Chronic Obstructive Pulmonary Disease (COPD) is a progressive condition that significantly limits airflow in the lungs, making breathing a persistent challenge. This difficulty often stems from airway blockage and the loss of lung elasticity, which traps air and causes the lungs to become hyperinflated. Finding effective ways to reduce the effort of breathing is a daily concern for people with COPD. Proper body positioning is a non-pharmacological strategy that can help maximize lung capacity, reduce the work needed to breathe, and improve overall comfort.
Optimizing Seated Positions for Easier Breathing
When a person with COPD is awake and seated, specific positioning can dramatically improve the efficiency of the breathing muscles. The goal is to stabilize the upper body so that the smaller accessory muscles of respiration can assist the diaphragm more effectively, mechanically opening the chest cavity for greater lung expansion.
The “tripod position” is a widely recognized and often instinctively adopted posture during breathlessness. To perform this, a person sits in a chair with their feet flat on the floor and leans the trunk forward slightly. They then place their elbows or forearms on their knees or on a sturdy surface, such as an overbed table, to brace themselves.
This forward-leaning posture allows the diaphragm to move downward more easily, which is crucial because the diaphragm in people with COPD can be flattened due to air trapping. By fixing the shoulder girdle, accessory muscles like the pectoralis muscles can lift the chest wall, increasing the volume within the thoracic cavity. Using a table for support allows the shoulders and arms to relax, focusing on respiratory muscle function. When simply sitting upright, avoiding slumping is important, as a collapsed posture compresses the chest and abdomen.
Best Practices for Sleeping and Resting Positions
Extended periods of rest or sleep require positioning that minimizes compression on the lungs and prevents the diaphragm from being restricted. Lying flat on the back (supine position) is often poorly tolerated because gravity forces the abdominal organs to push upward against the diaphragm.
The Semi-Fowler’s position is highly recommended for resting and sleeping, involving elevating the head and upper body to an angle between 30 and 45 degrees. This incline uses gravity to draw the abdominal contents away from the diaphragm, allowing the primary breathing muscle to descend more fully during inhalation. This elevated position can significantly improve oxygen saturation levels by facilitating better lung expansion.
For those who prefer lying on their side, a lateral position can be beneficial, particularly for promoting the clearance of mucus and fluids from the lungs. The head of the bed should still be elevated, and multiple pillows should be used for support. A pillow under the head and neck helps maintain spinal alignment, while another placed between the knees prevents the spine from twisting and keeps the chest cavity open.
Supporting the arms and back with pillows prevents the body from slouching or rolling into a position that restricts breathing. Proper support prevents the chest wall from collapsing inward, which would otherwise strain the accessory muscles. The goal is to maintain an open, relaxed chest to minimize the work of breathing throughout the night.
Acute Relief Positions During Breathlessness
When an episode of acute shortness of breath (dyspnea) occurs, adopting a specific “rescue” position can provide immediate, temporary relief. These maneuvers are designed to be adopted quickly to stabilize the body and recruit every available muscle for breathing.
One effective strategy is standing and leaning against a wall, with feet shoulder-width apart to provide a stable base. This posture allows the shoulders to relax and provides a brace for the chest muscles. Alternatively, standing and leaning forward, resting the forearms or hands on a sturdy object like a dresser, kitchen counter, or shopping cart, achieves a similar bracing effect.
If a chair is available, sitting and leaning over a table is an excellent rescue position. The person should sit close to the table, place a few pillows on the surface, and lean forward, resting their head or forearms on the pillows. This move stabilizes the upper body and allows the strong chest muscles to assist the flattened diaphragm.
Remaining calm during these acute episodes is important, as panic can worsen the sensation of breathlessness. Combining these relief positions with pursed-lip breathing can further aid recovery. Pursed-lip breathing involves inhaling slowly through the nose and then exhaling slowly through pursed lips, which helps keep the airways open longer and allows more trapped air to escape from the lungs.