Pursed-Lip Breathing
Pursed-Lip Breathing is a breathwork practice studied mainly in relation to respiratory function and respiratory health. Research also considers possible effects beyond this central area, but those uses are less firmly supported overall.
Pursed-Lip Breathing is a breathwork practice examined for its relationship to respiratory health and lung capacity.
Part of Breathwork
Overview
Pursed-Lip Breathing is a breathwork practice studied mainly in relation to respiratory function and respiratory health. Research also considers possible effects beyond this central area, but those uses are less firmly supported overall. The evidence base includes pooled research and clinical studies, yet support is not equally settled across all proposed outcomes. This means the body of research can inform understanding of the practice without establishing that it reliably produces every potential benefit. It is best understood as a breathing practice with a research focus on respiratory health, rather than as an all-purpose wellness intervention.
Well researched: 23 studies. Last checked Oct 9, 2026.
- 9
- human evidence
- 5
- eligible
- 7
- unclassified
- 1
- animal / null result
Best-evidenced uses
- Physical Endurance IncreaseMedium · Meta-analysis
- Respiratory Health SupportMedium · Meta-analysis
- Lung Capacity ImprovementMedium · Clinical
- 23
- Studies
Evidence checked Oct 9, 2026 · newest study 2025
- A
- 2
- B
- 1
- C
- 20
15 community reports across 2 platforms
Coverage
- Effects
- 14
- Helps with
- 8
- Interactions
- 5
How to read the evidence
Evidence tier — overall strength of the evidence for the whole compound
- StrongWell established — backed by strong, consistent human research.
- ModerateSome genuine support, but mostly from small or lower-quality studies. Promising, not proven.
- PreliminaryEarly-stage evidence — a promising hypothesis, not an established effect yet.
- LimitedVery limited evidence — treat this as a hypothesis, not proof.
- InsufficientNot enough good evidence to draw conclusions yet.
Certainty — how sure we can be that the effect is real
- Very highVery sure — strong, consistent evidence
- HighFairly sure — consistent evidence from good studies
- MediumModerately sure — new studies could change this
- LowNot sure — little or mixed evidence
- Very lowVery unsure — almost no usable evidence
Source — where the data comes from
- Meta-analysisPooled analysis of many trials — the strongest evidence
- RCTRandomized controlled trial — a strong human study design
- ClinicalA human clinical study
- Reference knowledgeFrom general health-science or pharmacology references, not a study of this exact claim
- Animal researchStudied in animals, not humans
- Community reportsAggregated user reports — anecdotal signal, not evidence
- TheoreticalMechanism-based reasoning, not yet tested
Study grade — quality of each underlying study (A best, D weakest)
- AHigh-quality — strong, consistent human trials
- BGood — solid evidence with some limitations
- CModerate — limited, small, or mixed-quality studies
- DWeak — preliminary, indirect, or animal-only
Confidence — how strongly the sources back a finding
A 0–100 score from study quality and agreement
Most supplement evidence is graded C–D. Read it as preliminary signal, not proof.
These are research findings, not promises. A practice does not replace medical treatment.
What does research say?
What studies found for each claimed effect, best evidence first.
14 claims:2 some evidence1 mixed6 not enough evidence4 not tested in people1 personal stories only
Physical Endurance IncreaseBreathwork in general: Medium · 14 trialsSome evidence it helpsSize of effect: Not known
Some human studies found a benefit. More research could change this.
5 of 6 studies found a benefit; 1 found none. Strongest study: a pooled analysis of several trials.
A pooled analysis of randomized trials found improved functional exercise capacity in people with COPD after breathing exercises lasting four to 15 weeks, compared with no intervention. Another pooled analysis reported a 6-min walk test distance mean difference of 29.09; the unit was not stated in the abstract.
Open the Physical Endurance Increase pageCompare with Breathwork in general →Lung Capacity ImprovementBreathwork in general: Medium · 22 trialsSome evidence it helpsSize of effect: Not known
Some human studies found a benefit. More research could change this.
5 of 6 studies found a benefit; 1 found none. Strongest study: a randomized controlled trial. A trial found it after a single session.
In a randomized trial of 39 healthy people and people with COPD, tidal volume was larger during breathing exercises than during quiet tidal breathing. A separate trial of 54 people reported increases in forced vital capacity, forced expiratory volume in one second, and maximal inspiratory pressure.
Open the Lung Capacity Improvement pageCompare with Breathwork in general →Respiratory Health SupportBreathwork in general: Medium · 41 trialsMixed resultsSize of effect: Small
Studies disagree: some found a benefit, others found none. Do not count on it.
11 of 13 studies found a benefit; 2 found none. Strongest study: a pooled analysis of several trials.
A pooled analysis of randomized trials involving 1,098 people found a small improvement in forced expiratory volume in 1 s. Results for breathlessness and health-related quality of life have been inconsistent across trials, so improvements in these areas are not established consistently.
Open the Respiratory Health Support pageCompare with Breathwork in general →Blood Pressure SupportBreathwork in general: Medium · 11 trialsNot enough evidence
Too few or too small studies to know if it works.
The one study found a benefit. Strongest study: a randomized controlled trial.
An RCT in 110 people with hypertension reported a mean systolic blood-pressure difference of 9.80 mm Hg.
Open the Blood Pressure Support pageCompare with Breathwork in general →Fatigue ReductionBreathwork in general: Medium · 8 trialsNot enough evidence
Too few or too small studies to know if it works.
2 of 5 studies found a benefit; 3 found none. Strongest study: a randomized controlled trial.
Open the Fatigue Reduction pageCompare with Breathwork in general →Sleep Quality ImprovementBreathwork in general: Medium · 13 trialsNot enough evidence
Too few or too small studies to know if it works.
The one study found a benefit. Strongest study: a randomized controlled trial.
A randomized trial involving 60 people with COPD reported improved sleep quality in both groups, with a greater effect in the first group than the second.
Open the Sleep Quality Improvement pageCompare with Breathwork in general →Improve Heart Rate Variability (HRV)Breathwork in general: Medium · 10 trialsNot enough evidence
Too few or too small studies to know if it works.
All 2 studies with a clear result found a benefit. Strongest study: a non-randomized trial.
A 2014 quasi-experimental study in 32 people with COPD found increases in the SD1, SD2, RMSSD and LF (ms(2)) indices after Pursed-Lip Breathing.
Open the Improve Heart Rate Variability (HRV) pageCompare with Breathwork in general →Antidepressant EffectBreathwork in general: Medium · 16 trialsNot enough evidence
Too few or too small studies to know if it works.
The one study found a benefit. Strongest study: a non-randomized trial.
In a quasi-experimental study of 39 people with COVID-19, the experimental group had greater reductions in HADS scores from admission to discharge than the control group.
Open the Antidepressant Effect pageCompare with Breathwork in general →
What to expect
After a single session, respiratory-health support and lung-capacity improvement have been reported. In trials finding respiratory-health support, the shortest programme ran 4 weeks and the median programme ran 8 weeks. One follow-up found this benefit had faded fully by 6 months after discharge; these study timelines do not guarantee an individual response or its timing.
Also studied in people with 8 health conditions
How strong the evidence is in each group. This is research, not a treatment recommendation.
Hypertension (High Blood Pressure)Breathwork in general: Medium · 8 trialsNot enough evidence
Too few or too small studies to know if it works.
The one study found a benefit.
A 2021 randomized controlled trial in 110 people with Hypertension found reductions in systolic blood pressure, diastolic blood pressure, and heart rate compared with usual care; the size of these reductions is not stated here.
Open the Hypertension (High Blood Pressure) pageCompare with Breathwork in general →COVID-19Breathwork in general: High · 3 trialsNot enough evidence
Too few or too small studies to know if it works.
The one study found a benefit.
A 2025 quasi-experimental study in 39 hospitalized people with COVID-19 found short-term improvements in breathlessness, respiratory symptoms, and mental health at discharge.
Open the COVID-19 pageCompare with Breathwork in general →Sleep ApneaBreathwork in general: Medium · 3 trialsNot enough evidence
Too few or too small studies to know if it works.
The one study found a benefit.
A 2022 randomized controlled trial evaluated breathing exercises for daytime sleepiness and fatigue in people with obstructive sleep apnea syndrome.
Open the Sleep Apnea pageCompare with Breathwork in general →Post-Surgery RecoveryNot enough evidence
Too few or too small studies to know if it works.
The one study found a benefit.
A 2025 quasi-experimental study in 60 post-bronchoscopy patients reported improved recovery parameters in the group receiving Pursed-Lip Breathing exercises.
Open the Post-Surgery Recovery pageTuberculosisBreathwork in general: 2 trialsNot enough evidence
Too few or too small studies to know if it works.
The one study found a benefit.
A 2024 randomized controlled trial in 54 people with Tuberculosis found reduced fatigue on the Piper Fatigue Scale after 4 weeks of breathing exercises.
Open the Tuberculosis pageCompare with Breathwork in general →StrokeNot enough evidence
Too few or too small studies to know if it works.
The one study found a benefit.
A 2017 randomized controlled trial in 30 people with Stroke found that 4 weeks of combined Diaphragmatic Breathing and Pursed-Lip Breathing increased respiratory muscle activation on the paretic side.
Open the Stroke pageGeneralized Anxiety DisorderBreathwork in general: Not rated, mixed results (1 trial)Not tested in people
Only tested in animals, cells or theory. Results like these often do not carry over to people.
The one study found a benefit.
Breathing exercises are used in cognitive-behavioral interventions for anxiety to reduce hyperventilation and promote autonomic balance.
Open the Generalized Anxiety Disorder pageCompare with Breathwork in general →AsthmaNot tested in people
Only tested in animals, cells or theory. Results like these often do not carry over to people.
The one study found a benefit.
Expert guidance describes breathing exercises as a non-drug technique for managing acute airway narrowing and reducing rescue inhaler use.
Open the Asthma page
Studied only as breathwork in general, not tested in pursed-lip breathing yet
These results come from studies of breathwork as a whole. No study of pursed-lip breathing has looked at them yet.
COPD (Chronic Obstructive Pulmonary Disease) (Medium · 19 trials) · Analgesic Effect (Medium · 15 trials) · Stress Resilience Improvement (Medium · 12 trials) · Lung Cancer (High · 8 trials) · Anxiety Disorder (General) (Medium · 7 trials) · Physical Strength Increase (Low · 6 trials) · and 16 more
Before you try it
What studies and reports say about side effects and who it may not suit.
- May not suit you if you have
- Recent Heart Attack (MI)
- Reported by users
- Dry Mouth and Hyperventilation
- Also listed for breathwork in general (written by our reviewers)
- Aortic Aneurysm · Epilepsy · Pheochromocytoma · Recent Stroke · Bipolar Mania · Psychosis · Unstable Heart Disease (Unstable Angina / Decompensated Heart Failure)Precautions from the Breathwork page. They are for breathwork as a whole and may not all fit pursed-lip breathing.
General wellness information, not medical advice. Ask a doctor before you start, especially if you take medicines or have a health condition.
How people do it
A gentle start, then what the studies used.
- Start with
- 1 minute (Pursed Lip Breathing in Forward Lean Position)A gentle start based on the easiest variation, not on a study.
- What the studies ran
- 4 weeks
- Longest session studied
- 15 minutes (Standard Pursed Lip Breathing)Not a target and not a safe limit: past it there is no evidence either way.
The expert view shows every study, dose protocol and source.
Effects
14 listedStart here
Most likely to help, from the evidence we have
- →Physical Endurance IncreaseCertaintyMediumSourceMeta-analysis5 cited studies · 1 other source
A pooled analysis of randomized trials found improved functional exercise capacity in people with COPD after breathing exercises lasting four to 15 weeks, compared with no intervention. Another pooled analysis reported a 6-min walk test distance mean difference of 29.09 (95% CI = 19.35-38.83); the unit was not stated in the abstract.
What the sources found
5 positive · 1 neutral · 0 negativeconfidence 54/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- Copd
Where the evidence comes from
- Article5
- Expert opinion1
Open Physical Endurance IncreaseShow studies (6)
Meta-analysisApositiven=123355% confidence2012Breathing exercises for chronic obstructive pulmonary disease.
Breathing exercises over four to 15 weeks improve functional exercise capacity in people with COPD compared to no intervention
Top journalPooled RCTsMain outcomeOpen-labelInactive controlMeta-analysisApositiven=109870% confidence20226-min walk test (6MWT) distance (MD = 29.09, 95% CI = 19.35-38.83, P
MD 29.09 [19.35, 38.83]Pooled RCTsRCTCpositiven=8050% confidence2021clinical outcomes were evaluated by ... the 6-minute walking test (6MWT) results ... significant enhancement in the clinical variables
Main outcomeOpen-labelInactive controlRCTCpositiven=4055% confidence2015Pursed lip breathing improves exercise tolerance in COPD: a randomized crossover study.
The nine patients who increased their endurance time by more than 25% during PLB (6.42 ± 2.36 vs. 10.51 ± 3.83 min; P
MD 4.09Top journalMain outcomeOpen-labelNo control groupRCTCneutraln=3545% confidence2019Acute exposure to PLB did not improve exertional dyspnea, walking distance, or gas exchange.
Main outcomeOpen-labelNo control groupExpert opinionpositive50% confidencePursed-lip breathing improves exercise tolerance by reducing dynamic hyperinflation and dyspnea, allowing patients to sustain physical activity longer.
Expert knowledge synthesis - →Respiratory Health SupportCertaintyMediumSourceMeta-analysisSmall effectconflicting findings12 cited studies · 1 other source
A pooled analysis of randomized trials involving 1,098 people found a small improvement in forced expiratory volume in 1 s. Results for breathlessness and health-related quality of life have been inconsistent across trials, so improvements in these areas are not established consistently.
What the sources found
11 positive · 2 neutral · 0 negativeconfidence 52/100
How big is the effect
Small effectA small but noticeable difference on average.
Who was studied
- Healthy people and patients
- Copd
- COVID-19
Where the evidence comes from
- Article12
- Expert opinion1
Protocol behind this outcome
3 protocolsMeasuredWhat the studies reporting this result did.
10 min
- Intensity
- Low
- Format
- Individual
- Supervision
- Instructor-led
Courses and single sessions · 2 repeated-course and 1 single-session protocols
What worked in trials2 trials and meta-analyses
Randomized trials and meta-analyses that found this benefit: the smallest and the typical amount. Not a target and not a limit.
Smallest Typical How often 3×/week 8.5×/week Timing
A trial found it after a single session
Trials that found it ran as little as 4 weeks, typically 8
After stopping, the benefit faded (1 study) · See “When you stop”
Follow-up: 6 months after discharge
Derived from (1)
Open Respiratory Health SupportShow studies (13)
Meta-analysisAneutraln=123330% confidence2012Breathing exercises for chronic obstructive pulmonary disease.
Effects on dyspnoea and health-related quality of life were inconsistent across trials
Top journalPooled RCTsStudies disagreeMain outcomeOpen-labelInactive controlMeta-analysisApositiven=109875% confidence2022Significant improvements were found in forced expiratory volume in 1 s (FEV 1 ) (SMD = 0.47, 95% CI = 0.27-0.67, P P
SMD 0.47 [0.27, 0.67]Small effectPooled RCTsMain outcomeRCTCpositiven=8050% confidence2021FEV1/FVC ratio has been indicated the significant improvement followed by TBTM compare to the baseline (p value truncated in source)
Main outcomeOpen-labelInactive controlRCTCpositiven=6770% confidence2022The median value of the mMRC scale score difference of the patients in groups I1 and I2 decreased from 4.0 at the first follow-up to 3.0 at the last follow-up... statistically significant for both groups (I1=p<0.001, I2=p<0.05).
MD -1Main outcomeOpen-labelAllocation not hiddenRCTCpositiven=5460% confidence2016the ratio of force vital capacity (FVC), forced expiratory volume in one second (FEV1), and maximal inspiratory pressure (MIP) were significantly increased (all p
No control group+7 more in SourcesRCTCpositiven=4050% confidence2015Pursed lip breathing improves exercise tolerance in COPD: a randomized crossover study.
In COPD patients with low PEF, pursed-lip breathing reduces dynamic hyperinflation and improves exercise tolerance, breathing pattern and arterial oxygenation at submaximal intensity exercise.
Top journalOpen-labelNo control group - →Lung Capacity ImprovementCertaintyMediumSourceClinical5 cited studies · 2 other sources
In a randomized trial of 39 healthy people and people with COPD, tidal volume was larger during breathing exercises than during quiet tidal breathing. A separate trial of 54 people reported increases in forced vital capacity, forced expiratory volume in one second, and maximal inspiratory pressure.
What the sources found
6 positive · 1 neutral · 0 negativeconfidence 45/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- Healthy people and patients
- Copd
Where the evidence comes from
- Article5
- Expert opinion1
- Community reports1
Protocol behind this outcome
2 protocolsMeasuredWhat the studies reporting this result did.
8 min · 14×/week
- Course
- 1 week
- Intensity
- Low
- Format
- Individual
- Supervision
- Instructor-led
Courses and single sessions · 1 repeated-course and 1 single-session protocols
Timing
A trial found it after a single session
Open Lung Capacity ImprovementShow studies (7)
RCTCpositiven=5460% confidence2016the ratio of force vital capacity (FVC), forced expiratory volume in one second (FEV1), and maximal inspiratory pressure (MIP) were significantly increased (all p
No control groupRCTCpositiven=3950% confidence2023tidal volume was significantly larger during various breathing exercises compared to quiet tidal breathing, in both healthy and COPD (p < 0.0001 as partially reported in abstract)
Main outcomeRCTCneutraln=3535% confidence2019Use of PLB resulted in lower mean respiratory rates and larger tidal volumes (both P .05).
Open-labelNo control groupQuasi ExperimentalCpositiven=3038% confidence2024Effects of Pursed Lip Breathing Training on Rehabilitation for Older Adults With Stable COPD.
maximum VC (P = .046) ... significantly increased from baseline
Main outcomeOpen-labelNo control groupCross SectionalCpositiven=1660% confidence2020PLB significantly and positively changed end-expiratory lung volume of abdominal compartment (EELV_AB ) end-expiratory lung volume, EILV_AB, tidal volume of pulmonary ribcage, tidal volume of abdomen, and ventilation than QB (P < .05).
MD -0.22Open-labelNo control group+1 more in SourcesExpert opinionpositive50% confidenceRegular practice improves functional residual capacity and tidal volume in obstructive lung disease.
Expert knowledge synthesis
Low probability(10)
- →Blood Pressure SupportCertaintyLowSourceRCT1 cited study
An RCT in 110 people with hypertension reported a mean systolic blood-pressure difference of 9.80 mm Hg (95% CI; 4.10 to 15.50).
What the sources found
1 positive · 0 neutral · 0 negativeconfidence 80/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- Hypertension (High Blood Pressure)
Where the evidence comes from
- Article1
Protocol behind this outcome
1 protocolMeasuredWhat the studies reporting this result did.
15 min
- Intensity
- Low
- Format
- Individual
- Supervision
- Instructor-led
Single sessions · 0 repeated-course and 1 single-session protocols
Timing
A trial found it after a single session
Open Blood Pressure SupportShow studies (1)
RCTBpositiven=11080% confidence2021The mean differences of SBP (9.80 mm Hg, 95% CI; 4.10 to 15.50) were significantly different (all p < .001)
MD 9.8 [4.1, 15.5]Main outcomeBlinded assessorInactive control - →Fatigue ReductionCertaintyLowSourceClinical4 cited studies · 1 other source
In a randomized trial of 54 people, the Piper Fatigue Scale score fell from 8.29±1.19 before the intervention to 6.83±1.02 at the fourth week. Another trial reported a decrease by the eighth week that was not statistically significant, so findings are not consistent.
What the sources found
2 positive · 3 neutral · 0 negativeconfidence 50/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- Healthy people and patients
- Sleep Apnea
- Tuberculosis
Where the evidence comes from
- Article4
- Expert opinion1
Protocol behind this outcome
1 protocolMeasuredWhat the studies reporting this result did.
15 min · 3×/week
- Course
- 4 weeks
- Per week
- 45 min
- Intensity
- Low
- Format
- Individual
- Supervision
- Instructor-led
A repeated course
Trials that found no benefit ran3 trials and meta-analyses
Smallest Typical Session 6 min 11 min How often 14×/week Course 1 week 5 weeks Open Fatigue ReductionShow studies (5)
RCTCneutraln=6040% confidence2020KBP & PLB did not decrease RPE as compared to AVP & DBE (p. > 0.05). RPE for PLB: pre 3.67 ± 2.02, post 3.47 ± .06, paired t=0.715 (p=0.46) on Borg's scale.
Main outcomeOpen-labelCompleters onlyRCTCpositiven=5470% confidence2024The Piper Fatigue Scale total mean score of the intervention group was 8.29±1.19 before the intervention and dropped to 6.83±1.02 at the fourth week (p<0.05)
MD -1.46Weak journalMain outcomeOpen-labelInactive controlBorderline p-valueRCTCneutraln=2055% confidence2023Significant differences in the Borg leg fatigue and dyspnea scale scores immediately after exercise were not confirmed.
Top journalOpen-labelCompleters onlyRCTCneutral35% confidence2022PFS total mean score of the intervention group which was 6.15 ± 1.65 before the application decreased to 5.34 ± 1.94 in the eighth week ( p > 0.05)
Weak journalNo control groupExpert opinionpositive50% confidenceBy reducing dyspnea and improving breathing efficiency, pursed-lip breathing decreases the work of breathing and delays respiratory muscle fatigue, thereby reducing overall fatigue during daily activities.
Expert knowledge synthesis - →Sleep Quality ImprovementCertaintyLowSourceClinical1 cited study
A randomized trial involving 60 people with COPD reported improved sleep quality in both groups, with a greater effect in the first group than the second.
What the sources found
1 positive · 0 neutral · 0 negativeconfidence 60/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- Copd
Where the evidence comes from
- Article1
Protocol behind this outcome
1 protocolEstimatedWhat the studies reporting this result did.
6 min · 14×/week
- Course
- 4 weeks
- Per week
- 84 min
- Intensity
- Low
- Format
- Individual
- Supervision
- Instructor-led
A repeated course
Open Sleep Quality ImprovementShow studies (1)
RCTCpositiven=6060% confidence2024PLB exercise had a significant effect on sleep quality in the first intervention (P < 0.001)... Overall, this exercise significantly improved sleep quality in both groups, with a greater effect observed in the first group (P < 0.001) compared to the second group (P < 0.05).
Weak journalMain outcomeOpen-label - →Improve Heart Rate Variability (HRV)CertaintyLowSourceClinical1 cited study · 1 other source
A 2014 quasi-experimental study in 32 people with COPD found increases in the SD1, SD2, RMSSD and LF (ms(2)) indices after Pursed-Lip Breathing.
What the sources found
2 positive · 0 neutral · 0 negativeconfidence 50/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- Healthy people and patients
Where the evidence comes from
- Article1
- Expert opinion1
Open Improve Heart Rate Variability (HRV)Show studies (2)
Quasi ExperimentalCpositiven=3250% confidence2014PLB promoted significant increases in the SD1, SD2, RMSSD and LF (ms(2)) indices ... in the COPD group.
Main outcomeNo control groupExpert opinionpositive50% confidencePursed-lip breathing slows exhalation and increases vagal tone, which may improve heart rate variability.
Expert knowledge synthesis - →Antidepressant EffectCertaintyLowSourceClinical1 cited study
In a quasi-experimental study of 39 people with COVID-19, the experimental group had greater reductions in HADS scores from admission to discharge than the control group (p = 0.02).
What the sources found
1 positive · 0 neutral · 0 negativeconfidence 55/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- COVID-19
Where the evidence comes from
- Article1
Protocol behind this outcome
1 protocolMeasuredWhat the studies reporting this result did.
60 min · 14×/week
- Course
- 2 weeks
- Per week
- 840 min
- Intensity
- Low
- Format
- Individual
- Supervision
- Instructor-led
A repeated course
Open Antidepressant EffectShow studies (1)
Quasi ExperimentalCpositiven=3955% confidence2025Significant interaction in HADS scores were also observed (p = 0.02), with the experimental group showing greater reductions in scores from admission to discharge compared to the control group.
Weak journalMain outcomeOpen-labelInactive controlAllocation not hiddenCompleters only39% dropped out - →Mood ImprovementCertaintyLowSourceClinical1 cited study
In a quasi-experimental study of 30 people with COPD, scores for daily life, anxiety, depression, and social activity on a quality-of-life scale decreased after the intervention.
What the sources found
1 positive · 0 neutral · 0 negativeconfidence 35/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- Copd
Where the evidence comes from
- Article1
Protocol behind this outcome
1 protocolMeasuredWhat the studies reporting this result did.
- Course
- 26 weeks
A repeated course
Open Mood ImprovementShow studies (1)
Quasi ExperimentalCpositiven=3035% confidence2024Effects of Pursed Lip Breathing Training on Rehabilitation for Older Adults With Stable COPD.
Postintervention, participants' scores for daily life (P = .035), anxiety (P = .034), depression (P = .036), and social activity (P = .041) on the QoL scale decreased significantly from baseline. The study names the QoL instrument as SF-36, but the decreases in anxiety and depression suggest a sympt
Main outcomeOpen-labelNo control group - →Anxiety ReductionCertaintyLowSourceAnecdotalnot used for recommendations2 other sources
Slow, controlled exhalation is proposed to activate the parasympathetic nervous system and reduce anxiety and panic associated with breathlessness. This effect was mentioned in 9 of 14 community reports.
What the sources found
2 positive · 0 neutral · 0 negativeconfidence 50/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Where the evidence comes from
- Expert opinion1
- Community reports1
Why it isn't used for recommendations
No supporting study on file
Open Anxiety ReductionShow studies (2)
Expert opinionpositive50% confidenceThe slow, controlled exhalation activates the parasympathetic nervous system, reducing anxiety and panic associated with breathlessness.
Expert knowledge synthesisCommunity reportsmoderate effectpositive50% confidenceThis effect was mentioned in 9 of 14 Reddit reports discussing it.
9 mentions - →Oxygen Utilization ImprovementCertaintyLowSourceTheoreticalnot used for recommendations1 other source
The proposed explanation is that Pursed-Lip Breathing prolongs exhalation, reduces air trapping, and improves ventilation-perfusion matching, which may support oxygen saturation and ease breathlessness during exertion. This is a rationale rather than a finding from human studies.
What the sources found
1 positive · 0 neutral · 0 negativeconfidence 50/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Where the evidence comes from
- Expert opinion1
Why it isn't used for recommendations
No supporting study on file
Open Oxygen Utilization ImprovementShow studies (1)
Expert opinionpositive50% confidencePursed-lip breathing prolongs exhalation, reduces air trapping, and improves ventilation-perfusion matching, leading to better oxygen saturation and reduced dyspnea during exertion.
Expert knowledge synthesis - →Vagal Tone ImprovementCertaintyLowSourceTheoreticalnot used for recommendations1 other source
The proposed rationale is that prolonged exhalation activates the vagus nerve, increasing parasympathetic tone and promoting relaxation.
What the sources found
1 positive · 0 neutral · 0 negativeconfidence 50/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Where the evidence comes from
- Expert opinion1
Why it isn't used for recommendations
No supporting study on file
Open Vagal Tone ImprovementShow studies (1)
Expert opinionpositive50% confidenceProlonged exhalation activates the vagus nerve, enhancing parasympathetic tone and promoting relaxation.
Expert knowledge synthesis - →Chronic Pain ReductionCertaintyLowSourceTheoreticalnot used for recommendations1 other source
Pursed-Lip Breathing has been used in chronic pain protocols with the aim of reducing sympathetic arousal and supporting pain coping through changes in breathing.
What the sources found
1 positive · 0 neutral · 0 negativeconfidence 50/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Where the evidence comes from
- Expert opinion1
Why it isn't used for recommendations
No supporting study on file
Open Chronic Pain ReductionShow studies (1)
Expert opinionpositive50% confidenceUsed in chronic pain protocols to reduce sympathetic arousal and improve pain coping via respiratory modulation.
Expert knowledge synthesis
Very low probability(1)
- →Respiratory Rate OptimizationCertaintyVery lowSourceTheoreticalnot used for recommendations1 cited study · 1 other source
The claim is not supported overall. One randomized trial involving 35 people reported lower mean respiratory rates and larger tidal volumes with Pursed-Lip Breathing.
What the sources found
1 positive · 1 neutral · 0 negativeconfidence 43/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
Where the evidence comes from
- Article1
- Expert opinion1
Why it isn't used for recommendations
Studied, with no positive result
Open Respiratory Rate OptimizationShow studies (2)
RCTCneutraln=3535% confidence2019Use of PLB resulted in lower mean respiratory rates and larger tidal volumes (both P .05).
Open-labelNo control groupExpert opinionpositive50% confidenceConsistently reduces respiratory rate in patients with chronic respiratory conditions by promoting longer exhalation.
Expert knowledge synthesis
What to expect
After a single session, respiratory-health support and lung-capacity improvement have been reported. In trials finding respiratory-health support, the shortest programme ran 4 weeks and the median programme ran 8 weeks. One follow-up found this benefit had faded fully by 6 months after discharge; these study timelines do not guarantee an individual response or its timing.
Conditions it's used for
Complaints and diagnoses people take it for8 listedThe best we have, but the evidence is still weak
- →Hypertension (High Blood Pressure)CertaintyLowSourceRCT1 cited study
A 2021 randomized controlled trial in 110 people with Hypertension found reductions in systolic blood pressure, diastolic blood pressure, and heart rate compared with usual care; the size of these reductions is not stated here.
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- Hypertension (High Blood Pressure)
Protocol behind this outcome
1 protocolMeasuredWhat the studies reporting this result did.
15 min
- Intensity
- Low
- Format
- Individual
- Supervision
- Instructor-led
Single sessions · 0 repeated-course and 1 single-session protocols
Open Hypertension (High Blood Pressure)Show studies (1)
RCTBn=11080% confidence2021RCT showing significant reductions in SBP, DBP, and HR compared to usual care
Blinded assessorInactive control - →COVID-19CertaintyLowSourceClinical1 cited study
A 2025 quasi-experimental study in 39 hospitalized people with COVID-19 found short-term improvements in breathlessness, respiratory symptoms, and mental health at discharge.
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- COVID-19
Protocol behind this outcome
1 protocolMeasuredWhat the studies reporting this result did.
60 min · 14×/week
- Course
- 2 weeks
- Per week
- 840 min
- Intensity
- Low
- Format
- Individual
- Supervision
- Instructor-led
A repeated course
Open COVID-19Show studies (1)
Quasi ExperimentalCn=3955% confidence2025Quasi-experimental study showing short-term improvements in breathlessness, respiratory symptoms, and mental health at discharge in hospitalized COVID-19 patients.
Weak journalOpen-labelInactive controlAllocation not hiddenCompleters only39% dropped out - →Sleep ApneaCertaintyLowSourceClinical1 cited study
A 2022 randomized controlled trial evaluated breathing exercises for daytime sleepiness and fatigue in people with obstructive sleep apnea syndrome.
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- Sleep Apnea
Protocol behind this outcome
1 protocolEstimatedWhat the studies reporting this result did.
14×/week
- Course
- 8 weeks
- Format
- Individual
- Supervision
- Instructor-led
A repeated course
Open Sleep ApneaShow studies (1)
RCTC50% confidence2022Study population: patients with obstructive sleep apnea syndrome; breathing exercise evaluated for daytime sleepiness and fatigue in this group.
Weak journalNo control group - →Post-Surgery RecoveryCertaintyLowSourceClinical1 cited study
A 2025 quasi-experimental study in 60 post-bronchoscopy patients reported improved recovery parameters in the group receiving Pursed-Lip Breathing exercises.
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
Open Post-Surgery RecoveryShow studies (1)
Quasi ExperimentalCn=6040% confidence2025Study population of post-bronchoscopy patients receiving PLB exercises with improved recovery parameters in the study group.
Inactive control - →TuberculosisCertaintyLowSourceClinical1 cited study
A 2024 randomized controlled trial in 54 people with Tuberculosis found reduced fatigue on the Piper Fatigue Scale after 4 weeks of breathing exercises.
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- Tuberculosis
Protocol behind this outcome
1 protocolMeasuredWhat the studies reporting this result did.
15 min · 3×/week
- Course
- 4 weeks
- Per week
- 45 min
- Intensity
- Low
- Format
- Individual
- Supervision
- Instructor-led
A repeated course
Open TuberculosisShow studies (1)
RCTCn=5470% confidence2024RCT showing significant reduction in fatigue (Piper Fatigue Scale) after 4 weeks of breathing exercises in TB patients.
Weak journalOpen-labelInactive control - →StrokeCertaintyLowSourceClinicalnot used for recommendations1 cited study
A 2017 randomized controlled trial in 30 people with Stroke found that 4 weeks of combined Diaphragmatic Breathing and Pursed-Lip Breathing increased respiratory muscle activation on the paretic side.
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
- Stroke
Protocol behind this outcome
1 protocolMeasuredWhat the studies reporting this result did.
15 min · 5×/week
- Course
- 4 weeks
- Per week
- 75 min
- Format
- Individual
- Supervision
- Instructor-led
A repeated course
Why it isn't used for recommendations
A hospital-managed condition, never self-care
Open StrokeShow studies (1)
RCTCn=3055% confidence2017RCT showing significant increases in paretic side respiratory muscle activation after 4 weeks of combined diaphragm and pursed-lip breathing exercise
Low-quality journalOpen-label - →Generalized Anxiety DisorderCertaintyLowSourceTheoreticalnot used for recommendations1 other source
Breathing exercises are used in cognitive-behavioral interventions for anxiety to reduce hyperventilation and promote autonomic balance.
How big is the effect
No study gave a number we could compare, so the size is not known.
Where the evidence comes from
- Expert opinion
Why it isn't used for recommendations
No supporting study on file
Open Generalized Anxiety DisorderShow studies (1)
Expert opinion50% confidenceUsed in cognitive-behavioral interventions for anxiety to reduce hyperventilation and promote autonomic balance.
Low probability(1)
- →AsthmaCertaintyLowSourceTheoreticalnot used for recommendations1 other source
Expert guidance describes breathing exercises as a non-drug technique for managing acute airway narrowing and reducing rescue inhaler use.
How big is the effect
No study gave a number we could compare, so the size is not known.
Where the evidence comes from
- Expert opinion
Why it isn't used for recommendations
No supporting study on file
Open AsthmaShow studies (1)
Expert opinion50% confidenceRecommended as a non-pharmacological technique to manage acute bronchoconstriction and reduce rescue inhaler use.
Studied only as breathwork in general, not tested in pursed-lip breathing yet
These results come from studies of breathwork as a whole. No study of pursed-lip breathing has looked at them yet.
COPD (Chronic Obstructive Pulmonary Disease) (Medium · 19 trials) · Analgesic Effect (Medium · 15 trials) · Stress Resilience Improvement (Medium · 12 trials) · Lung Cancer (High · 8 trials) · Anxiety Disorder (General) (Medium · 7 trials) · Physical Strength Increase (Low · 6 trials) · and 16 more
Side effects
Don't do it if
When to skip it or get medical advice first1 listedHighest probability
- →Recent Heart Attack (MI)CertaintyLowSourceReference knowledgeTheoretical
During early recovery, respiratory maneuvers that increase pressure inside the chest may reduce blood returning to the heart and cardiac output, potentially destabilizing circulation.
Where the evidence comes from
- Reference knowledge
Confidence
confidence 75/100
Open Recent Heart Attack (MI)Rationale
In early recovery, any respiratory maneuver that increases intrathoracic pressure may reduce venous return and cardiac output, risking hemodynamic instability.
Who the trials left out
Some trials of this practice did not take people with these conditions, so the studies say less about them. This is not a warning and does not show harm. Ask a clinician first.8 listedLeft out by one trial each (8)
- Anginaleft out by 1 trial
PubMed links (1)
- Bone Fractureleft out by 1 trial
PubMed links (1)
- Heart Arrhythmialeft out by 1 trial
PubMed links (1)
- Heart Disease (General)left out by 1 trial
PubMed links (1)
- Heart Failure (CHF)left out by 1 trial
PubMed links (1)
- Pregnancyleft out by 1 trial
PubMed links (1)
- Respiratory Failureleft out by 1 trial
PubMed links (1)
- Strokeleft out by 1 trial
PubMed links (1)
Also listed for breathwork in general (written by our reviewers)
Precautions from the Breathwork page. They are for breathwork as a whole and may not all fit pursed-lip breathing.
Aortic Aneurysm · Epilepsy · Pheochromocytoma · Recent Stroke · Bipolar Mania · Psychosis · Unstable Heart Disease (Unstable Angina / Decompensated Heart Failure)
When you stop
Rebound and withdrawal after discontinuing1 listedHighest probability
- →Respiratory Health SupportCertaintyLowSourceClinicalloss of benefit1 cited study
A quasi-experimental study involving 39 people found no significant long-term effects on the physical symptoms it assessed.
What the sources found
0 not observed · 0 unclear · 1 reportedconfidence 45/100
How big is the effect
No study gave a number we could compare, so the size is not known.
Who was studied
- People with a condition
Where the evidence comes from
- Article1
Protocol behind this outcome
1 protocolMeasuredWhat the studies reporting this result did.
60 min · 14×/week
- Course
- 2 weeks
- Per week
- 840 min
- Intensity
- Low
- Format
- Individual
- Supervision
- Instructor-led
A repeated course
Open Respiratory Health SupportShow studies (1)
Quasi ExperimentalCnegativen=3945% confidence2025However, there were no significant long-term effects on these physical symptoms.
Weak journal
Interactions
Okay to combine with
Highest probability of useful synergy
- →PracticesDiaphragmatic BreathingCertaintyMediumSourceReference knowledgeComplementary
Combining diaphragmatic breathing with pursed-lip breathing may improve ventilation efficiency and reduce work of breathing in COPD. In frail or neurologically impaired people, poor coordination could instead increase work of breathing.
Where the evidence comes from
- Reference knowledge
Open Diaphragmatic BreathingConfidence
confidence 70/100
- →SupplementsCaffeineCertaintyMediumSourceReference knowledgeAdditive
Caffeine acts as a mild respiratory stimulant and bronchodilator, so it may enhance the respiratory-efficiency gains of pursed-lip breathing.
- →PracticesCardioCertaintyMediumSourceReference knowledgeComplementary
For people with COPD, using pursed-lip breathing during exercise may help manage exertional breathlessness and sustain activity as part of pulmonary rehabilitation.
Weakens or is weakened by
Highest probability
- →SupplementsBeta-AlanineCertaintyMediumSourceReference knowledgeCompetitive
Beta-Alanine can induce paresthesia and may increase respiratory drive, potentially interfering with the calm, controlled breathing used in Pursed-Lip Breathing.
- →PracticesBreathworkCertaintyMediumSourceTheoreticalCompetitive
High-frequency or hyperventilation-based breathwork, such as holotropic breathwork, conflicts with the slow, controlled exhalation used in Pursed-Lip Breathing.
How it works
The mechanisms this practice works through16 listed · 0 established- Airway patencyVentilation efficiencyproposed
PLB improves airway patency and alveolar gas exchange, reducing dyspnea.
- Anxiety and stressMindfulness and stress reductionproposed
The number counting promotes mindfulness, reducing anxiety and stress, which may contribute to blood pressure reduction.
- Baroreflex sensitivityIncreased parasympathetic toneproposed
Deep and slow breathing increases vagal tone and baroreflex sensitivity, leading to reduced blood pressure.
- Breath holding timeRespiratory mechanicsproposed
PLB increases expiration time and decreases inspiration time, which may improve breath holding time.
- Diaphragm and accessory respiratory musclesRespiratory muscle strengtheningproposed
PLB may strengthen respiratory muscles and improve oxygen saturation, potentially contributing to better sleep.
- Diaphragmatic functionRespiratory mechanicsproposed
Breathing exercises restore normal diaphragmatic function, reducing dyspnea and respiratory rate.
- Expiratory time and total breath durationRespiratory mechanicsproposed
PLB lengthens expiratory time (TE) and total breath duration (TTOT), which the authors link to reduced end-expiratory chest wall volume and breathlessness.
- Lower chest wall (abdominal ribcage and abdomen)Bucket handle mechanicsproposed
PLB in forward trunk lean position increases AP diameter at umbilical level and ML diameter at xiphoid level, indicating enhanced bucket handle mechanics due to more effective diaphragm function.
- Lung volumes and ventilationRespiratory mechanicsproposed
PLB increases tidal volume, compartmental lung volumes, and ventilation parameters, likely by generating positive end-expiratory pressure (PEEP) that prevents airway collapse and air trapping.
- Stress reductionPsychologicalproposed
Progressive muscle relaxation promotes stress reduction, alleviates tension, and enhances psychological stability.
- Upper chest wall (pulmonary ribcage)Pump handle mechanicsproposed
PLB in upright position increases AP diameter changes at angle of Louis and xiphoid levels, indicating enhanced pump handle mechanics via intercostal muscle activation.
- Ventilation efficiencyAirway clearanceproposed
Techniques including huff coughing target airway clearance and ventilation efficiency.
- diaphragmventilationproposed
Diaphragmatic breathing involves the use of the diaphragm muscle instead of auxiliary muscles, lessening the respiratory load and raising the ventilation level of the lungs.
- inspiratory and expiratory musclesrespiratory muscle functionproposed
Pursed lip breathing increases the activity of inspiratory and expiratory muscles, gas exchange, and tidal volume by providing a controlled expiration, thus helping to lower the respiratory rate.
- upper trapezius, latissimus dorsi, rectus abdominis, external and internal abdominal obliquerespiratory muscle activationproposed
Combined inspiratory diaphragm breathing with manual resistance and expiratory pursed-lip breathing increased activation of paretic side respiratory muscles in chronic stroke patients.
- vagal activitycardiac autonomic modulationproposed
PLB increased vagal indices (SD1, RMSSD, HF-related markers) and altered fractal correlation properties of heart rate in COPD.
Variations
4 documentedTypical protocol
21 protocolsEstimatedAcross every study of this practice, whatever the variation.
13 min · 14×/week
- Course
- 4 weeks
- Intensity
- Low
- Format
- Individual
- Supervision
- Instructor-led
Courses and single sessions · 10 repeated-course and 9 single-session protocols
91% of the corpus contributed
Standard Pursed Lip Breathing
Beginner9/106–15 min · Twice a day
Standard Pursed Lip Breathing
Beginner9/106–15 min · Twice a day6–15 min · Twice a day
From studies- How often
- Twice a day
- Intensity
- Low
- Time of day
- Any time
- Where
- Indoors or outdoors
- Research depth
- Minimal
This foundational variation pairs a gentle nasal inhale with a longer, controlled exhale through pursed lips; forcing the exhale is discouraged because it can collapse the airways. It is described as a way to manage breathlessness during daily activities.
No equipment needed.
As studied
7 protocolsEstimatedThe protocol the studies of this variation actually used.
6–15 min
- Course
- 4 weeks
- Intensity
- Low
- Format
- Individual
- Supervision
- Instructor-led
A repeated course
Derived from2835663229927211330741103600472236028881+2 more in Sources
How it's done5 steps · 3 cues · 3 common mistakes
A general description of the practice, not instruction or medical advice.
Steps
- Sit comfortably with your shoulders and neck relaxed.
- Inhale slowly and gently through your nose for about 2 seconds.
- Purse your lips as if you are about to whistle or gently blow out a candle.
- Exhale slowly and steadily through your pursed lips for 4 to 6 seconds. Do not force the air out.
- Repeat the cycle for 5 to 15 minutes, focusing on making the exhale longer than the inhale.
Cues
- · Keep your shoulders down and relaxed.
- · The exhale should be gentle and controlled, like a soft breeze.
- · Count in your head: 'In, two... Out, two, three, four.'
Common mistakes
- Exhaling too forcefully, which can collapse the airways.
- Taking a deep, forced inhale instead of a normal, gentle breath.
- Puffing out the cheeks instead of keeping the air stream controlled through pursed lips.
Studied protocols16 on file
- 15 min· 5×/week· 4 weeks· n=30· A repeated coursePMID 28356632
- 15 min· 14×/week· 1 week· n=60· A repeated coursePMID 33074110
- 10 min· 14×/week· 4 weeks· n=67· A repeated coursePMID 36028881
- 15 min· 3×/week· 4 weeks· n=54· A repeated coursePMID 39630726
- 6 min· 14×/week· 4 weeks· n=60· A repeated coursePMID 39640085
- 3×/week· 12 weeks· n=54· A repeated coursePMID 29927211
Activity-Integrated Pursed Lip Breathing
Intermediate8/101–10 min · As needed
Activity-Integrated Pursed Lip Breathing
Intermediate8/101–10 min · As needed1–10 min · As needed
Editorial- How often
- As needed
- Intensity
- Moderate
- Time of day
- Any time
- Where
- Indoors or outdoors
- Research depth
- Minimal
This variation links the exhale to the most strenuous part of an activity, such as walking, bending, or lifting, and is intended for people with COPD or ILD who become short of breath with exertion. In one study, acute use during walking did not improve symptoms, muscle oxygenation, or SpO2 in people with ILD and may have reduced walking distance, so its benefit in ILD is uncertain.
No equipment needed.
How it's done5 steps · 3 cues · 3 common mistakes
A general description of the practice, not instruction or medical advice.
Steps
- Identify the phase of the activity that causes the most breathlessness (e.g., stepping up, lifting an object).
- Just before the exertion phase, inhale gently through your nose.
- Begin the exertion while exhaling slowly through pursed lips.
- Coordinate the rhythm: for walking, try inhaling for one step and exhaling through pursed lips for the next two steps.
- Continue this breathing pattern for the duration of the strenuous activity, returning to normal breathing during rest.
Cues
- · Match your breath to your movement.
- · Exhale during the hardest part of the movement.
- · Maintain a steady, slow rhythm.
Common mistakes
- Holding the breath during exertion, which increases pressure and breathlessness.
- Trying to coordinate a complex step pattern immediately; start with a simple 1:2 ratio.
- Inhaling too deeply before the exertion, causing tension.
Studied protocols1 on file
- 6 min· n=20PMID 37462163
Pursed Lip Breathing in Forward Lean Position
Beginner7/101–5 min · As needed
Pursed Lip Breathing in Forward Lean Position
Beginner7/101–5 min · As needed1–5 min · As needed
Editorial- How often
- As needed
- Intensity
- Low
- Time of day
- Any time
- Where
- Indoors
- Research depth
- Minimal
The forward lean is paired with Pursed-Lip Breathing to support diaphragm and accessory-muscle mechanics. It is described as a way to acutely improve ventilation and reduce shortness of breath in people with mild to moderate COPD, often as a recovery position after exertion.
No equipment needed.
How it's done6 steps · 3 cues · 3 common mistakes
A general description of the practice, not instruction or medical advice.
Steps
- Sit in a sturdy chair with your feet flat on the floor, slightly apart.
- Lean your trunk forward from the hips, resting your elbows or forearms on your thighs.
- Ensure your shoulders and neck are completely relaxed and your head is supported by your arms.
- Inhale gently through your nose, feeling your belly expand against your thighs.
- Exhale slowly through pursed lips, allowing the weight of your upper body to assist the exhale.
- Continue for 1 to 5 minutes until breathlessness subsides.
Cues
- · Let your body hang loosely from your hips.
- · Feel your back expand with the inhale.
- · Use gravity to help push the air out on the exhale.
Common mistakes
- Tensing the shoulders and neck instead of letting them relax completely.
- Leaning from the waist with a rounded back, which can compress the abdomen.
- Placing hands on the knees, which can cause shoulder tension; resting on forearms is better.
Studied protocols1 on file
- 1 min· n=16· Single sessionsPMID 33371099
Pursed Lip Breathing with Number Counting
Beginner7/1010–15 min · Twice a day
Pursed Lip Breathing with Number Counting
Beginner7/1010–15 min · Twice a day10–15 min · Twice a day
Editorial- How often
- Twice a day
- Intensity
- Low
- Time of day
- Morning
- Where
- Indoors
- Research depth
- Minimal
This variation adds counting during the exhale to maintain a steady rhythm and focus attention on the breath. The description says it can lower blood pressure and heart rate, and identifies it as suitable for people with hypertension or those seeking a meditative focus.
No equipment needed.
How it's done6 steps · 3 cues · 3 common mistakes
A general description of the practice, not instruction or medical advice.
Steps
- Assume a comfortable semi-supine or seated position with your back supported.
- Close your eyes to minimize external distractions.
- Inhale quietly through your nose for a count of 2.
- Purse your lips and exhale slowly while counting out loud or in your head from 1 to 4, or 1 to 6.
- Focus your attention entirely on the sound and rhythm of the counting.
- Repeat for 10 to 15 minutes, maintaining a consistent count length.
Cues
- · Make the counting a smooth, continuous sound.
- · The goal is a long, even exhale, not a loud count.
- · If you lose count, gently bring your focus back to 'one' on the next exhale.
Common mistakes
- Rushing the count to match a perceived pace instead of letting the breath dictate the speed.
- Counting in a staccato, choppy manner instead of a flowing one.
- Taking a large, gasping inhale after a long count.
Studied protocols1 on file
- 15 min· n=110· Single sessionsPMID 33410589
How to start
Community experience
Based on 15 public posts from Reddit and Bluesky.
What people report it did
3 outcomes mentioned across 15 public reports. A report often mentions several, so these counts do not add up to the total.
Reported benefits1
- Anxiety Reduction9 mentions
Reported side effects2
- Dry Mouthnot studied
- Hyperventilationnot studied
References
39 screened · 23 analysed · 24 listed below
Studies and sources cited on this page. Evidence quality varies — check the grade on each.
- The effects of pursed lip breathing combined with diaphragmatic breathing on pulmonary function and exercise capacity in patients with COPD: a systematic review and meta-analysis.Physiother Theory Pract2022Meta-analysisAn=1098
- Breathing exercises for chronic obstructive pulmonary disease.Cochrane Database Syst Rev2012Meta-analysisAn=1233
- The effect of pursed-lip breathing combined with number counting on blood pressure and heart rate in hypertensive urgency patients: A randomized controlled trial.J Clin Hypertens (Greenwich)2021RCTBn=110
- Effectiveness of Breathing Exercises and Stabilization Techniques on Patients with COVID-19: Quasi-Experimental Study.J Clin Med2025Quasi ExperimentalCn=39
- The Effects of Pursed Lip Breathing Exercises on Patients' Post-Bronchoscopy Recovery Parameters: A Nurse-Led Quasi-Experimental Study.Nurs Health Sci2025Quasi ExperimentalCn=60
- Comparison of the Effects of Diaphragmatic Breathing and Pursed-lip Breathing Exercises on the Sleep Quality of Elderly Patients with Chronic Obstructive Pulmonary Disease (COPD): A Clinical Trial Study.Ther Adv Pulm Crit Care Med2024Crossover RCTCn=60
- The effect of breathing exercises on fatigue in tuberculosis patients: a randomized controlled trial.Rev Assoc Med Bras (1992)2024RCTCn=54
- Effects of Pursed Lip Breathing Training on Rehabilitation for Older Adults With Stable COPD.Altern Ther Health Med2024Quasi ExperimentalCn=30
- Effects of walking with a portable oxygen concentrator on muscle oxygenation while performing normal or pursed-lip breathing in patients with interstitial lung disease: a randomized crossover trial.Ther Adv Respir Dis2023Crossover RCTCn=20
- The Influence of Breathing Exercises on Regional Ventilation in Healthy and Patients with Chronic Obstructive Pulmonary Disease.COPD2023Crossover RCTCn=39
Show all 24 references
- The effects of breathing exercises and inhaler training in patients with COPD on the severity of dyspnea and life quality: a randomized controlled trial.2022RCTCn=67
- Effect of pursed-lip breathing and forward trunk lean positions on regional chest wall volume and ventilatory pattern in older adults: An observational study.2022Observational Cross SectionalCn=20
- The effect of breathing exercise on daytime sleepiness and fatigue among patients with obstructive sleep apnea syndrome.2022RCTC
- The effect of teach-back training intervention of breathing exercise on the level of dyspnea, six-minutes walking test and FEV1/FVC ratio in patients with chronic obstructive pulmonary disease; a randomized controlled trial.2021RCTCn=80
- Breathing exercises and pranayamas to decrease perceived exertion during breath-holding while locked-down due to COVID-19 online randomized study.2020RCTCn=60
- Effects of pursed-lip breathing and forward trunk lean postures on total and compartmental lung volumes and ventilation in patients with mild to moderate chronic obstructive pulmonary disease: An observational study.2020Observational Cross SectionalCn=16
- Effects of Pursed Lip Breathing on Exercise Capacity and Dyspnea in Patients With Interstitial Lung Disease: A RANDOMIZED, CROSSOVER STUDY.2019Crossover RCTCn=35
- The effects of inspiratory diaphragm breathing exercise and expiratory pursed-lip breathing exercise on chronic stroke patients' respiratory muscle activation.2017RCTCn=30
- Effects of Pursed-Lip Breathing Exercise Using Windmill Toy on Lung Function and Respiratory Muscle Strength in the Elderly.2016RCTCn=54
- Pursed lip breathing improves exercise tolerance in COPD: a randomized crossover study.2015Crossover RCTCn=40
- Effect of pursed-lip breathing in patients with COPD: Linear and nonlinear analysis of cardiac autonomic modulation.2014Quasi ExperimentalCn=32
- Chest wall kinematics and breathlessness during pursed-lip breathing in patients with COPD.2004Quasi ExperimentalCn=22
- Comparison of the oxygen cost of breathing exercises and spontaneous breathing in patients with stable chronic obstructive pulmonary disease.2003Crossover RCTCn=30
- Expert knowledge synthesis