What is a 'Top Breather'?

This article was reviewed by Senior Director of Community Engagement and COPD360social Community Manager, Bill Clark, as well as certified staff Respiratory Therapists on February 23, 2020.

Dear COPD Coach,
I recently heard the term top breather. What does this mean?

-Breath Question

Dear Breath,
The term top breather is a term that indicates an inability to take deep breaths; breathing in a way that seems to use only the top parts of the lungs. This is somewhat common in people with COPD. It occurs because of hyperinflation of the lungs which does not allow us to expel all the air our lungs are holding.

When our lungs are hyperinflated (over inflated or too large) we are only able to expel a small amount of air, which in turn means that we can only take in smaller amounts of air. The problem with this is that the air in the lungs that remains trapped becomes “stale” and therefore not able to keep up our oxygen levels. Top breathing especially becomes a problem when we get short of breath and breathe rapidly because we’re hungry for air. The other problem with top breathing is that it can result in a retention on CO2 further triggering the feeling that we are short of breath. Because top breathing takes less effort, it is very easy to fall into doing it regularly which in turn causes problems with our oxygenation.

Pursed Lips It is very important for a person with COPD to practice breathing techniques to optimize the amount of oxygen our injured lungs are able to process. Some of these techniques might be familiar to you, but always worth mentioning. Be advised that the following is for information only. Always consult your healthcare professional before starting any new technique or exercise.

  • When you first start feeling that you are becoming short of breath, begin pursed lips breathing. The technique for pursed lips breathing is while sitting in a comfortable position inhale as deeply as you can through your nose. Put your lips in a position like you would to whistle, then blow the air out slowly for about twice as long as it took to breathe in. A good rule of thumb is to breathe in for two counts and out for four counts. Never force your air out when you exhale, just keep your lips together and let it go. This technique will allow you to slow down your breathing as well as allowing the lungs time to process the oxygen. This technique should be used throughout the day even if you are not feeling short of breath. I do it a lot when I am watching TV or just relaxing, and I immediately notice improved oxygen.
  • A second exercise is diaphragmatic breathing. This is an exercise you should do at least 3 times a day and will help strengthen the diaphragm resulting in better function. The exercise is accomplished by lying on your back. Your knees should be bent with one hand placed on your abdomen and the other on your chest. Inhale and exhale as deeply as you can while keeping your chest still, using the stomach to breathe. The important thing is to not allow ourselves to get into rapid breathing because with COPD that means that we are top breathing. In most cases just makes the shortness of breath worse. Make a conscious effort to slow your breathing down before we actually get short of breath. Utilizing the pursed lips breathing technique when exercising or exerting will result is better performance and less shortness of breath.

I hope this answers your question.

Best regards,
The COPD Coach

Ask the Expert is aimed at providing information for individuals with COPD to take to your doctor, and is not in any way intended to be medical advice. If you would like to submit a question to the Coaches Corner email us at coachescorner@copdfoundation.org. We would love to hear your questions and comments. You can address your emails to The COPD Coach.


You need to login to comment.
  • I too am a top breather or mouth breather. Due to a flat diaphram. I have had very severe COPD for years now. I've been going to pulmonary rehab for 3 years and it's helped with baby steps. Recently joined a gym to build up muscle and prevent excessive bone loss.
    My CO2 levels in my blood have always registered high. My doctor told me nothing could be done about this due to my condition. Well guess what? After a month at a gym, utilized their equiptment and purse lip breathing my CO2 levels are within normal range. Plus benefiting all the other pre diabetes conditions. Moving to sea level has also helped.
    Just wanted some to know that it does work. You have to work it though. In the beginning I could not even walk while talking. I am doing so much better and just wanted to share my excitement about the progress. Keep on keeping on and you too can do better. Don't ever let anybody tell you that you can't. good luck I am on oxygen 24/7 and carry it around in a backpack so I can pretty much go wherever I want. The portables do not put out enough air for me so I have to use a cannister.
    • @valiejean ~ I am inspired by your post. I'm on that grief, depression, anger roller coaster right now. I also am on oxygen 24/7 and use portable canisters. Just going to the grocery store is a challenge. Hard to exercise when it hurts to breath. . . it's seems like a vicious cycle. I swear I'm going to do better. I'm not going down without a fight!! : ) Thanks again for a great post.
    • Hi Valiejean ...... All we need is common sense and you seem to have it in abundance by moving down to sea level where oxygen is more plentiful. I had serious CO2 retention last year and could not raise my O2 above 69%.... I spent 12 days in hospital on a Non Invasive Vent [NIV] which cleaned my blood ..... it seemed to lower the CO2 in my arterial blood [ABG] .... I now use a small NIV machine regularly of a night time for an hour or so 3 or 4 nights a week to keep CO2 down in my blood to make room for more oxygen. I now only use low levels of O2 during the day at 1 l/m constant [2 l/m when exercising] and just HALF L/M during the night when asleep .... or no O2 when on the machine which pumps extra ROOM AIR into my lungs mechanically as my lungs cannot deep breathe .... I am stage 4 COPD and will not let it beat me...... COPD WILL NOT KILL >>> NEGLIGENCE WILL .... so we must all look after ourselves as best we can and inform others of our particular needs and how we deal with them to stay alive and positive.... keep on fighting its the only way to live! :-)
  • I too am a top breather, didn't know this until I read the description. I am having a hard time getting the proper medical treatment, I don't know who to go to or the proper questions to ask. My last pulmonary function test showed restrictive and obstructive lung disease, this report only gave me more questions. Any help would be greatly appreciated .
    • I suggest that you go see a good pulmonologist. I would ask them about medications that might make breathing a little easier for you.

      Make sure you bring all your medications with you. I like the idea of bringing them rather than writing them down this way if there are any questions you have them right there.

      That would be my step 1.
    • I agree clipper..... EZELLA you could ALSO print a copy of this entire article with all the comments and give to your pulmo who will hopefully understand your concerns a little better..... maybe email a copy even to your doctor.
      Do you know what your FEV1 reading was when last checked as that is the best guide to establish your stage in the long road down the COPD trail.... OK?
  • Thank you so much for posting this information. It is most helpful! Cheers, Loukat
  • I have been diagnosed with COPD about 6 years ago. In the last year I have been hyperventilating and it was causing extreme anxiety. I read where a buildup of co2 was not good and was causing my breathlessness and other symptoms. So I asked my doctor to write out a prescription for a oxygen concentrator. In the meantime I searched the internet for how to get rid of excess co2 and what I found was amazing!! First I have to tell you I ordered the concentrator but kept reading about co2. That was over 2 months ago and I have never used the concentrator. What I found on the net was I didn't have a problem with oxygen but I wasn't utilizing the co2 in a way the body needed it. My oxygen level was about 93. To make a long story short I have very little anxiety my oxygen level has went up to 94 and I am walking a mile a day. I take it slow with the walking and listen to my breathing. What I found on line was the BUTEYKO method of breathing. What they said that we are overbreathing and our co2 level is to low and that to build it up and get it to go into our blood cells we had to shut our mouth and start breathing out of our nose where all the good stuff happens. I suggest you Google it and find out if maybe it would be right for you. I am not going to argue with success.
  • I believed that I understood PLB as Coach describes it above, but in Pulmo Rehab they used the words "slight back-pressure" upon exhale. This is just a sanity check of what I was told, but seemed to help me zero in on what I seemed to be doing wrong with PLB.

    I found that my PLB exhale was probably too soft or shallow and told that it could cause Co2 retention. That is when she (RT) said "you need a slight back-pressure" (like cooling soup - NOT blowing out a candle). Breathing out too fast causes me to be lightheaded.

    Still catch myself almost panting through my mouth if I am not focused on PLB. It is nearly the opposite f how I have breathed most of my adult life. Granted I have very high anxiety (or possibly ADD) that may put me back into panting mode.

    Don't we all retain more CO2 than people without COPD to some extent?

    The other thing related to PLB that I am still re-training my mind and body is to EXHALE on exertion - like from sit to stand, or lifting things, etc. My natural instinct is to hold my breath to exert. So still practicing, focusing and re-training myself to exhale during these activities.