What is a "Top Breather"?

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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 any of the following: COPD Coach, Caregiver Coach, COPD Doctor or COPD RT.


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  • 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.
  • 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.

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