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Breathing training with the Breathing Trainer for COPD needs to be put in perspective, and the following diagram briefly summarizes some of the major physiologic components.
Breathing training and the Breathing Trainer is only part of the equation in breathing control, though certainly a very important part. It can show you very effectively how to breathe, but no breathing is possible without an effective chest and diaphragm so-called "Bellows" mechanism to make the lungs actually move. All active lung movement is totally dependant on an effective Bellows mechanism to enable more efficient breathing pattern training. It is therefore important you have some understanding of the bellows mechanism. In another module we will describe how the COPD chest becomes deformed into the so-called "Barrel Chest" deformity, the physiologic consequences of this, and how to deal with that problem with chest physiotherapy techniques.
The Bellows mechanism is composed of the "Chest Wall" as noted in the center of the diagram. The Chest Wall in turn has two distinct components, the "Ribs" of the chest, and the "Diaphragm," which is a thin curved muscle between the chest and the abdomen, attached to the lower ribs. The diaphragm is the major driving force of breathing, and in COPD it's function is typically severely compromised, by lung overinflation that pushes the diaphragm downwards into the abdomen, putting it into a position of mechanical inefficiency. It is critically important that diaphragm function be restored as much as possible, in order that you can then effectively use breathing training to learn more efficient breathing patterns.
The breathing pattern parameters are defined in the center of the diagram, by adjusting:
As noted in the small diagram on the right, it is critical the breathing pattern achieve a minimal adequate degree of "Alveolar Ventilation," i.e. the ventilation breath that actually gets down to lung alveoli (air sacks) where gas exchange takes place.
However, as noted in the small diagram on the left, it is also critical that the breathing pattern produce the minimal degree of "Work of Breathing" i.e. a measure of the effort and energy to breathe, as dyspnea is most closely related to the increased Work of Breathing.
It should be apparent that there are conflicting needs involved in developing an optimal breathing pattern, and that balancing these different breathing parameters of adequate Alveolar Ventilation versus minimal Work of Breathing is a delicate task, and one that requires compromises.
Considerable experimental adjustment may be needed to achieve the optimal compromise. I am impressed as to how small adjustments may make substantial differences in patient comfort. The Breathing Trainer is designed to permit very subtle adjustments to permit you to seek out the breathing pattern that is best for you. Another module will go into detail as to how to adjust your Breathing Trainer to make a "Breathing Prescription" individualized for your particular needs.
Be aware there are many therapists who strongly advocate for one or another type of breathing pattern. I would suggest that frequently a strong advocacy position does not take into account the fact that most every breathing parameter adjustment has both positive benefits, and also undesirable negative factors. The trick is to find the optimal balance between these conflicting parameters.
Please do not skip directly to the module on Breathing Trainer adjustment. It is suggested you proceed to the Barrel Chest module, to better understand the underlying problems that must be corrected by chest physiotherapy.
The more you know about these conflicting parameter requirements, the better the results you will achieve in your rehabilitation program.