HOW DOES THE BREATHER WORK?

How is the Breather therapeutic?

As you breathe in and out of the Breather, it functions as a therapeutic exerciser for the lungs and breathing muscles. Resistance to inhalation (breathing in) strengthens the diaphragm, the major muscle of breathing, and the accessory muscles of the neck.  Resistance to exhalation (breathing out) develops strength and tone in the abdominal muscles. Additionally, exhalation resistance mimics pursed lip breathing and helps to keep the airways clear of mucus.

Is the Breather clinically effective?

Yes. Hundreds of studies on patients of a wide variety of diseases as well as on non-patients have shown that respiratory muscle training (RMT) has measurable, reliable and clinically meaningful effects. Examples include the significant increase of maximal inspiratory and expiratory pressure, peak inspiratory and expiratory flow, vital capacity, forced expiratory volume, heart rate, blood pressure, and hyperinflation (24). Please see our website for the research based evidence of the efficacy of RMT (http://pnmedical.wpengine.com/science/).

How does the Breather compare to Incentive Spirometry (IS) devices?

While IS encourages deep breathing, there is no resistance to the intake of air through the device. To increase the strength and endurance of your breathing muscles, you need to inhale and exhale through the Breather. Incentive Spirometry does, however, remind you to take in a deep breath and some even use it as a tool to measure their gross lung volumes.

Does using the Breather have adverse effects?

It is important to carefully follow the instructions on how to use the Breather. If you feel unwell or lightheaded when using the Breather for the first time, it is important to reduce and/or stop your training. As with any form of training, it is essential to listen to your body and to not over-exercise. If the instructions are followed, the Breather is not known to have adverse effects.

Please check with your physician if you have health problems before using the Breather.

Careful evaluation is recommended before initiation of therapy for: active hemoptysis, untreated pneumothorax, esophageal surgery, airway stenosis (true vocal fold mass, vocal fold paralysis in adducted position, subglottic stenosis, etc), intracranial pressure > 20mm Hg, recent oral, facial or skull trauma / surgery, acute sinusitis, epistaxis, hemodynamic instability, bolus emphysema, tympanic membrane rupture or middle ear pathology.

When should I not use the Breather?

If you are feeling ill, check with your physician whether he would advise you to stop your training for a while. When you are ready to resume training, you may find you need to decrease your resistance settings; this is normal. You will build your resistance and repetitions again after a short while.

Should I stop using the Breather when I get ill?

If you get ill you should consult your doctor on whether it is advisable to continue using the Breather during illness. When you are ready to resume training, you may find you need to decrease your resistance settings; this is normal. You will build your resistance and repetitions again after a short while.

Using the Breather makes me feel lightheaded. Why is that?

Almost everyone gets lightheaded and may feel they are hyperventilating when they are new to Respiratory Muscle Training (RMT). Your body needs time to adjust to the increased exchange of oxygen and carbon dioxide. It may take you a week or two before the lightheadedness subsides while training. When it does occur during a session, pause for several minutes, breathing normally without The Breather and then continue. If the lightheaded feeling persists, stop and contact your care provider. You are welcome to contact us as well.

Using the Breather makes me cough. Why is that?

Due to the required force working against the resistance while you are exhaling, using the Breather might make you cough. This is great for airway clearance, so don’t try to suppress it. Remove the Breather until you are finished with coughing. If the cough produces phlegm or secretions, these should be expelled rather than swallowed. Then put the Breather back into your mouth to continue training.

USING AND CARING FOR YOUR BREATHER

How do I use the Breather?

Detailed instructions on how to use the Breather are found in the package on your Breather as well as on our website. It is important to follow these instructions carefully.

Can I use the Breather reclining or lying down?

You can, however, reclined or semi-reclined positions are known to impair respiratory muscle function. This is why we recommend sitting upright in order to practice proper diaphragmatic breathing during training. If you’re having trouble maintaining proper breathing while sitting upright, try leaning back a little during training. You may find this easier to complete your training properly in the beginning. However, as soon as possible, sit in an upright position since inspiratory muscle function is optimized while sitting or standing.

How do I clean the Breather?

The Breather should be regularly cleaned with mild, warm soapy water to prevent build-up of saliva during training. Rinse your Breather well; shake off excess water  and air dry on a clean paper towel. If it is completely dry, it can be stored in a plastic bag.

Is it safe to share the Breather?

No, it is very important to use one Breather per person. If it is being used in a nursing facility or some other medical institute, label the Breather with a permanent marker to ensure individual use.

 

When do I need to replace the Breather?

As with any regularly used product, proper care of the Breather will help to preserve its performance for a long time. We’ve known patients to have used their Breather for over 2 years. Also, please note “How do I clean the Breather?” in our FAQs.

 

How often do I need to use the Breather?

Try to train on a daily basis, as it may take up to  2 – 4 weeks to feel results. The deep, slow breathing is known to almost immediately assist in relaxation.

 

How long do I have to use the Breather?

The Breather will be beneficial for your breathing, exercising, blood pressure, sleep and circulation as long as you keep using it. Once you have built it into your daily routine it will not feel like exercise, but more like a relaxation session. Should you start using the Breather again after a break, for example during illness, make sure to find the right resistance; you might have to reduce it for a while until your respiratory muscles have gained strength again.

Where and when can I use the Breather?

The Breather can be used anytime and almost anywhere . . . watching TV, reading a book, or anytime you feel you need to relax.

THE BREATHER AND BREATHING

Why is the Breather so important?

The Breather is important because it will yield two different results: it will strengthen your muscles for breathing in and out, and will assist you to breathe properly and efficiently.

Ask yourself these questions. . . Do I always breathe correctly? Is it always under control? Am I a superficial, upper-chest breather? Take this simple test and find out for shallow, superficial, upper-chest breathing undermines your health. . .

Find Your Diaphragm. . . Place one hand on the upper portion of the stomach just a few inches above the navel but below the breastbone. Sniff in several small inhalations per breath through the nose. The movement in that area is the diaphragm working at its best.

Test Your Breathing Technique. . . The next time you feel short of breath in need of your inhaler, stressed out, or breathing rapidly, place one hand on your upper chest and the other on your stomach. If you are breathing correctly (diaphragmatically) your stomach should feel as if it is expanding – filling with air. If your chest is rising, you are breathing superficially.

Why Is Superficial Breathing So Harmful?

The average breath rate is up to 12 times per minute and many of us breathe even faster. Rapid, shallow breathing can reduce the level of carbon dioxide in the blood which causes the arteries to constrict, reducing the flow of blood throughout the body. When this constriction occurs, even though the lungs are breathing in more oxygen than the body needs, the brain and body will experience a shortage of oxygen. This lack of oxygen can play havoc with the sympathetic nervous system, making us feel tense or anxious and less likely to think clearly.

Most people habitually use superficial breathing rather than diaphragmatic breathing. Retraining your body to use more efficient diaphragmatic breathing by using the Breather might reduce tensions, worries and pains that you didn’t think were connected, such as back and neck pain (1). Regular resistive breathing training (RMT) can cancel superficial breathing and promote diaphragmatic breathing.

Will the Breather help my panic attacks?

Since anxiety can lead to shallow, upper chest breathing and in some cases full blown panic attacks, regular use of the Breather will assist you in learning diaphragmatic breathing. When you suddenly realize you’re upper chest breathing at an exceptionally fast rate and can’t seem to slow down, you may find inhaling and exhaling through the Breather especially helpful, even relaxing. Please read ‘Why is Superficial Breathing So Harmful?’ found in the FAQs.  Daily practice in any breathing awareness program has been used by thousands who suffer from panic attacks.

PATIENT USE OF THE BREATHER

I suffer from COPD. Can I use the Breather?

Research-based evidence has shown that Respiratory Muscle Training (RMT) in patients with stable COPD leads to significant improvements in dyspnea and breathlessness, fatigue and health-related quality of life (2). Even if you are already following an exercise regime to help alleviate the symptoms of COPD, adding RMT by using the Breather to your routine will further enhance your improvements and muscle strength (3).

Will the Breather replace my inhaler or bronchodilator?

No, the Breather does not replace the use of dry powder inhalers, corticosteroid therapy, bronchodilators, or any other medical therapy. The Breather should be used as a complementary therapy. However, you might find that you need to use your inhaler or bronchodilator less frequently (10). Studies have shown that respiratory muscle training (RMT) optimises the distribution of drugs in the lungs, thus making them more efficient. In addition, the beneficial effect of RMT on your expiratory muscles (needed for exhaling) will reduce residual drug build up in your lungs, again improving drug efficiency (11).

I suffer from asthma. Is it safe to use the Breather?

Yes, research has shown that respiratory muscle training (RMT) improves respiratory muscle strength. Children and adults suffering from asthma should benefit from using the Breather by being able to clear the airways more efficiently due to increased expiratory muscle strength. RMT also reduces the frequency of asthma attacks, severity and frequency of diurnal and nocturnal symptoms and perception of dyspnea. Regular RMT by using the Breather should result in reduced need for the use of your rescue bronchodilator (10).

 

Are there other conditions for which the Breather might be helpful?

Respiratory muscle training (RMT) such as using the Breather is beneficial and contributes to health and rehabilitation for a number of conditions, including COPD (2), asthma (10), obstructive sleep apnea (8), dysphagia (12), vocal fold pathologies (13), Parkinson’s Disease (14), Huntington’s Disease (15), cerebral vascular accident (16), congestive heart failure (17), muscular dystrophy (18), myasthenia gravis (19), weaning off mechanical ventilation (20), spinal cord injury (21), hypertension (22) and back pain (9).

Can I use the Breather instead of my medication?

No, the Breather does not replace any of your medication. However, you might find that you need to use inhalers or bronchodilators less frequently. Studies have shown that respiratory muscle training (RMT) optimises the distribution of drugs in the lungs, thus making them more efficient. In addition, the beneficial effect of RMT on your expiratory muscles (needed for exhaling) will reduce residual drug build up in your lungs, again improving drug efficiency (10),(11).

 

I have problems with my speech and/or swallowing. Can the Breather help me?

Yes. Respiratory muscle training (RMT) activates movement of the hyolaryngeal complex, which can be affected in voice disorders such as vocal cord paralysis or vocal fold motions (25). Training the expiratory muscles in particular has been shown to improve swallowing and cough, helping people with dysphagia (12). The Breather strengthens both the inspiratory and the expiratory musculature, and thus has the capacity to improve speech, swallowing and cough at the same time.

I easily get out of breath. Can I use the Breather?

Yes. You might find that you will have to work with low resistance for a while until your dyspnea, or breathlessness, has improved. Research has shown that respiratory muscle training (RMT) significantly improves dyspnea and breathlessness, which is especially important for people with COPD, asthma and the elderly. Using the Breather will strengthen your respiratory muscles, reduce your symptoms and increase your level of activity and exercise (23).

 

Can the Breather help patients with pulmonary hypertension?

Yes. Pulmonary hypertension (PHT) describes high blood pressure in the lung arteries, as these are constricted or blocked. It can occur as a symptom of other conditions, such as congestive heart failure, sleep apnea, and liver or autoimmune diseases. PHT patients have inspiratory and expiratory muscle weakness and poor ventilation (25). Respiratory muscle training (RMT) has been shown to be effective for PHT. RMT significantly increases inspiratory and expiratory pressure, exercise capacity, fatigue and health status in PHT patients, and it has been recommended as a ‘practical and safe treatment without complications’ (26).

NON-PATIENT USE OF THE BREATHER

I am a non-patient, how could I benefit from the Breather?

Using the Breather will increase the strength of your respiratory muscle, your chest wall muscles and your diaphragm, making your breathing more efficient (4). This will increase your exercise capacity and performance, depending on the level of your fitness. It might mean you will be able to climb the stairs more easily, or it could cut a slice off your personal best if you are an athlete (5),(6). In addition, using RMT with the Breather will lower your blood pressure, even if you are currently not at risk of hypertension (7).

 

Will the Breather improve my exercise capacity and performance?

Yes, studies have shown that regular respiratory muscle training (RMT), such as using the Breather, will improve your exercise capacity and performance, whether you have respiratory problems which limit your level of activity, or whether you’re a healthy person or an athlete swimmer (5),(6).

 

Does using the Breather have additional benefits?

Besides the positive effects respiratory muscle training (RMT) has on the strength of your respiratory muscles including chest wall muscles and diaphragm, regular RMT using the Breather can also lower your blood pressure (7), improve the quantity and quality of your sleep (8), increase your exercise capacity and performance (5), reduce neck and back pain (1), (9), and dramatically improve your quality of life (2).

Will the Breather improve my sleep?

Respiratory muscle training (RMT) using the Breather can have a dramatic effect of your sleep problems. RMT improves the quantity and quality of sleep, reduces night time awakenings, limb movement, sleep apnea and hypopnea. RMT particularly improves the quality of both the REM and non-REM phases of your sleep, making your sleep more efficient and leaving you feel refreshed (8).

 

I easily get out of breath. Can I use the Breather?

Yes. You might find that you will have to work with low resistance for a while until your dyspnea, or breathlessness, has improved. Research has shown that respiratory muscle training (RMT) significantly improves dyspnea and breathlessness, which is especially important for people with COPD, asthma and the elderly. Using the Breather will strengthen your respiratory muscles, reduce your symptoms and increase your level of activity and exercise (23).

References:

  1. https://www.painscience.com/articles/respiration-connection

  2. Borge, CR et al. “Effects of Controlled Breathing Exercises and Respiratory Muscle Training in People with Chronic Obstructive Pulmonary Disease: Results from Evaluating the Quality of Evidence in Systematic Reviews.” BMC Pulmonary Medicine 14 (2014): 184. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258938/.php

  3. Magadlea, R et al. Inspiratory muscle training in pulmonary rehabilitation program in COPD patients. Resp Med 2007;101:1500-5 http://www.resmedjournal.com/article/S0954-6111%2807%2900013-3/pdf

  4. Brown PI et al. Determinants of inspiratory muscle strength in healthy humans. Respir Physiol Neurobiol. 2014 Jun 1;196:50-5. http://www.ncbi.nlm.nih.gov/pubmed/24598814

  5. Segizbaeva, MO et al. Effects of inspiratory muscle training on resistance to fatigue of respiratory muscles during exhaustive exercise. Adv Exp Med Biol. 2015;840:35-43. http://www.ncbi.nlm.nih.gov/pubmed/25248344

  6. Shei, R et al. Effect of flow-resistive inspiratory loading on pulmonary and respiratory muscle function in sub-elite swimmers. J Sports Med Phys Fitness. 2014 Dec 11. http://www.ncbi.nlm.nih.gov/pubmed/25503711

  7. Vranish, J et al. Respiratory muscle training: a mechanism study. FASEB 2014;28(1):Supplement 706.22  http://www.fasebj.org/content/28/1_Supplement/706.22

  8. Silva MD, et al. Influence of Inspiratory Muscle Training on Changes in Sleep Architecture in Older Adult – Epidoso Projects. Aging Sci. 2015;3: 137. http://www.esciencecentral.org/journals/influence-of-inspiratory-muscle-training-on-changes-in-sleep-architecture-inolder-adult–epidoso-projects-2329-8847-1000137.php?aid=57335

  9. Janssens L, et al. Inspiratory muscle training affects proprioceptive use and low back pain. Med Sci Sports Exerc. 2015 Jan;47(1):12-9. https://www.researchgate.net/publication/262694152_Inspiratory_Muscle_Training_Affects_Proprioceptive_Use_and_Low_Back_Pain

  10. Lima, EVNCL et al. Inspiratory muscle training and respiratory exercises in children with asthma. J. bras. pneumol. [online]. 2008, vol.34, n.8, pp. 552-558. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132008000800003&lng=en&nrm=iso&tlng=en

  11. Weiner P, Weiner M. Inspiratory Muscle Training May Increase Peak Inspiratory Flow in Chronic Obstructive Pulmonary Disease. Respiration 2006;73:151–156. http://www.powerbreathebrasil.com.br/media/wysiwyg/pdfs/WEINER_IMTmayIncreasePeakInspiratoryFlowInCOPD.pdf

  12. Pitts, T et al. Impact of expiratory muscle strength training on voluntary cough and swallow function in parkinson disease. Chest. 2009;135(5):1301-1308.  http://journal.publications.chestnet.org/article.aspx?articleid=1089805

  13. Chiara, T et al. Expiratory muscle strength training: speech production outcomes in patients with multiple sclerosis. Neurorehabil Neural Repair. 2007 May-Jun;21(3):239-49 http://www.ncbi.nlm.nih.gov/pubmed/17351085?dopt=Abstract

  14. Sapienza, C et al. Respiratory Strength Training: Concept and Intervention Outcomes. Semin Speech Lang. 2011;32(1):21-30. http://uad-lab.slhs.phhp.ufl.edu/files/2012/07/Sapienza-et-al-2011.pdf

  15. Reyes A, et al.. Respiratory muscle training on pulmonary and swallowing function in patients with huntington’s disease: A pilot randomised controlled trial. Clin Rehabil. 2014 Dec 31. http://www.ncbi.nlm.nih.gov/pubmed/25552526

  16. Kulnik, ST et al. Does respiratory muscle training improve cough flow in acute stroke? Pilot randomized controlled trial. Stroke. 2015 Feb;46(2):447-53. https://www.researchgate.net/publication/269692480_Does_Respiratory_Muscle_Training_Improve_Cough_Flow_in_Acute_Stroke_Pilot_Randomized_Controlled_Trial

  17. Cahalin, LP et al. Inspiratory muscle training in heart disease and heart failure: a review of the literature with a focus on method of training and outcomes. Expert Rev Cardiovasc Ther. 2013 Feb;11(2):161-77. https://www.researchgate.net/publication/235619015_Inspiratory_muscle_training_in_heart_disease_and_heart_failure_A_review_of_the_literature_with_a_focus_on_method_of_training_and_outcomes

  18. Gozal D, Thiriet P. Respiratory muscle training in neuromuscular disease: long-term effects on strength and load perception. Med Sci Sports Exerc. 1999 Nov;31(11):1522-7. http://journals.lww.com/acsm-msse/Fulltext/1999/11000/Respiratory_muscle_training_in_neuromuscular.5.aspx

  19. Fregonezi, GA et al. Effects of 8-week, interval-based inspiratory muscle training and breathing retraining in patients with generalized myasthenia gravis. Chest. 2005 Sep;128(3):1524-30. http://www.ncbi.nlm.nih.gov/pubmed/16162753

  20. Martin, AD et al. Inspiratory muscle strength training improves weaning outcome in failure to wean patients: a randomized trial. Crit Care. 2011;15(2):R84. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219341/

  21. Postma, K et al.. Resistive inspiratory muscle training in people with spinal cord injury during inpatient rehabilitation: a randomized controlled trial. Phys Ther. 2014 Dec;94(12):1709-19. https://www.researchgate.net/publication/264429895_Resistive_Inspiratory_Muscle_Training_in_People_With_Spinal_Cord_Injury_During_Inpatient_Rehabilitation_A_Randomized_Controlled_Trial

  22. Ferreira, JB et al. Inspiratory muscle training reduces blood pressure and sympathetic activity in hypertensive patients: A randomized controlled trial. Int J Card 2013;166(1):61-67. http://www.internationaljournalofcardiology.com/article/S0167-5273%2811%2901798-0/abstract

  23. McConnell, AK. The role of inspiratory muscle function and training in the genesis of dyspnoea in asthma and COPD. Prim Care Respir J. 2005 Aug;14(4):186-94. http://www.ncbi.nlm.nih.gov/pubmed/16701724

  24. Petrovic, M et al. Effects of inspiratory muscle training on dynamic hyperinflation in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2012;7:797-805. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516469/

  25. Meyer FJ. Respiratory muscle dysfunction in idiopathic pulmonary arterial hypertension. ERJ  2005;25(1):125-130. http://www.ersj.org.uk/content/25/1/125.full

  26. Saglam, M et al. Inspiratory muscle training in pulmonary hypertension. ERJ 2013; 42(Suppl 57 3336). erj.ersjournals.com/content/42/Suppl_57/3336