Breathing Exercises for COPD and Asthma: What 73 Clinical Trials Show

For decades, breathing exercises have been recommended to people with chronic respiratory conditions like COPD and asthma — but how well does the evidence actually hold up? A major 2024 systematic review in the European Respiratory Review pooled data from 73 randomised controlled trials to answer that question.

What the Research Found

The review by Burge and colleagues (2024) included 5,479 participants, the majority living with COPD or asthma. It examined breathing techniques designed to alter respiratory pattern — including pursed lip breathing, diaphragmatic breathing, and yoga breathing — against usual care. The findings were consistently positive for quality of life outcomes, even where the effects on breathlessness itself were modest.

Specifically, breathing exercises reduced breathlessness measured on the modified Medical Research Council (mMRC) scale compared to usual care, though the effect did not always exceed the minimal important difference in isolation. Where the evidence was stronger and more consistent was in health-related quality of life: across multiple validated measures in COPD and asthma populations, the improvements “generally exceeded the minimal important difference.” No adverse events related to breathing techniques were reported across any of the 73 trials.

Which Techniques Were Studied?

The most commonly evaluated techniques were pursed lip breathing and diaphragmatic breathing — the two methods most commonly taught in pulmonary rehabilitation. Yoga breathing (pranayama) was also included and showed similar patterns of benefit. The review deliberately excluded respiratory muscle training (e.g. inspiratory muscle trainers), focusing only on techniques that modify breathing pattern through instruction and practice.

Why Breathing Exercises Help in Respiratory Disease

The mechanisms are reasonably well understood. In COPD, air trapping causes the diaphragm to flatten and lose mechanical advantage — breathing exercises help compensate by recruiting accessory muscles more efficiently and slowing the respiratory rate. Pursed lip breathing in particular extends exhalation time, reducing dynamic hyperinflation and improving gas exchange. In asthma, controlled breathing can reduce respiratory rate and improve the pattern of chest wall movement during episodes of bronchoconstriction.

Beyond the mechanical effects, there is an autonomic component. Slow, deliberate breathing activates the parasympathetic nervous system via vagal tone, reducing the anxiety and hyperarousal that often accompanies breathlessness — creating a feedback loop where calmer breathing leads to less perceived distress, which in turn makes breathing easier.

Practical Implications

The evidence does not support a single “best” breathing technique for respiratory disease. Pursed lip and diaphragmatic breathing are the most studied and have the broadest recommendation basis. For people with COPD or asthma who are not enrolled in formal pulmonary rehabilitation, self-directed practice of these techniques represents a low-cost, zero-risk intervention with consistent quality-of-life evidence behind it.

The key finding from this meta-analysis is that consistency matters more than technique selection. Breathing exercises were beneficial regardless of which specific method was used — the shared mechanism (slower rate, better diaphragm engagement, reduced anxiety) appears to account for most of the benefit.

Study Details

Burge AT et al. “Breathing techniques to reduce symptoms in people with serious respiratory illness: a systematic review.” European Respiratory Review, 2024; 33(174). DOI: 10.1183/16000617.0012-2024. Source: PubMed (PMID 39477355).

This article summarizes current research for informational purposes. Always consult with your healthcare provider for personalized medical advice.