BREATHING+

Pursed Lip Breathing

Respiratory Training Device


1 BREATHING DYNAMICS

2 BREATHING PROBLEMS

2.1 Shortness of breath

2.2 Asthma and COPD

2.3 Emphysema

2.4 Stress and Anxiety

2.5 Attention Deficit Disorder

2.6 Speech Disorders

3 TREATMENT AND PREVENTION

3.1 Breathing exercises

3.2 Pursed Lip Breathing

3.3 Technology Review

4 OUR PRODUCTS

4.1 Breathing Games

4.2 Breathing Toys

4.3 Breathing Video

4.4 Breathing Scrolling

4.5 Breathing Headset

4.6 Breathing Package

5 ADVANTAGES

5.1 Comparison with other technology for breathing exercises (table 1)

5.2 Comparison with other game controllers (keyboard, mouse, joystick, touchpad)

5.3 SWOT - Strengths, Weaknesses, Opportunities, Threats

6 EXPERT OPINIONS

6.1 American Lung Association

6.2 Cleveland Clinic

6.3 University of Iowa Children's Hospital

6.4 The Ohio State University Medical Center

6.5 University of Minnesota Medical Center

6.6 University Health Service, University of Michigan

6.7 Vanderbilt University Medical Center

6.8 UTMB, The University of Texas

6.9 American Thoracic Society

7 CONTACT AND MORE INFORMATION

1 BREATHING DYNAMICS

2 BREATHING PROBLEMS

2.1 Shortness of breath

Difficulty in breathing (also known as shortness of breath, breathlessness, or dyspnea) is the result of inefficient breathing. In one’s lifetime, one may experience rare episodes of shortness of breath as part of high levels of activity like exhaustive exertion, or during environmental conditions such as high altitude or very warm or cold temperatures. Other than these extreme conditions, shortness of breath is commonly a sign of a medical problem. Some of the causes of shortness of breath are asthma, bronchitis, tuberculosis, COPD and emphysema. These problems can be treated with breathing exercises such as Pursed Lip Breathing.[1]

2.2 Asthma and COPD

Asthma is most common chronic disease among children, and affects more than 253 million people around the world. Pursed lip breathing is most recommended to manage asthma and COPD as it makes breathing more efficient, improves oxygenation and reduces breathing rate[2]. Additionally Pursed Lip Breathing is recommended during an asthma attack by most asthma specialist organisations worldwide.[3] [4] [5].

2.3 Emphysema

In emphysema the alveoli and lung tissue are destroyed. With this damage, the alveoli cannot support the bronchial tubes. Consequently the airway collapses which causes an “obstruction” (a blockage), which traps air inside the lungs. Too much air trapped in the lungs can give some patients a barrel-chested appearance. Pursed Lip Breathing helps emphysema sufferers exhale more efficiently and allows them to prevent airway collapse by maintaining a positive pressure inside airways[6].

2.4 Stress and Anxiety

The stress response can be viewed as an interactional process that causes psychophysiologic reactions that are immediate and can occur up to and including physiologic events 3 weeks after confrontation with the stressor[7]. Pursed lip breathing helps in coping with stress and anxiety related disorders. It can be used as a 10-20 minutes daily systematic respiratory exercise to train breathing in combination with other rehabilitative activities[8].

2.5 Attention Deficit Disorder

Attention deficit hyperactivity disorder (ADHD, similar to hyperkinetic disorder in the ICD-10) is a developmental neuropsychiatric disorder in which there are significant problems with executive functions (e.g., attentional control and inhibitory control) that cause attention deficits, hyperactivity, or impulsiveness which is not appropriate for a person's age. ADHD usually appears first in childhood, but can also now be diagnosed in adults (as long as some symptoms were present in the individual’s childhood, but simply never diagnosed). Breathing exercises have been recomended to patients suffering from ADHD [9]

2.6 Speech Disorders

Speech disorders or speech impediments are a type of communication disorder where 'normal' speech is disrupted. This can mean stuttering, lisps, etc. Someone who is unable to speak due to a speech disorder is considered mute. In many cases the cause is unknown. However, there are various known causes of speech impediments, such as "hearing loss, neurological disorders, brain injury, intellectual disability, drug abuse, physical impairments such as Cleft lip and palate, and vocal abuse or misuse.” As speech is fundamentally linked to breathing, breathing exercises act as a basis for good articulation, projection and tone. [10]


3 TREATMENT AND PREVENTION

3.1 Breathing exercises

Breathing Exercises should be advised to patients with a variety of medical respiratory conditions, with the aim of breathlessness management and symptom control, mobility and function improvement or maintenance, and airway clearance and cough enhancement or support.[11]

 

3.2 Pursed Lip Breathing

Pursed Lip Breathing (PLB) is a breathing technique that aims to make exhalations longer and more efficient, PLB helps people cope with asthma, COPD, emphysema, and stress related disorders. It is described in the American Thoracic Society guidelines as ‘a nasal inspiration followed by expiratory blowing against partially closed lips, avoiding forceful exhalation’. PLB reduces breathing rate, helps make exhalation more efficient, reduces dyspnoea (shortness of breath), and improves cellular oxygenation. PLB is gaining recognition in medical community since mid 60s when its positive effects had been first observed. Today there are over 2000 articles indexed in google scholar, pubmed and similar medical databases describing its clinical benefits. According to Cleveland Clinic[12], its effects as are:

3.3 Technology Review

Technology for breathing exercises range in respiratory detection principles, biofeedback principles and its methods of operation (Table 1).

 

Table 1: Review of technology for breathing exercises

 Device

Respiratory Detection System

Description

Advantages and Disadvantages

RESPeRATE device by InterCure Ltd.

Mechanic principle (lung expansion detection)

-Non-drug therapy

-Guidance system: visual

-For the treatment of high blood pressure

-Portable computerized device

✔ Guidance provided

✘ Does not require exhalation against pressure, therefore it is less beneficiary

HFCWO Device by Electromed

Mechanic principle (lung expansion detection)

-High Frequency Chest Wall Oscillation device

-Guidance system: N/A

-Positive pressure air pulses are applied to the chest wall

✔ Therapy session lasts about 30 minutes

✘ Not entertaining

OHFO device

Pneumatic principle (using mouth to force air into device)

-Oral High Frequency Oscillation

-Guidance system: N/A

-Developed from the technique of high frequency jet ventilation

-Provides a practical and simple method of supplementing breathing in conscious subjects

✘ Used only in USA

✘ Not entertaining

✘ Unhygienic

IPV device by Percussionaire Corp.

Pneumatic principle (using mouth to force air into device)

-Intrapulmonary Percussive Ventilation

-Guidance system: N/A

-Utilizes high frequency

-Combines aerosol inhalation and internal thoracic percussion applies via mouthpiece

✘ Unhygienic

✘ Not entertaining

Acapella by Smiths Medical

Pneumatic principle (using mouth to force air into device)

-Combines the benefits of both PEP therapy and airway vibrations

-Guidance system: N/A

-Improves clearance of secretions

-Can accommodate virtually any patient’s lung capacity

✔ Allows inhalation and exhalation without removing from mouth

✘ Unhygienic

✘ Not entertaining

Cornet device by R. Cegla GmbH & Co. KG

Pneumatic principle (using mouth to force air into device)

-Adapter with mouthpiece

-Guidance system: N/A

-Reduces unproductive cough

-Increases the vital capacity

✘ Unhygienic

✘ Not entertaining

Flutter by Aptalis Pharma US, Inc.

Pneumatic principle (using mouth to force air into device)

-Mucus Clearance Device

-Guidance system: audio

-Provides PEP

-Ability to vibrate the airways, intermittently increase endobronchial pressure, accelerate expiratory airflow

-Changing inclinations makes higher or lower frequency

✘ Unhygienic

✘ For single patient use only

Frolov breathing by Dinamika Ltd., Russia

Pneumatic principle (using mouth to force air into device)

-A type of intermittent hypercapnic hypoxic training

-Guidance system: visual

-Exposure to the short-term hypoxia (the state of oxygen deficiency)

-Cures asthma, pneumonia, tuberculosis and helps with sports

✘ Unhygienic

✘ Not entertaining

Powerlung by PowerLung Inc.

Pneumatic principle (using mouth to force air into device)

-Strength training techniques

-Guidance system: N/A

-Expanding lung capacity

-Different models

✘ Unhygienic

✘ Not entertaining

Spiro-Ball by Leventon, Barcelona (Werfen Group Corporation)

Pneumatic principle (using mouth to force air into device)

-Volumetric/Spirometric Exerciser

-Guidance system: visual

-Shows inspiratory volume

✔ Easy usage

✘ Unhygienic

✘ Not entertaining

Three-ball by Leventon, Barcelona (Werfen Group Corporation)

Pneumatic principle (using mouth to force air into device)

-Restores and maintains lung capacity

-Guidance system: visual??

-Enhances inspiratory and expiratory muscles

✔ Easy usage

✘ Unhygienic

✘ Not entertaining

Threshold PEEP/IMT by Respironics Inc. Healthscan

Pneumatic principle (using mouth to force air into device)

PEEP

-Designed for therapy with positive expiratory pressure

-Guidance system: N/A

-PEEP therapy helps reducing the amount of air that is trapped in the lungs

-Resistance is provided by a spring-loaded valve

-Forced pressure opens the airways and helps mobilize secretions

IMT

-Provides consistent and specific pressure for inspiratory muscle strength and endurance training

PEEP

✔ Promotes effective breathing patterns improves gas exchange and central and peripheral airway function.

✘ It is only meant for expiratory exercise

✘ Unhygienic

✘ Not entertaining

IMT

✔ Increases respiratory muscle strength and endurance

✔ Increases exercise tolerance

✘ Effects of IMT have not been adequately tested

✘ Only meant to be used as a inspiratory exercise

RFB micro biofeedback by BioMental GmbH

Pneumatic principle (using mouth to force air into device)

-For functional disturbances of heart and cycles

-Guidance system: visual, audio

-Influence on blood pressure

✘ Difficult to use

I-330 C2 by J&J engineering

Mechanic principle (measuring lung expansion)

-12 channel capability

-Guidance system: visual

-Supports simultaneous monitoring of signals

-More options for analyses (ECG, HRV, Respiration, Skin Resistance…)

✔  Two people can use it at the same time

✘ Hard to use

✘ Very expensive

Pulmonica by Harmonica Tech

Pneumatic principle (using mouth to force air into device)

-It produces deep, resonant, meditative sounds that can be felt vibrating in the lungs and sinuses

-Guidance system: N/A

-It is meant to promote airway clearance, oxygenation and strengthening of respiratory muscles

✔ Usage does not require musical skill

✔ Activation of diaphragmatic breathing

✘ Forcing air

✘ Detaining water inside during usage

✘ Unhygienic

Alvio by Alvio

Pneumatic principle (using mouth to force air into device)

-An all-in-one breathing trainer, symptom tracker and mobile game controller

-Guidance system: visual

-Controlling a video game on a smartphone or tablet  

✔ Wirelessly communication with phones/tablets

✔ Cloud sharing information

✘ Forcing air

✘ Unhygienic

✘ Danger for open mouth breathing

Respi by Respio

Pneumatic principle (using mouth to force air into device)

-For preventing or reducing asthma attacks

-Guidance system: visual

-Disposable mouth tube

-Proper body posture with smartphone laser sensors

-GPS for ascertaining dangerous areas for asthmatics

-Analyzed data sent to physicians

 ✔ Linked to smart phone

✔ Hygienic

✘ Forcing air

✘ No positive side effects (relaxation, longer exhalation)

Zenytime by Zenytime

Pneumatic principle (using mouth to force air into device)

-For promoting deep, rhythmic breathing to increase oxygen levels

-Guidance System: visual

-Scientifically engineered

-Comes with an application

-Sharing experiences on social media

-Dongle is connected with bluetooth

✔ Lightweight dongle

✘ Unhygienic use (you hold dongle with bare hands)

✘ Water collecting on the device

My Spiroo by My Spiroo

Pneumatic principle (using mouth to force air into device)

-Mobile spirometer

-Guidance System: visual

-Connected, ultraportable peak flow meter

-Measures how much air is passing out of users’ lung

-My Spiroo Pro: version for doctors to see patients data

-My Spiroo Home: version for patients

✔ For assessing what is causing a bronchial flare-up

✘ Unhygienic

Sensawaft by Zyxio

Pneumatic principle (using mouth to force air into device)

-For disabled people or hands-free mobile phone makers

-Guidance system: visual

-Senses pressure variations from the chip into which user exhales

✔ Chipset can be integrated into hardware (mp3 players, phones, laptops)

✔ Fun

✘ Non-medical purpose (does not describe how should people improve breathing)

✘ Dizziness if one breaths incorrect

Talk by Arsh Shah Dilbagi

Pneumatic principle (using mouth to force air into device)

-Exhales with varying intensities for converting them into electrical signals

-Guidance system: visual

-Signals processed by microprocessor  (Morse engine)

-Morse code: converting signals into words

✔ For people with developmental disabilities

✘ Not entertaining

✘ Non-medical purpose (does not describe how should people improve breathing)

Powerbreathe by Powerbreathe

Pneumatic principle (using mouth to force air into device)

-Inspiratory Muscle Trainer

-Guidance system: N/A

-For strengthening the muscles we use to breathe

-Optimisation of airflow

-3 variable resistance levels

✔ Suitable for beginners

✘ Not entertaining

✘ Mostly designed for athletes

BREATHING+ by BreahingLabs

Non-contact/pneumatic principle (using mouth to force air into device)

-Making exhalations longer and more efficient

- Guidance system: Visual and auditory

- operates on Android, iOS, Windows and Mac devices

-Includes numerous “breathing games” and accessibility tools for pulmonary rehabilitation

-Clinically tested “Pursed Lip Breathing” technique

✔ Fun, entertaining

✔ Medical purpose

✔ Non-contact operation

✔ Realtime feedback

✔ Progress tracking

✘ Does not operate standalone, requires phone or computer to operate

4 OUR PRODUCTS

4.1 Breathing Games

Breathing games are based on a breathing technique called Pursed Lip Breathing and they are designed to train kids to exhale longer. Breathing games run on computers and mobile devices. Breathing guidance is being provided and breathing rate is being monitored.

4.2 Breathing Toys

Breathing Toys are electronic toys that are played with your breathing exercise implementation and offer the excitement of real life interaction of two competitive players.

4.3 Breathing Video

Breathing Video is a tool to improve breathing by watching television. It is designed to most efficiently reduce users’ breathing rate. It does so by synchronising video content with the act of exhaling through pursed lips. It has been tested against the control group and it showed a consistent improvement in breathing rate reduction in less than 5 minutes of use.

4.4 Breathing Scrolling

Breathing Scrolling is a new healthy way to scroll websites or pdf documents - without using computer mouse or keyboard. Just blow into the headset to scroll any website or pdf document. Scrolling speed can be adjusted to your preference. Breathing scrolling is available as a Chrome extension on Google Chrome browser or as a bookmarklet that can be easily dragged and dropped into bookmarks bar in other web browser.


4.5 Breathing Headset

BREATHING+ headset is built out of soft and comfortable polyethylene plastic. It is adjustable for different head sizes, durable and washable. It is designed to provide maximum comfort and best possible PLB detection in a quiet or loud environment. Additionally BREATHING+ headset provides hands-free operation, firm position in front of mouth and a superb signal-to-noise ratio resulting in the most accurate breathing detection.

4.6 Breathing Package

BREATHING+ package is a complete solution that turns your desktop computer and/or mobile phone into a fun interactive breathing exercises gaming system. BREATHING+ is already being used in clinical environments to manage asthma, COPD, postoperative rehabilitation, stress and anxiety. Now you can use this technology in your home to play breathing games and efficiently improve your breathing. It's a new kind of fitness, it's "pilates" of the next century!


5 ADVANTAGES

5.1 Comparison with other technology for breathing exercises (table 1)


5.2 Comparison with other game controllers (keyboard, mouse, joystick, touchpad)

Typing on a keyboard/mouse or on screen causes tension in hands and upper back resulting in a tense posture and possibly leading to injuries like “carpal tunnel syndrome”. Thus kids start breathing shallow, with upper parts of their lungs which is leading to shortness of breath and low oxygenation. With breathing games kids learn to breathe deeper and slower and also improve speaking skills so they consequently become more assertive, confident and socially active.


5.3 SWOT - Strengths, Weaknesses, Opportunities, Threats

Strengths

Weaknesses

  • video games enhance motivation which leads to greater compliance of breathing exercises
  • better hygiene due to non-invasive detection of breathing
  • improves breathing without raising dependence on technology (because user provides pressure by exhaling through pursed lips and not by exhaling into a tube or pipe)
  • higher long term motivation due to weekly new breathing games on Android, iOS, Windows and Mac devices

  • cannot be used standalone, requires mobile phone or personal computer to work
  • kids under 7 years should be assisted by their parents, caregivers or respiratory physiotherapist

Opportunities

Threats

  • healthier way to use computers, for example “breathing scrolling” or “breathing television”
  • improves speaking and singing skills
  • “breathing scrolling” may reduce repetitive strain injuries such as carpal tunnel syndrome

  • drink water before and after exercise to prevent dehydration
  • short-term dizziness is possible, in that case user should rest between breaths and after exercise




6 EXPERT OPINIONS

6.1 American Lung Association

"Keep using the pursed-lip breathing until the breathless feeling goes away. Rest in between breaths if you feel Dizzy. Give sips of room temperature water."

6.2 Cleveland Clinic

"Pursed lip breathing is one of the simplest ways to control shortness of breath. It provides a quick and easy way to slow your pace of breathing, making each breath more effective."

6.3 University of Iowa Children's Hospital

“Pursed lip breathing helps you use less energy to breathe. It can help you relax. When you are short of breath, it helps you slow the pace of your breathing and can help you feel less short of breath.”

6.4 The Ohio State University Medical Center

“Pursed Lip Breathing keeps airways open longer during exhalation. This helps release trapped air from your lungs and allow fresh air to come in. Practise PLB while you are resting so you can use this technique when you are feeling short of breath.”

6.5 University of Minnesota Medical Center

“Inhaling through the nose and exhaling through pursed lips makes breathing easier. Pursed-lip breathing can also help you regain control if you’re having trouble catching your breath. You can practice breathing this way anytime, anywhere. If you’re watching TV, practice during the commercials. Try to practice several times a day. Over time, pursed-lip breathing will feel natural.”

6.6 University Health Service, University of Michigan

“Pursed-lip breathing helps you breathe more air out so that your next breath can be deeper.”

6.7 Vanderbilt University Medical Center

“Pursed-lip breathing can help you get more oxygen into your lungs when you are short of breath. When you start to feel short of breath, use pursed-lip breathing to control your breathing. Breathing in through the nose and exhaling through pursed or closed lips makes breathing easier.“

6.8 UTMB, The University of Texas

“It is often helpful to have a patient with asthma or COPD exhale through "pursed lips," a maneuver that increases resistance to exhalation at the mouth. This maneuver is believed to transmit an early expiratory back pressure to the bronchial tree and the back pressure is believed to prevent early collapse of small bronchioles and improve exhalation from alveoli (specifically COPD patients).”

6.9 American Thoracic Society

“Pursed-lip breathing attempts to prolong active expiration through half-opened lips, thus helping to prevent airway collapse. Compared with spontaneous breathing, pursed-lip breathing reduces respiratory rate, dyspnea, and PaCO2, while improving tidal volume and oxygen saturation in resting conditions.


7 CONTACT AND MORE INFORMATION


[1] Bozkurt, Biykem, and Douglas L Mann. "Shortness of breath." Circulation 108.2 (2003): e11-e13.

[2] Bott, Julia, and British Thoracic Society Physiotherapy Guideline Development Group. Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. BMJ Publ. Group, 2009.

[3] "Asthma Action Plan - American Lung Association." 2012. 26 Nov. 2014 <http://www.lung.org/associations/states/colorado/asthma/asthma-action-plan.html>

[4] American Association of Cardiovascular & Pulmonary Rehabilitation. Guidelines for pulmonary rehabilitation programs. Human Kinetics, 2010.

[5] Bott, Julia, and British Thoracic Society Physiotherapy Guideline Development Group. Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. BMJ Publ. Group, 2009.

[6] Fregonezi, GA de F, VR Resqueti, and R Güell Rous. "Pursed lips breathing." Archivos de Bronconeumología ((English Edition)) 40.6 (2004): 279-282.

[7] Robinson, Linda. "Stress and anxiety." The Nursing clinics of North America 25.4 (1990): 935-943.

[8] "Principles and Practice of Stress Management, Third Edition ..." 2012. 7 Dec. 2014 <http://www.amazon.com/Principles-Practice-Stress-Management-Edition/dp/160623000X>

[9] "Attention Deficit Disorder (ADD and ADHD) - Psych Central." 2004. 9 Apr. 2015 <http://psychcentral.com/disorders/adhd/>

[10] "Speech and Language Disorders and Diseases." 2003. 9 Apr. 2015 <http://www.asha.org/public/speech/disorders/>

[11] Bott, Julia, and British Thoracic Society Physiotherapy Guideline Development Group. Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. BMJ Publ. Group, 2009.

[12] "Pursed Lip Breathing - Cleveland Clinic." 2014. 9 Apr. 2015 <http://my.clevelandclinic.org/health/diseases_conditions/hic_Understanding_COPD/hic_Pulmonary_Rehabilitation_Is_it_for_You/hic_Pursed_Lip_Breathing>