How do different breathing exercises for chronic obstructive pulmonary disease compare?

The Bottom Line

  • Chronic obstructive pulmonary disease (COPD) is one of the leading causes of poor health worldwide.
  • Some types of breathing exercises can improve outcomes like exercise capacity, endurance, and quality of life in people living with COPD.
  • Work with your healthcare team to select breathing exercises that are appropriate for you and your condition. 

Tiredness, a hard time breathing, wheezing, coughing with and without phlegm. These are all symptoms associated with one of the top 10 causes of poor health across the globe: chronic obstructive pulmonary disease (COPD) (1). COPD is a lung disease that usually gets worse as time goes on (1;2). From the social to the physical to the financial and everything in between, COPD negatively impacts many aspects of daily life (2-4). Given its far reaching effects, it should come as no surprise that COPD significantly reduces quality of life (1;3).

While there is currently no cure for COPD, there are various strategies and treatments that can help improve symptoms and different areas of health and well-being. These include lifestyle changes like quitting smoking, and medication (1).

One simple, commonly used strategy is breathing exercises (1;3). This umbrella term includes specific exercises like diaphragm breathing, pursed-lip breathing, a combination of diaphragm and pursed-lip breathing, singing, yoga, inspiratory muscle training (inhaling using a device), and traditional Chinese fitness exercises (like Tai Chi and health Qigong). The question is how do these exercises compare when it comes to improving outcomes like exercise capacity (the greatest amount of physical exertion that you can maintain), endurance, and quality of life? Let us turn to a recent systematic review for answers (2).

What the research tells us

Overall, the review found that three of the studied breathing exercises appear to improve outcomes in people living with COPD, compared to the control group (often people receiving usual care or health education) or other breathing exercises. However, the outcomes that benefitted and to what degree differ based on the breathing exercise.

Let us start with exercise capacity and endurance. Here we see that both traditional Chinese fitness exercises and inspiratory muscle training can improve exercise capacity and endurance by a large amount compared to the control group.

Then we have quality of life. For this, traditional Chinese fitness exercises can improve this outcome by a large amount compared to the control group and other breathing exercises, namely singing and inspiratory muscle training. Yoga showed similar benefits in comparison to the control group and singing. It is worthwhile to note that the review did not assess the safety of the breathing exercises it looked at (2).

If you are interested in trying breathing exercises, it is important to discuss their addition to your pulmonary rehabilitation plan or program with your healthcare team prior to starting. This way a tailored plan with exercises and exercise prescriptions that are appropriate for your condition, needs, and wants—such as which outcomes you are trying to improve—can be developed.

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  1. World Health Organization. Chronic obstructive pulmonary disease (COPD), [Internet] 2023. [cited February 2020]. Available from:
  2. Cai Y, Ren X, Wang J, et al. Effects of breathing exercises in patients with chronic obstructive pulmonary disease: A network meta-analysis. Arch Phys Med Rehabil. 2023; S0003-9993(23)00283-6. doi: 10.1016/j.apmr.2023.04.014.   
  3. Jaitovich A, Barreiro E. Skeletal muscle dysfunction in chronic obstructive pulmonary disease. What we know and can do for our patients. Am J Respir Crit Care Med. 2018; 198:175-186.
  4. Menn P, Heinrich J, Huber RM, et al. Direct medical costs of COPD−An excess cost approach based on two population-based studies. Respir Med. 2012; 106:540-548.

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