I'm a Respiratory Therapist. Here Are the Breathing Exercises I Teach My Patients With Lung Cancer

By Mark Courtney, RRT, as told to Hallie Levine

Mark Courtney, RRT, has been a respiratory therapist for over four decades. He worked with hospitalized patients with lung cancer for 25 years and now serves as a manager at the HelpLine for the American Lung Association, where he counsels people with lung cancer. Here, he shares the most common breathing exercises he teaches his patients with lung cancer.

Shortness of breath is common with lung cancer. The tumor itself can block your airways. Fluid can collect around your lungs and heart, which makes it harder for your lungs to expand fully. You also may have stress and anxiety, causing you to take fast, shallow breaths.

One of the best ways to manage this is through breathing exercises. Just like aerobic exercise strengthens your heart, and resistance training strengthens your muscles, breathing exercises strengthen your lungs and make them more efficient.

You probably never thought about breathing before you were diagnosed with lung cancer. It’s something that seems to occur automatically. But when you develop a chronic lung condition, it’s something that you have to relearn.

When you have lung cancer, you often need treatments such as surgery, radiation, and chemotherapy. All of these can affect lung function. Your lungs may lose some of their “springiness,” causing them to work less efficiently. Stale air gets trapped, which means there’s less room for fresh oxygen. The muscles of your diaphragm may also be weaker, making it harder for them to bring in fresh air.

When you do regular breathing exercises, you help your lungs get rid of built-up stale air and increase oxygen levels. They also help reduce any stress and anxiety you may feel about your lung cancer diagnosis.

I recommend that you initially do these breathing exercises under the guidance of a trained respiratory therapist. These exercises may seem easy, but they take some time to master. You don’t want to first try them when you are short of breath. A therapist can make sure that you are breathing fine and guide you through them to make sure you are doing them correctly. They can also modify the exercises if necessary.

Once you’ve done them a few times with a respiratory therapist, you can try them on your own at home. I recommend that you practice them, especially the first two, for 5-10 minutes every day. Other ones you can do as needed, or when you feel particularly stressed or anxious.

This exercise is good to do whenever you feel short of breath. It slows down your breathing rate, helping you bring in more oxygen and expel more carbon dioxide. This keeps your airways open longer so that more air is able to flow in and out of your lungs. It’s very easy to do. You simply breathe in through your nose and breathe out at least twice as long through your mouth, with pursed lips.

Step by step

  • Sit in a chair and relax your neck and shoulder muscles.
  • Breathe in slowly through your nose with your mouth closed. If it’s helpful, you can silently count to two.
  • Purse your lips, like you are going to whistle or blow out a candle.
  • Breathe out all of the air in your lungs through your pursed lips, slowly, for a count of four.
  • Repeat this exercise until your breathing becomes normal.

Modifications

If this exercise is hard for you to do, you can try it with a flutter valve. This is a respiratory tool that adds vibration to help you clear mucus from your lungs. To use it, you inhale through your nose, then exhale into the device. After about 10 repetitions, you should be able to cough and get rid of some of that extra mucus.

Diaphragmatic breathing, also called belly breathing, helps you deal with shortness of breath. It helps slow down your breathing, so you can catch your breath and use less energy. It also helps get more oxygen into your lungs, making you feel calmer. This will also help you better control your breath.

Step by step

  • Lie down with your hands on your belly.
  • Take a slow, deep breath through your nose. As you breathe in, your belly should fill with air like a balloon.
  • Blow air out slowly through pursed lips, like you are blowing bubbles. 
  • Keep your hands on your belly. It will help you focus on the air going in and out.
  • Repeat for 5-10 minutes. 

Modifications

Belly breathing works best if you lie on your back, but if you can’t tolerate that, then sit in a comfortable chair. If you want to step it up a notch, place a sandbag or small weight on your upper abdomen, just above your rib cage. This will strengthen your diaphragm muscle even more, so you can better control your breathing.

Box breathing, also known as 4x4 breathing, can help you manage stress. It helps to clear your mind, so you can simply focus on your breathing. It’s called box breathing because, just like a box with four sides, the technique involves slowly counting to four during four phases of breathing.

Box breathing is a form of mindfulness breathing that helps relax you and ease stress. It also activates your parasympathetic nervous system, which is the part of your nervous system that allows you to “rest and digest.” When you’re stressed, you breathe shallowly and quickly, which can make you even more anxious. Box breathing helps to move you out of that state, so you can breathe more comfortably.

Step by step

  • Breathe in through your nose as you slowly, silently count to four.
  • Hold your breath for a count of four.
  • Exhale for a count of four.
  • Hold your breath again for a count of four.
  • Repeat three to four times, or until you feel calmer.

Modifications

If it’s too hard for you to inhale or exhale for a count of four, start with just a count of two, then gradually work your way up.

This is a breathing technique that helps you force mucus up your throat and out of your lungs. We use it a lot in patients with lung cancer, after they’ve had surgery, to help clear out their airways and prevent pneumonia. A huff cough is different from a regular cough: it has more force to carry mucus up and out of your airways. There’s a lot of emphasis on breath and control. It’s like when you try to fog up a mirror: you take small, forceful exhales, rather than large coughs.

Step by step

  • Sit on a chair, tilt your chin up slightly, and open your mouth.
  • Take a slow and deep breath and hold it for two to three seconds.
  • Exhale slowly but forcefully (this is the “huff” part of huff coughing) once or twice.
  • Repeat the whole exercise two to three times.

Modifications

If it hurts too much to do huff coughing, ask your health care provider if you can take pain medication beforehand. If you use a bronchodilator, time your dose so that you do huff coughing right afterward. This will make it easier to get rid of mucus in your lungs.

This is another breathing exercise we recommend here at the American Lung Association to help ease stress and anxiety. It’s a simple breathwork technique you can do anytime, anywhere. It’s a double inhale followed by a single exhalation. That may not sound like a big deal, but it can do a lot to calm your nervous system. You can do it whenever you feel overwhelmed or anxious. 

Step by step

  • While you sit or stand, take a long, deep inhale through your nose.
  • Without exhaling, take a second, shorter inhale.
  • Slowly exhale through your mouth.
  • Repeat once or twice.

Modifications

You can do this exercise while you sit, stand, walk, or lie down. Whatever feels most comfortable for you.

Here’s some other advice I give to my patients:

Breathe through your nose as much as possible. When you are short of breath, your instinct is to breathe in and out through your mouth. But breathing through your nose is easier because it naturally filters and humidifies air for you. Use saline sprays during the winter to help keep your nasal passages open.

Move around as much as you can. I know it’s tough if you’ve just had surgery or if you are often short of breath. But physical activity can help reduce symptoms such as shortness of breath. Even something as simple as a short walk up and down the hallway helps.

Sleep propped up. When you lie flat, mucus can collect in your lungs and make it harder for you to breathe. Raise your head and upper body with a wedge pillow, or stack two or three firm pillows, which will help keep your airways open.

Stay hydrated. Your lungs depend on water to help them push impurities out of your airways. You can also get dehydrated with lung cancer treatments such as chemotherapy. Keep a water bottle near you and take small sips throughout the day, to make sure you get enough.

Don’t rely on humidifiers. Some patients with lung cancer use them to help them clear mucus, especially when the room air is dry during the winter. But they can be hard to keep clean, and encourage mold growth. I recommend that you avoid them, and if you do use one, buy a hydrometer to make sure home humidity levels don’t go above 50%. 

Get support. As a respiratory therapist, I can help you find ways to breathe better. But it’s important to connect with other people who have been in your shoes. That’s why I recommend all my patients join a support group. One good one is Inspire, an online community run by the American Lung Association. You can connect with over 100,000 folks who are happy to share their experiences and offer advice.

Add WebMD as a Preferred Source to see more of our trusted content across Google Search, AI Overviews, and AI Mode