COPD Breathing Retraining Protocol

Developed by: Specialist Physical Therapist

Disclaimer: This protocol is a guideline. Individualized treatment plans should be based on patient-specific needs and clinical assessment.

I. Clinical Presentation of COPD

Patients with Chronic Obstructive Pulmonary Disease (COPD) often present with the following:

• Dyspnea (shortness of breath), especially with exertion
• Chronic cough, often with mucus production
• Wheezing or whistling sound when breathing
• Chest tightness
• Fatigue
• Decreased exercise tolerance
• Increased use of accessory muscles for breathing
• Barrel chest (in advanced stages)
• Postural changes (forward head posture, rounded shoulders)

These symptoms are often exacerbated by infection, allergens, or irritants.

II. COPD Rehab Phases

Phase 1: Acute Management & Education

Goals: Symptom management, education on COPD, breathing techniques, and energy conservation.

• Education on COPD pathophysiology and self-management strategies.
• Instruction in proper inhaler technique.
• Airway clearance techniques (e.g., huff cough).
• Initiation of diaphragmatic breathing exercises.
• Gentle range of motion exercises.
• Energy conservation strategies (e.g., pacing activities).

Phase 2: Breathing Retraining & Exercise

Goals: Improve breathing efficiency, increase exercise tolerance, and reduce dyspnea.

• Progression of diaphragmatic breathing exercises.
• Introduction of pursed-lip breathing.
• Thoracic mobility exercises.
• Progressive aerobic exercise (e.g., walking, cycling).
• Strength training (focusing on upper and lower extremities).

Phase 3: Maintenance & Long-Term Management

Goals: Maintain improvements, prevent exacerbations, and promote a healthy lifestyle.

• Independent continuation of breathing exercises and aerobic exercise.
• Maintenance of strength training program.
• Pulmonary rehabilitation maintenance program.
• Smoking cessation support (if applicable).
• Flu and pneumonia vaccinations.

III. Specific Exercise Examples

1. Diaphragmatic Breathing: Lie supine with knees bent. Place one hand on your chest and the other on your abdomen. Inhale slowly through your nose, allowing your abdomen to rise. Exhale slowly through pursed lips.
2. Pursed-Lip Breathing: Inhale slowly through your nose. Exhale slowly through pursed lips, as if blowing out a candle.
3. Huff Cough: Sit upright. Take a deep breath. Open your mouth wide and say "ha, ha, ha" to forcefully expel air.
4. Thoracic Extension: Sit tall in a chair. Clasp your hands behind your head. Gently extend your upper back, arching backward.
5. Shoulder Blade Squeeze: Sit upright. Squeeze your shoulder blades together, holding for 5 seconds.
6. Walking: Begin with short distances and gradually increase duration and intensity.
7. Cycling: Use a stationary bike to improve cardiovascular fitness.
8. Arm Ergometry: Utilize an arm ergometer to strengthen upper extremity muscles.
9. Bicep Curls: Use light weights to strengthen biceps muscles.
10. Leg Extensions: Use a leg extension machine to strengthen quadriceps muscles.
11. Chair Squats: Stand in front of a chair and slowly lower yourself down as if sitting, then stand back up.
12. Stair Climbing: Gradually increase the number of stairs climbed to improve cardiovascular fitness and leg strength.

IV. Evidence-Based Return to Function Criteria

Return to function is determined by achieving the following criteria:

• Dyspnea: Ability to perform activities of daily living with minimal dyspnea (Borg scale score of 3 or less during activity).
• Exercise Tolerance: Ability to walk for at least 20 minutes continuously without significant dyspnea or fatigue.
• Strength: Adequate muscle strength to perform functional tasks (e.g., lifting groceries, climbing stairs).
• Breathing Pattern: Consistent use of diaphragmatic breathing and pursed-lip breathing during activities.
• Self-Management: Ability to independently manage COPD symptoms and medications.
• Exacerbation Frequency: Reduced frequency and severity of COPD exacerbations.
• Quality of Life: Improved quality of life as measured by validated COPD questionnaires (e.g., St. George's Respiratory Questionnaire).

Successful completion of a pulmonary rehabilitation program is a strong indicator of readiness to return to full function. Ongoing monitoring and maintenance are crucial for long-term success.