Pursed-lip breathing

How to do it

1. Sit in a chair with your feet on the floor. Relax your neck and shoulders.
2. With your mouth closed, breathe in through your nose for 2 seconds. A normal breath, not a full one.
3. Bring your lips together, leaving a small opening in the center, as if to whistle or cool a spoonful of hot soup.
4. Breathe out through that opening for 4 seconds. The air leaves soft and even; your cheeks don't puff out.
5. Close your lips and breathe in through your nose again for 2 seconds. Keep going, 2 in and 4 out.
6. Continue for 3 minutes. That's about 30 breaths, ten a minute.
7. To finish, let your mouth rest and breathe through your nose without counting for a few moments.

What pursed-lip breathing is

It's an exhale with a brake on it. The inhale comes in through the nose in 2 seconds and the exhale goes out in 4, through lips that are almost closed. That narrow opening acts like a valve: the air can't rush out, so the exhale lasts twice as long without you having to control it from your throat or your belly.

That's the difference from the other long-exhale breathings on this site, which go through the nose. Here the lips do the work, which is why many people find it easier when they're winded. Its closest relative is Catching your breath, which uses the same technique at a slower count.

Where it comes from

It comes from respiratory medicine and, before that, from patients themselves. A 2018 historical review reports that doctors first noticed it in people with emphysema, who pursed their lips on their own to ease breathlessness, and that it was recommended as an exercise as early as 1910 and 1925.

Over time it moved into pulmonary rehabilitation programs. According to the same review, in 1997 the American College of Chest Physicians and the American Association of Cardiovascular and Pulmonary Rehabilitation endorsed it as part of pulmonary rehab. Today pulmonary rehabilitation specialists teach it to people with chronic lung diseases such as COPD and asthma, and institutions like the American Lung Association and Cleveland Clinic describe it with the same count as this guide: 2 in, 4 out.

What people use it for

Outside a clinic, it's used mostly to get your rhythm back: after climbing stairs, carrying something heavy or running for the bus. It also shows up in nervous moments, because it gives your mouth something concrete to do and lengthens the exhale without any thinking.

Wind players and singers will recognize the gesture: it's a simple way to feel a steady stream of air. If you have a lung condition, how you use it is for your care team to decide, not this page.

What studies say

Nearly all the research was done with people who have COPD, not with healthy people looking for calm. A 2012 Cochrane review of breathing exercises for COPD pulled together 16 trials with 1,233 participants. In the pursed-lip group, 60 participants, six-minute walking distance improved by about 50 meters; results for breathlessness and quality of life were inconsistent, and the authors caution that the lack of blinding may inflate the reported benefits.

A 2018 review with meta-analysis (Mayer and colleagues) combined eight studies of using it during exercise. It found fewer breaths per minute and less air moved per minute, with no significant difference in walking distance, and concluded that it's still unclear who it helps and who it doesn't.

The usual explanation is mechanical: the resistance at the lips keeps some pressure inside the airways, which stay open longer while the air leaves. For someone without lung disease, what remains is slow breathing with a long exhale, and the evidence that applies is the evidence for that family, which is limited.

What it feels like and what to notice

You feel cool air on your lips and hear a very faint blowing sound. After a few cycles the exhale starts to lengthen by itself and your chest gets quieter. It's normal for your lips to feel a little dry.

If your lips or cheeks get tired, you're pressing too hard. If you feel dizzy or tired, stop and rest. Cleveland Clinic says to get emergency care for sudden or severe shortness of breath or chest pain: that isn't something an exercise handles.

Variations

• Easier, no counting: breathe in through your nose and out through your lips until the air runs out by itself. Just make sure the way out lasts longer than the way in.
• Slower, 3 and 6: breathe in for 3 seconds and out through your lips for 6. On this site, that's Catching your breath.
• With the belly: the American Lung Association teaches belly breathing with this kind of exhale, two to three times as long as the inhale.
• On the move: Cleveland Clinic suggests it during the hardest part of an activity, such as bending, lifting or climbing stairs. Breathe out on the effort.

Common mistakes

• Blowing hard. It's a breath that would make a candle flame flicker, not go out.
• Puffing your cheeks. If they fill up, the opening is too small.
• Breathing in through your mouth between cycles. The way in is always the nose.
• Emptying your lungs to the bottom on every exhale. Four seconds, then breathe in again.
• Trying it for the first time when you're already out of breath. You learn it when calm, so it's ready when you need it.

How often and how long

To get to know it, three minutes once or twice a day is enough. After that, use it when it's called for: at the end of an effort, or during a break.

The guidance for people with lung disease is different, and longer. The American Lung Association talks about 5 to 10 minutes a day, and Cleveland Clinic about several sessions a day until it feels natural. That guidance is followed with direction from your own care provider.

Before you start

• If you feel dizzy, lightheaded or tired, stop and breathe normally.
• If you have COPD, asthma or another lung condition, follow your care team's guidance on when and how to use it. This guide doesn't replace it.
• Sudden or severe shortness of breath, or chest pain, is an emergency: get medical care.
• Don't force the air out and don't hold it. If the count feels long, breathe out without counting.