Segmental Breathing

Thanks for checking out the next post in the pulmonary rehab toolbox! We’re going to talk about the performance and use of segmental breathing techniques.

In relationship to COVID-19, segmental breathing can be utilized to target specific lung segments that have been affected by alveolar collapse or damage, but it can also be utilized to target areas of consolidation for pulmonary hygiene purposes. If not treating COVID-19, segmental breathing can be used for pulmonary hygiene purposes for all diagnoses that experience consolidation including COPD, Pneumonia, and CHF.

Start by auscultating the lungs. Areas of diminished sound may indicate decreased gas exchange and alveolar collapse. You can utilize this technique on more than one segment, if you find that is indicated based on your auscultation.

Place a hand on this area and ask your patient to breathe in, trying to bring all their air to your hand. Repeat this for several breaths, but make sure to give your patient rest breaks so that they don’t unintentionally hyperventilate.

I’m not going to lie, this technique is very difficult to perform even for someone who has good body awareness. So, for patients, even just grasping the concept of directing their inspiration towards a particular segment can be very difficult. However, it can be done! And with practice, they can get quite good at it.

This techniques also takes practice, not just by the patient but also by the clinician. You need to have a good understanding of your anatomy and a good amount of experience with lung auscultation to know the difference between normal and diminished sounds. Taking baseline auscultation on all of your patients is a great way to establish what their normal is, so you can compare.

Remember, diminished sound can also indicate other things such as atelectasis. If your patient is experiencing significant resistance and discomfort with attempting to target their inspirations towards a specific segment, they may be experiencing atelectasis, not collapsed alveolar sacs.

Remember, if this is too difficult for your patient, there are other ways to expand collapsed airways such as positive exploratory pressure or hyperinflation techniques!

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What are some funny or creative cues you’ve used to help patient breathe better? Tell me about them in the comments!

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