Diaphragmatic breathing exercises. Therapy in chronic obstructive pulmonary disease

DIAPHRAGMATIC breathing exercises have long been advocated in the therapy of patients with chronic obstructive pulmonary disease (COPD). The control of diaphragmatic excursions is accomplished by (1) consciously contracting the muscles of the anterior abdominal wall to obtain preferential descent of the diaphragm during inspiration, (2) assuming the head-down, supine, or leaning-forward posture to facilitate a diaphragmatic breathing pattern, and (3) placing weights or strapping belts on the abdomen to force the diaphragm craniad.¹⁻³ Often, dyspnea is relieved by these maneuvers, but it is uncertain what are the mechanisms responsible for the improvement. The following hypotheses have been suggested: (1) reduction of minute ventilation with maintenance of alveolar ventilation, (2) slowing of inspiratory flow rates, (3) improvement of ventilation-perfusion relationships at the bases of the lungs, (4) diminution of the work of breathing, and (5) promotion of a feeling of well-being. Reduction of Dead-Space Ventilation The hypothesis that reduced