Slow Breathing for COPD and Emphysema
This post is inspired by Anne, a customer who was in touch recently (February 2021) and mentioned that our slow breathing exercises help with her emphysema. I wondered if this had any precedent so I looked online. I couldn’t find any research on emphysema and slow breathing directly. However, I did find a study which looked at the effect of slow breathing on chronic obstructive pulmonary obstructive disease (COPD).
With COPD, there is chronic inflammation in the lungs which obstructs the airflow from the lungs. As such, its symptoms include difficulty breathing, coughing, wheezing and producing mucus (sputum). Emphysema is a different disease but, along with chronic bronchitis, can contribute to COPD.
Emphysema refers to a condition where the alveoli in the lungs are being destroyed. It’s generally caused by long-term exposure to irritants and pollutants like cigarette smoke and air pollution. (The alveoli are the minute air sacs at the end of the airways of the lungs where the gases in your lungs are exchanged with the gases in your blood.)
How does slow breathing affect COPD and emphysema?
The study into slow breathing and COPD noted that COPD sufferers tend to have over-activation of their sympathetic nervous system. (This is the part of your nervous system which initiates the body’s ‘fight-or-flight’ response in situations of stress and also continually works to regulate basic functions in the body, such as body temperature. When it’s activated you generally have a higher heart rate and blood pressure and are producing more stress hormones.)
COPD sufferers also tend to have poor baroreflex sensitivity. This refers to the body’s ability to detect and respond to changes in the width of blood vessels (and thus blood pressure) in order to maintain a relatively consistent blood pressure and a good flow of blood to the brain.
This was the case for the 15 COPD sufferers who participated in this study. There were also 15 healthy participants, forming a control group. Both groups of participants had their sympathetic nerve activity and baroreflex sensitivity monitored while breathing at different rates: their own natural rate, 15 breaths per minute, and 6 breaths per minute (following instructions from the investigators).
The study found that doing slow breathing at 6 breaths per minute, compared to 15 breaths per minute, led to “acutely reduced” activation of the sympathetic nervous system in the 15 participants with COPD but not in the control group of 15 healthy participants.
Breathing at 6 breaths per minute compared to 15 breaths per minute also was associated with improved baroreflex sensitivity in both COPD and control groups.
In conclusion, the researchers note that slow breathing could improve the health of COPD sufferers.
In summary, patients with chronic obstructive pulmonary disease showed sympathetic excitation and depression of the baroreflex. Slow breathing counteracted these changes. Given the negative consequences of sympathetic activation and vagal withdrawal, modulation of the sympathovagal balance by slow breathing might have the potential to impact on systemic effects in chronic obstructive pulmonary disease patients. –
T. Raupach et al, 2008
Slow breathing also good for those with cardiovascular problems…
The researchers noted that this effect of slow breathing on reducing sympathetic over-excitation and improving baroreflex sensitivity has also been found in people with chronic heart failure and high blood pressure (see references below): “Previous studies in patients with chronic heart failure or arterial hypertension found an effect similar to that observed in the present study.” (T. Raupach et al, 2008).
… and good for the health more generally
They also note that slow breathing can beneficially improve respiratory and cardiovascular health more generally.
“Taking the present study together with previous studies, it seems that slow breathing induces a generalised attenuation of excitatory pathways regulating respiratory and cardiovascular systems.” In other words, slow breathing reduces over-excitation of the nerve pathways regulating the functioning of our lungs, hearts and blood vessels.
However, it should be remembered that this study did not look at the long-term effects of slow breathing on COPD and general health. The researchers note that, “although clear short-term effects of slow breathing were observed, it remains to be assessed whether longer term practice will lead to stable modifications of cardiovascular and respiratory control.”
I would expect that it’s likely that doing slow breathing regularly would continue to be beneficial, possibly more so over time. The more you do slow breathing, the better you get at it, so hopefully the more it has an effect! Indeed, if you browse this website, you’ll see that slow breathing can have many other benefits for your health as well.
NOTE: If you have such breathing or lung issues, or if you’re concerned about changing your breathing for any other reason, please check with your doctor or another health professional before doing slow breathing.
How to best do slow breathing
How long should you do it for?
In the study described above, participants were breathing at a specific rate for just four minutes. However, studies into slow breathing and other health issues, such as high blood pressure, has generally used time periods of about 15 minutes.
Most of the studies I’ve read have used a slow breathing rate of 6 breaths per minute (a ‘breath’ being both an inhalation and exhalation). It doesn’t so much matter how many breaths per minute you are doing. The key thing is that you are breathing steadily at a pace that is slower than usual. That way you’ll get the benefits for your respiratory system. Breathing slowly is also useful for general relaxation and stress reduction.
How to keep a steady rate of breathing?
This is the tricky part. Slow breathing is obviously very simple. However, like many simple things, it can be surprisingly difficult. It’s easy to drift off and forget what you’re doing – particularly as slow breathing is quite relaxing – and then notice minutes later that you’re breathing normally.
Guided slow breathing
To make it easier, we’ve created a series of guided slow breathing audio tracks. You can just listen to these and breathe along in time with the prompts.
The audio tracks have breathing prompts at different breathing rates – from 10 breaths per minute down to 8, 6, 5, and 4 breaths per minute. Most of us usually breathe at a rate of about 12 breaths per minute (one ‘breath’ being an in-breath and out-breath). So you can start at 10 breaths per minute and gradually work your way down to slower paces as you get used to it.
Listening to relaxing music has also been found to be relaxing in and of itself. As such, most of our audio tracks have soothing music in the background. For each breaths-per-minute cycle, you can choose from tracks with three different types of background music. You can also listen to the breathing prompts on their own, or with your own background music playing along.
You can click here to listen to some samples: Slow breathing audio samples
With the whole set of Breathe Slow audio tracks, you can find a pace which suits you, and select a music (or your own) which suits you.
The full Breathe Slow collection of guided slow breathing audio tracks is now available for $17 (about £13 or €15).
The Breathe-Slow audio tracks come with a 60 day no-questions-asked 100% money-back guarantee if you’re not completely satisfied with your investment. Note that this is a digital download ONLY – no CDs will be sent to you.
To order physical CDs, click here:
(note that the physical CDs do not include the 4 breaths per minute tracks)
Slow Breathing for COPD and Emphysema: References
The study: Slow breathing reduces sympathoexcitation in COPD – https://erj.ersjournals.com/content/32/2/387
COPD and emphysema – https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679
Slow Breathing Increases Arterial Baroreflex Sensitivity in Patients With Chronic Heart Failure – https://www.ahajournals.org/doi/full/10.1161/hc0202.103311
Effect of breathing rate on oxygen saturation and exercise performance in chronic heart failure – https://pubmed.ncbi.nlm.nih.gov/9643792/