DEEP BREATHING & COUGHING

How are These Exercises Helpful?

• These exercises facilitate a wide exchange of gases.

• They maximize the amount of oxygen available to the cells.
• They prevent orthostatic pneumonia.
• They make you relaxed.
• They help you cope with pain.
• They help reduce the chances of chest complications after surgery.

Why should I do these exercise?

Deep breathing and coughing exercises facilitate the respiratory function by

helping in removing secretion from airway tract. Voluntary coughing in conjunction with
deep breathing facilitates the movement and expectoration of secretion in the respiratory
tract. Frequent deep breathing exercise automatically initiates the cough reflex.

Who Should Perform These Exercises?

• Patients on bed rest or those who have undergone any surgical procedure, for
example abdominal or chest surgery.
• Patients prone to pulmonary problems.
• Patients susceptible to accumulating respiratory secretions.

How Frequently Should These Exercises be Performed?

• Deep breathing should be performed every hour while awake.

• Patients who have had abdominal or chest surgery need to perform deep breathing
at least three to four times daily. Each session should include a minimum of five
deep breaths.
• Deep breathing exercise may be performed every hour, specially by patients who
are prone to pulmonary problems.

How Should These Exercises Be Performed?

Voluntary Coughing:

• The coughing needs to be deep, reaching into the lungs and not merely the throat;
• Effective coughing is best achieved in the sitting position;
• Hold your breath for about three seconds;
• After deep inhalation, cough forcefully using the abdominal and other accessory
respiratory muscles;
• If you have had an incision, you can provide support by placing your palms on
either side of the incision during coughing;
• For patients with abdominal incision, splint the abdomen with a rolled pillow held
against it.

Deep Breathing Exercises

There are two types of deep breathing exercises.

• Diaphragmatic Breathing Exercise;

• Pursed-lip breathing;
Diaphragmatic

Diaphragmatic breathing can relax muscles, improve oxygen levels and provide a
feeling of release from tension.

 Place one hand on the abdomen, the other on the chest;

 Inhale concentrating on pushing the abdominal hand outward while the chest hand
remains still;
 Hold air in your lungs for five counts;
 Exhale slowly, while the abdomen hand moves inward and the chest hand remains
still. Let all the air out slowly through your mouth;

Pursed-Lip Breathing

• Help maintain open airways by maintaining positive pressure longer during

exhalation;
• Inhale through nose with mouth closed;
• Exhale slowly through nurse-lips, as through whistling or blowing out a candle,
making exhalation twice as ling as inhalation.

INCENTIVE SPIROMETRY
Incentive spirometry, also referred to as sustained maximal inspiration (SMI), is a
component of bronchial hygiene therapy.

Incentive spirometry is designed to mimic natural sighing or yawning by encouraging the

patient to take long, slow, deep breaths. This is accomplished by using a device that provides
patients with visual or other positive feedback when they inhale at a predetermined flowrate or
volume and sustain the inflation for a minimum of 3 seconds.

The objectives of this procedure are to increase transpulmonary pressure and inspiratory
volumes, improve inspiratory muscle perfor-mance,8 and re-establish or simulate the normal
pattern of pulmonary hyperinflation.3 When the procedure is repeated on a regular basis, airway
patency may be maintained and lung atelectasis prevented and reversed.

INDICATIONS:
1. Presence of conditions predisposing to the development of pulmonary atelectasis
1 upper-abdominal surgery
2 thoracic surgery
3 surgery in patients with chronic obstructive pulmonary disease (COPD)
2. Presence of pulmonary atelectasis
3. Presence of a restrictive lung defect associated with quadraplegia and/or dysfunctional
diaphragm.

CONTRAINDICATIONS:
1.Patient cannot be instructed or supervised to assure appropriate use of the device.
2.Patient cooperation is absent or patient is unable to understand or demonstrate proper use of the
device.
3.IS is contraindicated in patients unable to deep breathe effectively (eg, with vital capacity [VC]
less than about 10 mL/kg or inspiratory capacity [IC] less than about one third of predicted).
4.The presence of an open tracheal stoma is not a contraindication but requires adaptation of the
spirometer.

HAZARDS AND COMPLICATIONS:

1. Ineffective unless closely supervised or performed as ordered
2. Inappropriate as sole treatment for major lung collapse or consolidation
3. Hyperventilation
4. Barotrauma (emphysematous lungs)
5. Discomfort secondary to inadequate pain control
6. Hypoxia secondary to interruption of prescribed oxygen therapy if face mask or shield is being
used
7. Exacerbation of bronchospasm
8. Fatigue

MONITORING:
Direct supervision of every patient performance is not necessary once the patient has
demonstrated mastery of technique;(6,16,23) however, preoperative instruction, volume goals,
and feedback are essential to optimal performance.
1. Observation of patient performance and utilization
1.1 frequency of sessions(16)
1.2 number of breaths/session(16)
1.3 inspiratory volume or flow goals achieved(16) and 3- to 5-second breath-hold
maintained
1.4 effort/motivation(16)
2. Periodic observation of patient compliance with technique,(6,16,23) with additional in-
struction as necessary
3. Device within reach of patient(5) and patient encouraged to perform independently
4. New and increasing inspiratory volumes established each day
5. Vital signs

FREQUENCY:
A number of authors suggest using the device 5-10 breaths per session, at a minimum,
every hour while awake (ie, 100 times a day).