In January 2011, a group of Iranian researchers reported that study participants with COPD (chronic obstructive pulmonary disease) who engaged in a regimen of three breathing technique exercises four times a day over a ten-day period experienced an average 27% reduction in fatigue intensity. 
While this particular study focused on assessing the use of breathing technique training specifically for COPD patients, we believe the findings are applicable to anyone who is concerned about persistent shortness of breath.
In introducing their study findings, the researchers set the stage by noting, “Two significant symptoms of COPD frequently complained by the patients are dyspnea (shortness of breath) and fatigue. Any patient who feels tired for more than one month is considered as affected by chronic fatigue. Chronic fatigue is [an] important and common sensation in patients with COPD that interferes with the quality of life but [is] almost neglected. As the disease advances, hard breathing followed by dyspnea and increasing limitation of the patient’s ability to perform daily activities are worsened, and even for doing simple work during the day, the patient gets out of breath and is affected with early fatigue …
“Respiratory exercises such as lip-pursing (pursed-lips breathing) or diaphragm respiration (diaphragmatic breathing), are considered as a part of pulmonary rehabilitation programs, which could lead to an improvement in gas exchange, exercise tolerance and quality of life. The goal of respiratory exercises in patients with COPD is for the patients to replace their ineffective respiratory techniques with effective ones and to discharge the lungs from secretions through deep respiratory exercises and effective coughing.”
In other words, the study team speculated that employing breathing techniques that help re-train COPD patients to breathe more deeply and at a slower speed would reduce the sensation of fatigue and enable the patients to participate in more activities and thereby enjoy a higher quality of life.
In our opinion, this approach can be extended to others who experience notable shortness of breath but who don’t have lung disease. For example, pursed-lips breathing is a technique employed to help push out used air that is trapped in the lungs and allow more fresh air to be inhaled. While COPD patients are taught this technique to address the sensation of breathlessness, it is also a technique employed by world-class athletes engaged in intense competitive activities that demand peak cardiovascular function.
As another example, diaphragmatic breathing helps COPD patients retrain their abdominal muscles to engage their diaphragm more prominently with each breath. You see, the diaphragm is intended to be a muscular ally in the breathing process, but when we become inactive and/or gain significant abdominal weight our diaphragm muscles weaken. COPD patients typically become highly sedentary and as a result experience significant muscle weakening. This makes the lungs work harder than they should, which heightens the sensation of fatigue, shortness of breath and anxiety (i.e. it feels they have to work so hard to inhale and exhale even when resting). The same phenomenon occurs in those who live primarily a sedentary lifestyle and/or have “pot” bellies. The diaphragmatic breathing technique can be helpful in strengthening the diaphragm and other abdominal muscles thereby taking some of the stress off the lungs to inhale and exhale in these circumstances as well.
Getting back to the study results, a total of 60 COPD patients participated (30 in the breathing exercise group and 30 in the control group). Both groups completed a “fatigue severity scale” survey upon enrollment. Then the breathing exercise group received instruction in three respiratory exercise techniques (pursed-lips breathing, diaphragmatic breathing and “effective coughing” — the technique for effective coughing was not identified in the study but was most likely the Huff Cough technique taught in many pulmonary rehab programs).
After the COPD patients in the breathing exercise group received instruction and supervision of the proper breathing and coughing techniques, they were asked to practice these techniques 4 times a day for 10 consecutive days. The control group did not receive the breathing/coughing training and were not instructed to utilize such techniques over the same 10-day period. After the 10-day study period, both groups again completed the fatigue survey, and the researchers compared the pre- and post-results within and across each group.
For such a short duration of breathing/coughing technique training, the breathing exercise group recorded significant improvements. For example, at the outset of the study 27 of the 30 COPD patients indicated their fatigue was “severe” (the highest level on the survey), while 3 rated their fatigue as “moderate.” At the end of the study, only 16 reported their fatigue as severe (a 41% drop in the number of COPD patients who considered their fatigue severe), 11 indicated their fatigue was moderate, and 3 reported their fatigue as mild. On average, the breathing exercise group demonstrated a 27% improvement in perceived fatigue.
The control group barely moved in their fatigue perceptions. At the outset of the study, 27 of the 30 COPD patients reported their fatigue as severe. At the end of the study, 26 still perceived their fatigue intensity as severe.
These are pretty remarkable findings especially considering the study was only 10 days in duration and did NOT involve the core regimen of physical exercise typically offered in a pulmonary rehabilitation program. The only element of pulmonary rehab used in the study was the training and application of breathing and coughing techniques.
The study authors concluded, “Results of the present research showed a reduction in the fatigue intensity among COPD patients under interference as well as a meaningful reverse relationship between the fatigue intensity and the rate of respiratory exercises. In other words, the higher the rate of respiratory exercise applied, the less the fatigue intensity among the samples under interference. The present research also showed that it was the change of respiratory pattern that caused the reduction of fatigue intensity in COPD patients. Patients with COPD have a shallow, fast and insufficient breathing. Through exercises, this type of respiration has improved to diaphragm respiration in which the breathing speed is reduced leading to an increase of alembic aeration. By lip-pursing respiration also, the breathing depth is increased in patients.
“Training of respiratory exercises through face to face procedure while implementing treatment procedures may have significant effects on controlling and improving the symptoms, raising the level of awareness and finally, upgrading their quality of life.”
If you are unfamiliar with pursed-lips breathing, diaphragmatic breathing or the huff cough techniques, consider making an appointment with your physician to learn and practice the techniques.
 Zakerimoghadam, M et al. The effect of breathing exercises on the fatigue levels of patients with chronic obstructive pulmonary disease. Acta Medica Indonesia. January 2011;43(1):29-33.