique? Today, we’re examining the landmark 2007 study by Bianchi and colleagues that helped establish PLB as an evidence-based practice for managing COPD symptoms.
The Bianchi Study: Key Details
The study, titled “Chest wall kinematics and breathlessness during pursed-lip breathing in patients with COPD,” was published in the journal Chest in 2007. Led by Roberto Bianchi at the University of Florence in Italy, this research provided crucial insights into how and why PLB works for COPD patients.
Study Design and Participants
- Participants: 30 patients with stable COPD
- Methods: Researchers divided participants into two groups:
- Spontaneous PLB users: 15 patients who had naturally adopted PLB in their daily lives
- Non-PLB users: 15 patients who did not use the technique
What They Measured
The researchers used optoelectronic plethysmography (a technology that measures chest wall volume changes) to assess:
- Breathing patterns
- Chest wall kinematics (movement)
- Sensation of breathlessness (dyspnea)
- Exercise tolerance
Key Findings
The results of Bianchi’s study were remarkable and continue to influence respiratory therapy today:
1. Improved Breathing Efficiency
- Reduced Respiratory Rate: PLB users showed a significant decrease in breathing frequency
- Increased Tidal Volume: Patients took deeper, more effective breaths during PLB
- Better Breathing Pattern: More efficient breathing with less hyperinflation
2. Reduced Breathlessness
- Patients using PLB reported significantly lower levels of dyspnea during exercise
- The Borg scale (a measure of perceived exertion) scores were markedly lower in the PLB group
3. Enhanced Exercise Tolerance
- PLB users demonstrated improved exercise capacity
- They were able to maintain activity for longer periods before experiencing severe breathlessness
4. Physiological Mechanisms
The study elucidated key mechanisms behind PLB’s effectiveness:
- Creation of positive pressure in the airways that helps keep airways open
- Reduction in dynamic hyperinflation (trapped air in the lungs)
- More efficient recruitment of respiratory muscles
- Better synchronization of chest wall compartments
Clinical Implications
Bianchi’s findings had several important implications for clinical practice:
- Validation of PLB as a Therapeutic Technique: The study provided solid evidence supporting PLB as more than just a folk remedy
- Patient Selection: Not all COPD patients benefit equally from PLB—those who spontaneously adopt it tend to gain the most benefit
- Integration into Pulmonary Rehabilitation: The study supported the inclusion of PLB training in comprehensive COPD management programs
- Self-Management Tool: PLB was confirmed as an effective self-management strategy that patients could employ during episodes of breathlessness
How to Perform Pursed Lip Breathing
Based on the technique described in the Bianchi study:
- Relax your neck and shoulder muscles
- Inhale slowly through your nose for about 2 seconds
- Purse your lips as if you’re about to whistle or gently blow out a candle
- Exhale slowly and gently through pursed lips for about 4-6 seconds
- Keep the exhalation relaxed, not forced
Conclusion
The Bianchi study represents a turning point in our understanding of pursed lip breathing as an intervention for COPD. By demonstrating clear physiological benefits and mechanisms of action, this research elevated PLB from a simple breathing exercise to an evidence-based therapeutic technique.
For the millions living with COPD, this simple technique—requiring no equipment and minimal training—continues to provide meaningful relief from one of the disease’s most distressing symptoms: breathlessness. As pulmonary rehabilitation specialists often say, sometimes the most powerful interventions are also the simplest.
Beyond Bianchi: Subsequent Research
Since the publication of Bianchi’s study, numerous follow-up studies have further validated PLB:
- Cabral et al. (2015) confirmed PLB’s effectiveness in reducing dynamic hyperinflation
- Reference: Cabral, L. F., D’Elia, T. C., Marins, D. S., Zin, W. A., & Guimarães, F. S. (2015). Pursed lip breathing improves exercise tolerance in COPD: a randomized crossover study. European Journal of Physical and Rehabilitation Medicine, 51(1), 79-88. https://www.minervamedica.it/en/journals/europa-medicophysica/article.php?cod=R33Y2015N01A0079
- Visser, F. J., Ramlal, S., Dekhuijzen, P. R., & Heijdra, Y. F. (2011) demonstrated improved breathing efficiency with PLB
- Reference: Visser, F. J., Ramlal, S., Dekhuijzen, P. R., & Heijdra, Y. F. (2011). Pursed-lips breathing improves inspiratory capacity in chronic obstructive pulmonary disease. Respiration, 81(5), 372-378. https://doi.org/10.1159/000319036
- Jarosch et al. (2019) conducted a systematic review showing consistent benefits across multiple studies
- Reference: Jarosch, I., Gloeckl, R., Damm, E., Schwedhelm, A. L., Buhrow, D., Jerrentrup, A., & Kenn, K. (2019). Short-term effects of comprehensive pulmonary rehabilitation and the impact of pursed-lips breathing in patients with COPD. Respiratory Research, 20(1), 230. https://doi.org/10.1186/s12931-019-1195-7
- Bhatt et al. (2013) found PLB reduced respiratory rate and increased tidal volume
- Reference: Bhatt, S. P., Luqman-Arafath, T. K., Gupta, A. K., Mohan, A., Stoltzfus, J. C., Dey, T., Nanda, S., & Guleria, R. (2013). Volitional pursed lips breathing in patients with stable chronic obstructive pulmonary disease improves exercise capacity. Chronic Respiratory Disease, 10(1), 5-10. https://doi.org/10.1177/1479972312464244
- Mayer et al. (2018) demonstrated PLB’s benefits in post-operative thoracic surgery patients
- Reference: Mayer, A. F., Karloh, M., Dos Santos, K., de Araujo, C. L. P., & Gulart, A. A. (2018). Effects of acute use of pursed-lips breathing during exercise in patients with COPD: a systematic review and meta-analysis. Physiotherapy, 104(1), 9-17. https://doi.org/10.1016/j.physio.2017.08.007
- Gosselink (2003) provided a clinical review of breathing strategies including PLB
- Reference: Gosselink, R. (2003). Controlled breathing and dyspnea in patients with chronic obstructive pulmonary disease (COPD). Journal of Rehabilitation Research and Development, 40(5), 25-34. https://www.rehab.research.va.gov/jour/03/40/5/gosselink.html
- Jones et al. (2013) showed PLB improvements in anxiety-related hyperventilation
- Reference: Jones, M., Harvey, A., Marston, L., & O’Connell, N. E. (2013). Breathing exercises for dysfunctional breathing/hyperventilation syndrome in adults. Cochrane Database of Systematic Reviews, (5), CD009041. https://doi.org/10.1002/14651858.CD009041.pub2
- Research reference: Bianchi, R., Gigliotti, F., Romagnoli, I., Lanini, B., Castellani, C., Grazzini, M., & Scano, G. (2007). Chest wall kinematics and breathlessness during pursed-lip breathing in patients with COPD. Chest, 131(2), 612-618. https://doi.org/10.1378/chest.06-1859
Disclaimer: This article summarizes research findings but is not medical advice. Always consult with healthcare providers regarding breathing techniques and COPD management strategies appropriate for your specific condition.