respiratory health exercisesrespiratory health exercises
Image Source : GOOGLE 5 respiratory health exercises for late winter

Late winter can be tough on your lungs. Cold air, Changing weather conditions, and increased exposure to viruses can all contribute to breathing difficulties and even illnesses. But fear not! By incorporating specific exercises into your routine, you can strengthen your respiratory system and improve your overall lung health. Here are 7 exercises to help you breathe easier this late winter.

Diaphragmatic breathing:

Also known as belly breathing, diaphragmatic breathing focuses on engaging the diaphragm muscle to promote deeper, more efficient breathing. To practice, lie down or sit comfortably and place one hand on your abdomen and the other on your chest. Inhale deeply through your nose, allowing your abdomen to rise while keeping your chest relatively still. Exhale slowly through pursed lips, gently drawing your abdomen inward. Repeat for several breaths, aiming to expand and contract your diaphragm with each breath.

Alternate nostril breathing: 

This technique can help clear congestion and improve airflow. Close your right nostril with your thumb and inhale slowly through your left nostril. Hold for a few seconds, then close your left nostril with your ring finger and exhale slowly through your right nostril. Inhale through your right nostril, hold, and exhale through your left. Repeat for 5-10 minutes.

Pursed lip breathing:

Pursed lip breathing is a simple technique that helps improve lung function and relieve shortness of breath. Start by inhaling slowly through your nose for a count of two. Then, purse your lips as if you’re about to blow out a candle and exhale slowly and evenly for a count of four. This prolonged exhalation helps keep airways open, reduces air trapping in the lungs, and promotes relaxation.

Chest physiotherapy:

Chest physiotherapy techniques, such as chest percussion and postural drainage, can help mobilize and clear excess mucus from the lungs, making breathing easier. Perform chest percussion by gently tapping on the chest with cupped hands to loosen secretions, followed by postural drainage, where you position your body to allow gravity to help drain mucus from specific lung segments. 

Chest expansion exercises: 

These gentle stretches help open up your chest cavity and improve lung capacity. Stand tall with your shoulders back and arms relaxed at your sides. Inhale deeply, feeling your chest expand. Hold for a few seconds, then exhale slowly. Repeat 5-10 times. You can also try variations like arm circles or chest stretches with your hands clasped behind your back.

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ByZarafshan Shiraz, New Delhi

The end of winters are here and as much as we enjoy the last of the cold weather, there are people who get sick due to the weather change which includes flu, sinuses, cold and cough etc. On the other hand, people with known respiratory illness face a lot of challenges with regular breathing function especially in cities but sweat not as we got an expert on board to discuss more about pulmonary function, respiratory health and how breathing exercises can be an aid.

12 ways and exercises to manage your respiratory health during end of winters (Photo by Freepik)
12 ways and exercises to manage your respiratory health during end of winters (Photo by Freepik)

In an interview with HT Lifestyle, Priya Singh, Women’s Health Physiotherapist and Lactation Consultant at Cloudnine Group of Hospitals, in Navi Mumbai's Vashi, highlighted the common concerns people face with most of the respiratory illness when combined -

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  • Breathlessness ( Dyspnea )
  • Cough, sputum secretions
  • Weight loss
  • Generalised fatigue
  • Chest pain
  • Fever followed by an infection
  • Noisy breathing (wheezes), most common in patients with Obstructive lung disease and Asthma.

Priya Singh said, “Breathing is one of the automated function for humans for living but no one has ever thought about the numerous benefit breathing consciously would have on lungs and over all respiratory health.” She explained:

  1. Breathing exercise helps with generalized fatigue
  2. Provides relief from Breathlessness ( Dyspnea) by improving oxygenation
  3. Improves respiratory muscle function and strength
  4. Helps in clearing out secretions and sputum
  5. Relaxes body through reducing elevated blood pressure and heart rate

Asserting that maintaining respiratory health during winter is important since cold and dry air can have an impact on the respiratory system, Priya Singh suggested some tips to help you manage your respiratory health -

  1. Stay Warm and Layered: Dress warmly to protect yourself from the cold air. Use layers to trap heat and prevent your body temperature from dropping too much.
  2. Stay Hydrated: Cold air can be drying to the respiratory passages. Drink plenty of water to stay hydrated and keep your mucous membranes moist.
  3. Use Humidifiers: Humidifiers add moisture to the air, which can be beneficial, especially in heated indoor environments. This helps prevent the airways from becoming too dry.
  4. Practice Good Hand Hygiene: Wash your hands regularly to reduce the risk of respiratory infections. Viruses that cause respiratory illnesses are more prevalent during the winter months.
  5. Avoid Smoke and Pollutants: Stay away from tobacco smoke and other pollutants, as they can irritate the respiratory system and worsen respiratory conditions.
  6. Exercise Regularly: Regular physical activity can help strengthen your respiratory muscles and improve lung function. However, if you have respiratory conditions, consult your healthcare provider before starting a new exercise program.
  7. Practice Deep Breathing Exercises: Engage in deep breathing exercises to improve lung capacity and promote better respiratory function.
  8. Maintain Indoor Air Quality: Ensure good ventilation in your home and avoid the use of strong chemicals or cleaning products that may irritate the respiratory system.
  9. Get Vaccinated: Consider getting vaccinated against respiratory infections, such as the flu. Consult with your healthcare provider for advice on vaccines that are appropriate for you.
  10. Eat a Balanced Diet: Consume a diet rich in fruits, vegetables, and whole grains. These foods provide essential nutrients that support overall health, including respiratory health.
  11. Manage Respiratory Conditions: If you have pre-existing respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD), work closely with your healthcare provider to manage and control your symptoms. Ensure that you have an action plan in place.
  12. Stay Informed: Be aware of air quality levels and weather conditions, especially if you have respiratory conditions that may be affected by changes in temperature and air quality.

Talking about the types of breathing exercises that are available to us to manage respiratory illness, Priya Singh explained -

  1. Diaphragmatic Breathing exercise - This breathing involves filling air in your lungs while you allow your abdomen to expand and gradually breath out and engage your abdomen inwards. This breathing exercise helps particularly with releasing tension around the intercostal muscles, relaxes he body by lowering blood pressure, provides energy to continue with activity of daily living.
  2. Pursed lip breathing - In this type of breathing you have to inhale deep and exhale gradually through your mouth, note that your exhalation time has to be more than inhalation. This breathing particularly with breathlessness, calms down the system. Mostly helpful in cases of asthma and COPD.
  3. Segmental expansion breathing exercise – This exercise as the name suggests is perform at particular segment, helps in conditions where there is accumulation of fluid around the segment of the lung like in pneumonia, improves chest wall movement, the aim remains to improve oxygenation and ventilation followed by underlying respiratory illness.

She revealed an another pulmonary rehabilitation program that includes the below breathing techniques -

  • Forced Expiratory Technique – also known as FET technique: As we can understand by the name of the technique this pattern of breathing is focusing on force full exhalation across the lung volumes, this technique of breathing helps with effective coughing and clearance of collected mucus.
  • Active Cycle of Breathing Technique – also known as ACBT technique: This pattern of breathing involves cyclic pattern breathing combining FET that is breathing for 5 times and controlling the same followed by again active cycle of 5 breaths and 2-3 FET Breathing ending with breath control , when performed in cyclic manner helps with mobilizing the mucus, improves lung volume and capacity.
  • Autogenic drainage: This technique of breathing is when you are breathing deeply through your nose keeping the rate and depth of it in mind during inspiration, which starts from the lowest segment of lung and moves towards apical segment. This technique has stages where it helps in providing great relief with chest congestion by mobilising the secretions.

Priya Singh concluded, “The above exercise are beneficial not only during winters but when practiced under guidance of a Physiotherapist can bring improvement in ones respiratory health. The atmosphere where you are practicing breathing exercise is equally important, so while you start performing make sure that you have good source of ventilation.”

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Do These Breathing Exercises To Strengthen Your Lungs
Breathing exercise helps with generalised fatigue. (Photo: Freepik)

Breathing is an "automated function" for humans, but no one has ever thought about the numerous benefits it has on lungs and respiratory health, said an expert.

Written by Prerna Mittra |Updated : February 9, 2024 11:24 AM IST

There are many things you can do to strengthen your lungs, especially if you are susceptible to seasonal illnesses and infections. The basic thing would be to stay away from irritants, pollutants, and to quit smoking completely. Other than that, there are many breathing exercises that you can try to bolster the health of your lungs that are crucial organs.

Priya Singh, women's health physiotherapist and lactation consultant, Cloudnine Group of Hospitals, Vashi, Navi Mumbai said breathing is an "automated function" for humans, but no one has ever thought about the numerous benefits it has on lungs and respiratory health.

  • Breathing exercise helps with generalised fatigue.
  • It provides relief from breathlessness (dyspnea) by improving oxygenation.
  • It improves respiratory muscle function and strength.
  • It helps in clearing out secretions and sputum.
  • It relaxes the body through reducing elevated blood pressure and heart rate.

According to the expert, in order to manage respiratory health and to stay away from illnesses, one needs to practise the following breathing exercises:

  1. Diaphragmatic breathing exercise: It involves filling air in your lungs while you allow your abdomen to expand; gradually breathe out and engage your abdomen inwards. This breathing exercise helps with releasing tension around the intercostal muscles, relaxes the body by lowering blood pressure, and provides energy for everyday activities.
  2. Pursed lip breathing: You have to inhale and exhale gradually through your mouth. Your exhalation time has to be more than inhalation. This breathing, particularly with breathlessness, calms down the system. It is mostly helpful in cases of asthma and COPD.
  3. Segmental expansion breathing exercise: This exercise helps with conditions where there is accumulation of fluid around the segment of the lung like in pneumonia. It improves chest wall movement. The aim is to improve oxygenation and ventilation followed by underlying respiratory illness.

breathing exercises, effective breathing excercises, Breathing exercise, Lung health care, ways to improve lung health, home remedies to improve lung health,

Singh added that other "pulmonary rehabilitation programs" include the below breathing techniques:

  1. Forced Expiratory Technique: FET focuses on the force of full exhalation across the lung volumes; this technique of breathing helps with effective coughing and clearance of collected mucus.
  2. Active Cycle of Breathing Technique: ACBT pattern of breathing, when performed in cyclic manner, helps in mobilising the mucus, improving lung volume and capacity.
  3. Autogenic drainage: This technique of breathing is when you are breathing deeply through the nose keeping the rate and depth of it in mind. It has stages where it helps in providing relief from chest congestion by mobilising the secretions.

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Breathing can be of varied types and the way we breathe can be very critical especially if we have some medical condition. Thus it is important to have a sense of control over our breathing. Pursed lip breathing is one such technique that can help you breathe in a better way.

Chronic Obstructive Pulmonary Disease (COPD) is a lung condition in which breathing becomes very difficult. Even in the case of asthma or other breathing related conditions, pursed lip breathing can come in handy. Practicing this breathing technique will provide you relief and help you gain more control over your condition.

In this article, we will look more into this breathing technique, its advantages, and how to perform it.

Pursed lip breathing: Understanding the procedure

How to perform this breathing technique? (Image by Freepik on Freepik)How to perform this breathing technique? (Image by Freepik on Freepik)
How to perform this breathing technique? (Image by Freepik on Freepik)

This technique is quite simple but it takes time to make it a habit. Thus, practicing it every day is the key to master and enjoy the whole lot of benefits of pursed lip technique.

To perform this, all you need to do is breathe through your nose while keeping your mouth closed. Now, exhale slowly for five to six seconds through your lips held in a whistling position.

While doing this, make sure you do not force the air out and the period of breathing in should be smaller compared to breathing out. Practicing this for 10 minutes a day will help you get a step closer to gaining control over your breathing.

How is it helpful?

what is the significance of this technique? (Image by yanalya on Freepik)what is the significance of this technique? (Image by yanalya on Freepik)
what is the significance of this technique? (Image by yanalya on Freepik)

Performing this technique daily improves our lung capacity. As we exhale for a longer time, it keeps our air pathways open for a longer period of time. This enables our lungs to intake a higher amount of oxygen and exhale more carbon dioxide.

Further, it makes us feel relaxed as our breathing rate slows down and helps in getting relief from stress. Regular slow breathing and following this breathing technique will make your nervous system feel more relaxed. The reason behind this is that your nervous system sends a signal to your brain, which makes you feel calmer.

Other than this, there are more benefits to pursed lip breathing technique. Performing this regularly also makes you more capable of performing your daily activities or workouts effortlessly as this technique strengthens your lungs.

What else can you do to get control over your breathing?

Box breathing or diaphragmatic breathing can also be helpful (Image via Freepik on Freepik)Box breathing or diaphragmatic breathing can also be helpful (Image via Freepik on Freepik)
Box breathing or diaphragmatic breathing can also be helpful (Image via Freepik on Freepik)

Pursed lip breathing is not the only breathing technique that can help you breathe efficiently. There are more ways you can opt for like box breathing where all you need to do is breathe in for four seconds, hold for four seconds, again breathe out for four seconds, and again hold it. Repeat this four to five times a day.

This is also a very highly efficient way to get control of your breathing. Just like pursed lip breathing, box breathing can also provide you with a calming effect. There are various breathing techniques available one can choose from based on their needs. If you suffer from asthma or COPD, then it is advised to go for pursed lip breathing.

There are no risks related to this breathing technique, however, it is better to take advice from your medical adviser before inculcating it in your routine. Whether used during exercise or moments of distress, pursed lip breathing offers a breath of relief in the face of respiratory challenges.

Edited by Sudeshna Banerjee

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Oxygen saturation is a critical indicator of your respiratory health. When blood oxygen levels are low, it can indicate that insufficient oxygen is reaching your organs and tissues, which may lead to various health problems. Therefore, it is crucial to understand the normal range of oxygen levels in your blood. So, read this guide to know how normal oxygen levels can be maintained and also discover tips on how to boost oxygen levels naturally in the blood.

What Does Blood Oxygen Level Mean?

Blood oxygen level, often measured as oxygen saturation or SpO2 (Peripheral Capillary Oxygen Saturation), indicates the amount of oxygen carried by red blood cells throughout your body. It represents the number of haemoglobin molecules in your bloodstream that are bound to oxygen. Haemoglobin is a protein in red blood cells that binds to oxygen in your lungs and carries it to the rest of your body's tissues and organs.

This blood oxygen level indicates how well the body is oxygenated. Having adequate blood oxygen levels is essential for cellular energy production, influencing cognitive function, immune response, and metabolic processes in your body. When blood oxygen levels fall lower than usual, it is termed hypoxemia, caused by conditions like anaemia, sleep apnea, certain lung disorders and cardiovascular conditions. While high blood oxygen levels (hyperoxemia), are less common and are usually seen in patients receiving too much supplemental oxygen or with certain conditions like polycythemia (excessive red blood cells). This makes monitoring and maintaining a normal range of oxygen levels paramount for overall health and sustaining vital physiological processes in your body.

What is a Blood Oxygen Level Test?

A blood oxygen level test measures the amount of dissolved oxygen in your blood. It is commonly performed using a pulse oximeter or an arterial blood gas test (ABG test) that measures oxygen and CO2 levels directly from the blood. An ABG test is more informative than pulse oximetry.

Oxygen Level Blood Draw Test

The oxygen level blood draw test involves obtaining a blood sample to assess the oxygen content in the bloodstream. This test directly analyses blood gases.

A healthcare professional typically draws blood from an artery. The sample is then analysed to determine oxygen and carbon dioxide levels. This method is commonly used in critical care settings to evaluate patients with severe respiratory conditions or those undergoing specific medical procedures.

Pulse Oximetry

Pulse oximetry is a non-invasive medical technique used to measure the normal range of SpO2. This quick and painless method can monitor patient's oxygen levels in various clinical settings, including hospitals, outpatient care, and home environments.

A small device called a pulse oximeter is typically clipped onto a fingertip, toe, or earlobe, emitting light that passes through the skin and blood vessels. The device calculates oxygen saturation levels as a percentage by assessing the colour changes in oxygenated and deoxygenated haemoglobin, making it helpful in detecting early signs of respiratory distress or hypoxemia.

Why Do I Need to Have My Blood Oxygen Level Tested?

Monitoring blood oxygen levels is essential for early detection of respiratory issues such as Chronic Obstructive Pulmonary Disease (COPD), asthma, or pneumonia. It is also vital for assessing the effectiveness of treatments for respiratory conditions and ensuring optimal oxygen supply to the body's tissues and organs. Therefore, this test is particularly important for individuals with pre-existing respiratory conditions, heart conditions, or those undergoing surgery, as they are at a higher risk of experiencing fluctuations in oxygen levels. Even during the SARS-CoV-2 outbreak that caused a global pandemic, regular monitoring of blood oxygen levels was a critical step as a potential indicator of the COVID-19 disease, making regular blood oxygen level testing crucial for various health reasons.

Doctors can detect abnormalities early on by routinely testing blood oxygen levels, enabling prompt intervention and preventive measures. After all, it determines the efficiency with which your lungs are able to filter oxygen from the air into the blood when you breathe in and if CO2 is being adequately filtered out of the blood when you breathe out.

How Can I Increase My Blood Oxygen Level?

Here is how you can increase your blood oxygen level:

  • Deep Breathing Exercises: Engage in deep breathing exercises, such as diaphragmatic breathing or pursed lip breathing, to enhance lung capacity and oxygen exchange.
  • Regular Physical Activity: Incorporate regular aerobic exercise into your routine. Activities like walking, jogging, or swimming can improve cardiovascular health, promoting efficient oxygen transport.
  • Maintain Hydration: Staying hydrated is vital for optimal blood viscosity, facilitating smoother oxygen transport throughout the body.
  • Adequate Sleep: Ensure sufficient and quality sleep to support overall health, including respiratory function and oxygenation.
  • Avoid Smoking: Quit smoking and avoid exposure to secondhand smoke, as it can impair lung function and decrease oxygen levels.
  • Maintain Healthy Weight: Achieve and maintain a healthy weight to reduce the strain on the respiratory system and enhance oxygenation.
  • Foods to Increase Oxygen Levels in the Body: While no specific foods directly increase oxygen levels, incorporating a diet rich in antioxidants, vitamins, and minerals can support overall respiratory health. Nutrient-dense foods like dark leafy greens, berries, citrus fruits, nuts, seeds, etc., contribute to overall well-being and may indirectly support respiratory function. Moreover, consuming iron-rich foods like lean meats, beans, and leafy greens supports haemoglobin production, enhancing oxygen-carrying capacity in your blood.

Who Performs a Blood Oxygen Level Test?

A blood oxygen level test is typically performed by healthcare professionals, including nurses, respiratory therapists, and physicians. These trained individuals have the expertise to use a pulse oximeter or blood test for measuring oxygen saturation.

However, patients with chronic respiratory conditions or those requiring at-home monitoring may be instructed on how to perform the test through guidance from the healthcare team. These healthcare professionals then interpret the test results to guide diagnosis and treatment decisions.

What Happens Before a Blood Oxygen Level Test?

Before a blood oxygen level test, you are likely to have a brief preparation process. In a clinical setting, a healthcare professional, such as a nurse or respiratory therapist, will guide you through the procedure and explain the test's purpose, ensuring you understand its importance.

You might be asked to remove any nail polish or artificial nails, as these can interfere with accurate readings from the pulse oximeter. Before a blood test, it may be ensured that you have not been on supplemental oxygen for a specific duration, as this can impact the results. It is, therefore, essential to follow the instructions closely to obtain accurate and reliable results.

What Should I Expect During a Blood Oxygen Level Test?

Here is how it goes for:

Pulse Oximetry

When undergoing a blood oxygen level test with a pulse oximeter, you can expect a straightforward and non-invasive process.

A healthcare technician will attach the device to the selected site (often the fingertip) with its clip. The clip does not cause pain, and the device is designed to be minimally intrusive. The pulse oximeter emits two types of light, typically red and infrared, which pass through the skin and are absorbed by oxygenated and deoxygenated haemoglobin in the blood. The device calculates oxygen saturation based on the absorption of light and the device continuously monitors your blood oxygen levels for a few seconds. During this time, it is necessary to remain still and avoid excessive movement or talking, as these factors can affect the accuracy of the readings.

Once the measurement is complete, the pulse oximeter displays your oxygen saturation level as a percentage. This provides a quick assessment of how well your blood is carrying oxygen. If your oxygen saturation falls within the normal range, it indicates effective oxygen delivery to your body. If the levels are lower than normal, further investigation may be needed to identify the underlying cause.

Blood test

For the blood test (Arterial Blood Gas test), you may be asked to lie still during the procedure.

Unlike routine blood tests that use venipuncture (drawing blood from a vein), an ABG test involves drawing a small sample of arterial blood. Arterial blood is collected as the amount of oxygen in arterial blood is higher compared to venous blood. A phlebotomist or nurse will locate an artery, commonly the radial artery in the wrist, and use a needle to collect the blood. It is also possible to extract it from an artery located in the groin area or on the inner side of the arm just above the elbow fold. This collected arterial blood is typically placed in a heparinised syringe to prevent blood clotting. After collecting a sufficient amount of blood for testing, the needle will be removed, and pressure with a cotton ball or gauze will be applied to the site to control bleeding followed by applying a bandage on the draw site. The sample is immediately labelled with your information and sent to the laboratory for analysis.

The blood sample then undergoes thorough analysis in the laboratory, assessing parameters such as pH, Partial Pressure of Oxygen (PaO2), Partial Pressure of Carbon Dioxide (PaCO2), and Oxygen Saturation (SaO2). Once the analysis is complete, the results are sent to your doctor to interpret the findings in the context of your overall health. If the ABG test reveals any abnormalities, your doctor may recommend further tests or adjustments to your treatment plan. For individuals with respiratory conditions, such as COPD or asthma, the results can guide ventilator settings, oxygen therapy, or other interventions.

What Should I Expect After My Blood Oxygen Level Test?

There is a slight risk of bleeding or infection at the puncture site for the ABG test. However, any discomfort is typically brief. While after the pulse oximetry test, you can resume your normal activities.

What Do The Results of a Blood Oxygen Level Test Mean?

The test results mean the following:

In Pulse Oximetry

If you have an oxygen saturation of 95% and above, it means you have normal blood oxygen. However, any percentage lower than this can signify problems with oxygen loading and transport in the body. It is important to note that pulse oximetry has a margin of error of around 2-4%, therefore, not entirely accurate.

In Arterial Blood Gas Test

ABG test reports the pressure exerted by oxygen dissolved in arterial blood. This test is considered to provide a more accurate measure of blood oxygen levels than pulse oximetry. Moreover, you can also find out if CO2 is adequately filtered out of your blood (given by PaCO2) or if you have an oversaturation of oxygen (high PaO2).

What is a Normal Blood Oxygen Level?

The normal range of SpO2, typically falls between 95% to 100%. However, the ideal normal range of oxygen levels can vary slightly with age. For instance, in healthy individuals, the normal oxygen level for adults is generally considered to be 95% or higher across all age groups. Infants and young children may have slightly higher baseline levels, often around 98% to 100%.

If you suffer from certain respiratory diseases like COPD, Asthma, Pneumonia, etc, your normal range of oxygen levels may be slightly lower than normal (90-95%) and has to be determined by your doctor. Individual variations and factors like activity level, various medical conditions, and altitude can influence baseline levels. However, mild fluctuations within the normal range are common.

It is important to note that various laboratories may establish distinct reference ranges for the components measured in a blood oxygen level test. Upon receiving your blood test results, you will find details specifying the normal range of oxygen levels set by that particular lab for each measurement. If you have inquiries regarding your results, it is advisable to consult your healthcare provider for clarification.

What Does a Low Blood Oxygen Level Mean?

A low blood oxygen level indicates insufficient oxygen in your bloodstream to meet the body's needs adequately. Since the normal range for blood oxygen saturation (SpO2) typically falls between 95% and 100%, oxygen levels drop below 95% may signal a potential issue with respiratory function. However, what oxygen level is too low or what is a dangerously low oxygen level depends on the specific condition of the person.

Generally, a SpO2 level below 90% is considered way below normal and warrants medical attention. Levels between 92% and 88% are considered mild hypoxemia, 87% to 84% moderate hypoxemia, and below 84% severe hypoxemia. A dangerously low oxygen level is typically defined as SpO2 below 80%, which can pose severe health risks, including organ damage and life-threatening complications.

Immediate medical intervention is crucial for individuals with dangerously low oxygen levels to provide supplemental oxygen and initiate appropriate treatments to restore optimal oxygenation and prevent complications.

When Should I Know The Results of My Blood Oxygen Level Test?

You should typically receive immediate results after a blood oxygen level test with a pulse oximeter. For more comprehensive tests like Arterial Blood Gas (ABG), results may take a little longer, usually within a few hours to a day.

When Should I Call My Doctor?

Call your doctor if you experience persistent symptoms of low oxygen levels, such as shortness of breath, rapid breathing, confusion, or chest pain or your oxygen saturation (SpO2) in the pulse oximeter drops below 92%. Immediate medical attention is also crucial if symptoms worsen and SpO2 levels fall significantly (less than 90%). Additionally, if you have a pre-existing respiratory condition or chronic health issues and notice any changes in your symptoms or SpO2 levels, contact your healthcare provider promptly.

What Are The Symptoms of Not Enough Oxygen in The Blood?

Symptoms of low oxygen levels in the blood (hypoxemia) include shortness of breath, rapid breathing, confusion, dizziness, chest pain, and a bluish tint to the skin or mucous membranes (cyanosis). In severe cases, it can lead to mental confusion, lethargy, and unconsciousness. If experiencing symptoms of low oxygen levels, seek prompt medical attention.


Understanding the significance of blood oxygen levels is pivotal for evaluating your respiratory health. While normal blood oxygen levels signal a SpO2 level of 95% and above, low oxygen levels, particularly below 90%, signal potential respiratory issues, necessitating prompt medical attention. Whether measured through pulse oximetry or arterial blood gas tests, interpreting results within the normal range is essential. Looking to undergo a blood oxygen test to measure your SpO2 accurately? Look no further! With state-of-the-art testing facilities alongside expert technicians, Metropolis Labs is the trusted choice by top hospitals and doctors in India. Book your blood oxygen test with Metropolis Labs today!

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Winter health: Impact of cold wave on asthma patients, expert shares tips to curb severe symptoms

Cold air is a common trigger for asthma symptoms (Photo credit: Freepik)

New Delhi: The colder months can significantly impact individuals with asthma, presenting unique challenges that may exacerbate their respiratory condition. As several states recorded dropping temperature, Dr Harish Chafle, Senior Consultant, Chest Physician, Bronchoscopists , Intensivist and Sleep Disorders specialist, Global Hospitals Parel Mumbai, warned that asthma patients should be especially vigilant during colder months, taking proactive measures to minimise triggers and maintain optimal respiratory health.

“By adopting a multifaceted approach that encompasses medication adherence, trigger management, healthy living practices, and proactive monitoring, individuals with asthma can effectively curb severe symptoms and maintain optimal respiratory health. Regular communication with healthcare professionals ensures a collaborative effort in managing and controlling asthma,” he said.

How colder days impact asthma patients?

Several factors associated with colder weather contribute to increased difficulties for asthma patients:

Cold Air Trigger: Cold air is a common trigger for asthma symptoms. Inhaling cold air can cause airway constriction and bronchoconstriction, leading to coughing, wheezing, and difficulty breathing. This effect is particularly pronounced during outdoor activities in cold weather.

Dry Air and Dehydration: The expert said, “Cold air is often dry, which can contribute to dehydration of the airways. Dehydrated airways are more prone to irritation and inflammation, exacerbating asthma symptoms. Proper hydration becomes crucial during colder months.”

Viral Infections: Cold weather is associated with an increased prevalence of respiratory infections, including the flu and the common cold. For asthma patients, respiratory infections can act as triggers, leading to more frequent and severe asthma attacks.

Indoor Allergens: Individuals tend to spend more time indoors during colder months, leading to increased exposure to indoor allergens such as dust mites, mold, and pet dander. These allergens can worsen asthma symptoms and trigger allergic reactions.

Heating Systems: Indoor heating systems, especially those using forced air, can contribute to a reduction in indoor air humidity. Dry indoor air can irritate the respiratory tract, making it more challenging for asthma patients to breathe comfortably.

Reduced Physical Activity: Cold weather may discourage outdoor physical activities, leading to a more sedentary lifestyle. Regular exercise is essential for maintaining lung function, and a reduction in physical activity can impact overall respiratory health for asthma patients.

Tips for asthma patients in colder months

Here are several strategies that can be implemented to curb severe asthma symptoms:

Follow an Asthma Action Plan: Collaborate with a healthcare professional to create a personalized asthma action plan. This plan should outline daily medications, rescue inhaler use, and steps to take in case of worsening symptoms.

Take Medications as Prescribed: Consistent use of prescribed medications, including long-term controllers and rescue inhalers, is essential in managing asthma. Adhering to the prescribed dosage and schedule helps prevent exacerbations.

Identify and Avoid Triggers: Dr Chafle said, “Work with healthcare providers to identify specific triggers that worsen asthma symptoms. Common triggers include allergens, smoke, pollutants, and respiratory infections. Taking steps to minimise exposure to these triggers can significantly reduce the frequency and severity of symptoms.”

Use Peak Flow Meters: Regularly monitor lung function using peak flow meters. This helps individuals track changes in airflow and detect early signs of worsening asthma, allowing for prompt intervention.

Maintain a Healthy Lifestyle: He said that adopting a healthy lifestyle contributes to overall respiratory well-being. This includes regular exercise, a balanced diet, and adequate hydration. Physical activity can improve lung function and reduce the likelihood of severe symptoms.

Stay Informed: Education is crucial in managing asthma. Stay informed about the condition, understand medication usage, and recognise warning signs of worsening symptoms. Regular follow-ups with healthcare providers ensure ongoing support and adjustments to the management plan.

Incorporate Breathing Exercises: Practice breathing exercises, such as pursed lip breathing and diaphragmatic breathing, to enhance lung function and manage symptoms during periods of distress.

Create a Clean Indoor Environment: Minimise exposure to indoor allergens by regularly cleaning and ventilating living spaces. Use air purifiers, and consider implementing dust mite-proof bedding to create a clean indoor environment.

Emergency Preparedness: Be prepared for emergencies by having a well-stocked emergency kit that includes prescribed medications, a rescue inhaler, and a copy of the asthma action plan. Educate family members and caregivers on how to respond during an asthma attack.

Seek Immediate Medical Attention: If severe symptoms persist or worsen despite following the action plan, seek immediate medical attention. Prompt intervention can prevent the progression of an asthma exacerbation.

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Dubai, United Arab Emirates, January 5, 2024 Since breathing is the basic rhythm of life, breathing control has a major influence on lung health and general well-being. Breathing techniques are among the many methods used to improve respiratory function; they are considered very effective tools which have been valued for ages in many cultures. These methods, which range from conventional therapeutic exercises to age-old yoga poses like pranayama, provide a way to unleash the power of our lungs, improving oxygenation, lowering stress levels, and strengthening our respiratory system. People may take a journey towards better lung health, vibrancy, and a more intimate connection with their bodys most fundamental function by practicing purposeful and mindful breathing while consulting with a top hospital.

Breathing Diaphragmatically

The diaphragm, a dome-shaped muscle located underneath the lungs, must be engaged in order to breathe diaphragmatically, sometimes referred to as diaphragm or deep breathing. Through the expansion of the lower lungs, this method facilitates deeper inhalations and more thorough exhalations, leading to a fuller and more effective breath. The diaphragm pulls downward during contraction, making room for the respiratory tract to broaden and take in more air that is rich in oxygen. In addition to raising oxygen intake, this technique triggers the relaxation response in the body, which lowers the heart rate and reduces tension. In many disciplines, such as meditation, yoga, and other relaxation and stress-reducing therapies, diaphragmatic breathing is a fundamental practice that provides a straightforward yet effective means of increasing lung capacity, enhancing respiratory function, and promoting general well-being.

Pursed-Lip Inhalation

The concentrated breathing method known as pursed-lip breathing is defined by slowly expelling via lips that are pursed, as if blowing out a candle, and inhaling through the nose. This method, which is especially helpful for people with trouble breathing or shortness of breath, tries to slow down breathing, lengthen exhalation, and control airflow. Pursed-lip breathing keeps airways open for a longer period, preventing tiny airways from closing and encouraging a more thorough expiration by introducing little resistance during exhalation. By increasing breathing efficiency and facilitating a more calm and regulated breathing pattern, this technique helps manage illnesses such as asthma and COPD (chronic obstructive pulmonary disease) and lessens dyspnea.

Square Respiration, Or Box Ventilation

Square breathing, often called box breathing, is a methodical breathing technique usually done in four counts. It consists of consecutive equal-length inhalations, holds, breathes, and holds. The procedure leads people through a regular breathing cycle in a square or box shape. This technique, professionally handled by pulmonologists in dubai, effectively reduces stress and improves mental clarity. Breathing synchronized with equal-duration counts (e.g., breathing for four counts, holding for four, expelling for four, and holding again for four) helps people control their nervous system, encourage relaxation, and sharpen their focus. Box breathing is a common technique used in mindfulness exercises, meditation, and by performers and athletes to improve mental clarity, manage stress, and lessen anxiety.

Changing The Nostril Breath

In yoga practice known as Nadi Shoshanna or alternative nostril breathing, changing the nostril breath is a particular breathing rhythm that rotates between nostrils. This method seeks to ease tension, quiet the mind, and harmonize the bodys energy flow. People regulate how much air passes through each nostril by alternately blocking one with their thumb and then ringing their finger when they inhale and exhale. By balancing both the right and left sides of the brain, this practice would balance the neurological system and enhance mental clarity. Breathing through both nostrils is frequently used in yoga, meditation, and mindfulness exercises to increase relaxation, sharpen attention, and control emotions.

Conscious Breathing

Intentionally paying attention to ones breath to center oneself at the moment at hand is known as conscious breathing, and it is frequently derived from mindfulness exercises. This approach focuses on becoming aware of each breath, noting its depth, timing, and sensation without trying to change it. People can develop awareness and increase awareness of their bodily and mental states by purposefully focusing on their breathing. By using conscious breathing as an anchor, people may learn to pay attention to their breath and use it to manage stress, lower anxiety, and promote relaxation. It promotes taking a break from the bustle of everyday life. It provides a straightforward yet effective instrument for self-reconnection, stress relief, and the development of a clearer viewpoint by pulmonologist in dubai.

Breathing Long-Term Exhalation

Increasing the length of the expiration phase compared to the inhale emphases breathing with a prolonged exhalation technique. This method improves lung function, induces relaxation, and lessens tension. People who purposefully prolong their exhalation activate the parasympathetic nerve system, which causes the body to relax. This practice promotes slower breathing rates to facilitate a more thorough exhalation and help clear the lungs of stagnant air. In meditation, yoga, and stress-reduction techniques, prolonged expiratory breathing patterns are frequently employed. This deliberate breathing pattern promotes relaxation, aids in autonomic nervous system regulation, and is especially helpful for people trying to reduce anxiety or increase respiratory efficiency.

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Company: Dubai London Hospital

Email: [email protected]

Phone: +971 54 447 9903


Address: Dubai London Hospital, Umm Suqeim 2, Jumeirah Beach Road, Dubai, UAE

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Harnessing the Power of Breathing Exercises in Managing Anxiety

Anxiety disorders, impacting up to 30% of adults globally, have been found manageable using various coping mechanisms, including breathing exercises. These exercises, when complemented with counseling and other treatments, can aid in reducing symptoms such as mood disturbances and elevated heart and respiratory rates.

Demystifying Breathing Techniques for Anxiety

Breathing techniques like box breathing, cyclic sighing, deep breathing, alternate nostril breathing, humming breathing, 4-7-8 breathing, pursed lip breathing, resonance breathing, and lion’s breath have emerged as effective tools to manage anxiety.

Box breathing is a four-part cycle involving inhalation, holding, exhalation, and holding. It can be practiced irrespective of the environment and reduces stress and tension. Cyclic sighing focuses on extended exhalations to engage the parasympathetic nervous system, promoting calmness and relaxation. Deep breathing utilizes the diaphragm to alleviate feelings of anxiety and stress.

Exploring Other Breathing Techniques

Alternate nostril breathing, known to improve attention and lower blood pressure, is another effective technique. Humming breathing, which combines slow breathing with a humming sound during exhalation, contributes to immediate stress relief. The 4-7-8 technique necessitates a specific rhythm of breathing and holding the breath, providing instant calm.

Pursed lip breathing can alleviate shortness of breath and enhance relaxation, while resonance breathing is practiced at a slow rate to decrease stress and blood pressure. Lastly, lion’s breath, which mirrors a lion’s roar for a more forceful exhalation, is also employed to manage anxiety.

Caveats and Considerations

While breathing exercises are generally safe, individuals experiencing significant anxiety should engage healthcare professionals for additional coping strategies and treatment plans. Exercise, sufficient sleep, a nutritious diet, and mindfulness-based practices such as meditation are recommended for maintaining optimal mental health. Supportive relationships and pursuing hobbies can further bolster feelings of well-being, contributing to anxiety management.

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Breathing Exercises For Lung Health: As the cold months gripple, seasonal illnesses such as cough, cold, flu and fever increase significantly. The dry and cold air irritates the passage of the lungs, especially in people with existing lung conditions. One of the best ways to protect your lung health amid winter is to adopt a habit of practising indoor breathing exercises regularly. Being physically active ensures that the body makes use of oxygen to help you breathe and decrease the symptoms of lung diseases. Here are some powerful breathing exercises that you should practise to keep your lungs clean and healthy.

Watch the video below about best foods for lung health: 

Breathing Exercises For Lung Health

1. Pursed Lip Breathing

It is a breathing technique effective for people with asthma, COPD and other breathing problems. It helps control shortness of breath, slows the pace of breathing and enhances the breathing process. According to the Cleveland Clinic, it is a breathing exercise that helps you slow your breathing and inhale and exhale more air. You slowly inhale through your nose and gently exhale through pursed lips. Pursed lip breathing makes it easier to perform physical activities and reduces stress.

ALSO READ: Cold, Cough And Flu In Winters: 5 Home Remedies To Protect Yourself From Influenza During Cold Season

2. Alternate Nostril Breathing

It is a type of yogic breathing that helps in reducing anxiety and stress. Also known as nadi shodhana, this deep breathing exercise helps to regulate the nervous system, lowers blood pressure and enhances healthy breathing.

3. Kapalbhati

Best Breathing Exercises For Lungs (Image Credits: Canva)

It is one of the best breathing exercises for helping the body's entire respiratory system become more detoxified. It helps to eliminate mucus from the airways and congestion in the chest, which relieves shortness of breath.

4. Bhastrika

Bhastrika is a powerful breathing technique that gives the body energy and aids in respiratory system detoxification. It purges the body of all hazardous air contaminants. Practise this exercise under supervision if you have asthma or other breathing difficulties.

ALSO READ: Do Digestive Problems Worsen In Winters? Doctor Lists Tips To Keep In Mind

5. Anuloma Viloma

One of the most beneficial breathing techniques in Hatha yoga is Anuloma pranayama. By performing this exercise regularly, you may help keep the obstructions in your respiratory system free.


(Disclaimer: This article is for informational purposes only. It is not a substitute for professional advice, diagnosis or treatment.)

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As the first signs of winter are palpable, and we are bracing ourselves for the transition, a huge chunk of population has started to feel the dread of the frigid, chilly, dry air….and the encumbent pulmonary distress.


Chronic obstructive pulmonary disease (COPD)] is a common and treatable disease characterised by progressive airflow limitation and tissue destruction. It is associated with structural lung changes due to chronic inflammation from prolonged exposure to noxious particles or gases, most commonly cigarette smoke. COPD is a complex interaction between asthma, chronic bronchitis, and emphysema.
Chronic inflammation causes airway narrowing and decreased lung recoil. The disease often presents with cough symptoms, dyspnea(breathlessness), and increased sputum production which in turn increases chances of lung infections. Symptoms can range from being asymptomatic to respiratory failure.


COPD is primarily present in smokers and those over 40. Prevalence increases with age and is currently the third most common cause of morbidity and mortality worldwide. In 2015, the prevalence of COPD was 174 million, and there were approximately 3.2 million deaths due to COPD worldwide. However, the prevalence is likely to be underestimated due to the under diagnosis of COPD.


Cigarette smoking is the most common cause of COPD worldwide.

Other causes may include second-hand smoke, environmental and occupational exposures,alpha-1 antitrypsin deficiency (AATD) ageingand gene-environment interactions (GxE).

Exposure to cold and dry weather conditions.

People who suffer from COPD acknowledge that harsh winds and frigidair can result in wheezing and breathlessness which can be frightening and sometimes dangerous.Cold irritates and causes dryness of the mouth and air passages which in turn intensify symptomstemporarily. Winter also means enclosed spaces,less ventilation and more spread of infections.


Avoid going outdoors in early mornings and late evenings.

According to the AMERICAN LUNG ASSOCIATION covering the nose and mouth areas while venturing out is a must.

Stay away from active and passive cigarette smoke.

Avoid strenuous activity outdoors in the cold.

Stay committed to your medical regime.

Team up with your physical therapist for designing a physical therapy regime that is practicable and maximizes your capacity and ease of Activities of Daily Living.


Exercise prescription is a key component of pulmonary rehabilitation programmes, part of the non-pharmacological approach to managing COPD. There is a high level of evidence for the benefits of pulmonary rehabilitation for people with COPD. Strength and endurance exercises are endorsed for people with COPD. Deep breathing exercises are beneficial in teaching breathing control, improving lung expansion and
hence Spo2 and inducing general relaxation .

Incentive spirometers are simple yet effective tools that help. Even during an acute episode of dyspnoea, breathing control in the form of techniques such as pursed lip breathing and timed inspiration-expiration, reduces airway collapse during expiration thereby reducing severity of the attack. These also instill some sense of control in the breathless patient whose anxiety is already making his attack worse.

Many patients use accessory muscles of respiration to improve their breathing which include the Sternocleidomastoid,scaleni, pectoral and abdominal muscles.The patient needs to be taught the correct use of these muscles during an attack and use of the Primary breathing muscles when not experiencing symptoms. The next issue to be addressed is loosening and removal of secretions from the chest.

A simple routine can be followed, that of steam inhalation or nebulization followed by techniques such as percussion, clapping, vibration over lung areas( that loosen the secretions), which are then easily coughed out. A variety of devices are available in the market now which can be easily used at home for example A capella devices,vibrators, and postural drainage tables. Teaching general relaxation techniques and correction of posture also need to be addressed for a more wholesome treatment approach. A study suggests that patients affected with COPD and pulmonary hypertension experience a lower exercise capacity reducing the general Quality of life.

Gradually improving the exercise capacity by progressive aerobic training under expert guidance is immensely helpful. If you or someone you know is suffering from any form of COPD it is very advisable to get expert help and work in a multidisciplinary way to improve their quality of life.

Dr Mehreen Mustafa Physiotherapist

HOD PMRD-Khyber Medical Institute Srinagar Kashmir

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Can you fix weak lungs?

In a world where respiratory diseases are becoming increasingly prevalent, the question of whether weak lungs can be fixed is a pressing concern for many. While there is no magical cure-all for lung conditions, there are certainly steps that can be taken to improve lung health and function. Let’s explore some of the ways in which individuals can work towards strengthening their lungs.

1. Quit smoking: Smoking is one of the leading causes of lung damage and weakens the respiratory system over time. By quitting smoking, individuals can significantly improve their lung health and reduce the risk of developing chronic lung diseases.

2. Regular exercise: Engaging in regular physical activity can help strengthen the lungs and improve overall respiratory function. Aerobic exercises, such as running, swimming, or cycling, can increase lung capacity and enhance the efficiency of oxygen intake.

3. Breathing exercises: Certain breathing techniques, such as diaphragmatic breathing and pursed-lip breathing, can help improve lung function. These exercises focus on deep breathing and can assist in expanding lung capacity and strengthening respiratory muscles.

4. Avoiding environmental pollutants: Minimizing exposure to air pollutants, such as smoke, dust, and chemicals, can help prevent further damage to the lungs. Using air purifiers and wearing masks in polluted areas can also be beneficial.

While these measures can contribute to improving lung health, it is important to note that the extent of improvement may vary depending on the individual’s condition and the underlying cause of their weak lungs. Consulting with a healthcare professional is crucial for a proper diagnosis and personalized treatment plan.


Q: What is lung capacity?
A: Lung capacity refers to the maximum amount of air that can be inhaled or exhaled from the lungs. It is an indicator of lung health and can be affected by various factors, including age, gender, and overall fitness level.

Q: Can weak lungs be completely cured?
A: While it may not be possible to completely cure weak lungs, taking proactive steps to improve lung health can lead to significant improvements in respiratory function and overall well-being.

Q: Can lung exercises help with asthma?
A: Breathing exercises can be beneficial for individuals with asthma as they can help improve breathing control and reduce the frequency and severity of asthma attacks. However, it is important to consult with a healthcare professional for personalized advice and treatment.

In conclusion, while there is no quick fix for weak lungs, individuals can take proactive steps to improve their lung health. By quitting smoking, engaging in regular exercise, practicing breathing exercises, and avoiding environmental pollutants, individuals can work towards strengthening their lungs and enhancing respiratory function. Remember, consulting with a healthcare professional is essential for personalized guidance and treatment options.

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Amidst the chaos, the power of breath becomes a valuable ally. These 12 breathing exercises are your passport to serenity, providing a quick and effective way to ease the burden when everything becomes too much.

1. Box Breathing:

Inhale for a count of four, hold for four, exhale for four, and pause for another four. This simple yet powerful technique helps regulate your breath and calm the nervous system.

2. Deep Belly Breaths:

Focus on breathing deeply into your belly rather than shallow chest breaths. Inhale slowly through your nose, allowing your abdomen to expand, and exhale fully through your mouth, releasing tension.

3. 4-7-8 Technique:

Inhale quietly through your nose for a count of four, hold your breath for seven, and exhale audibly through your mouth for eight. This method is proven to induce relaxation and alleviate stress.

4. Alternate Nostril Breathing (Nadi Shodhana):

Gently close one nostril with your thumb and inhale through the other, then close the other nostril with your ring finger as you exhale through the first. This balances energy and brings a sense of calm.

5. Breath Counting:

Focus solely on your breath, counting each inhalation and exhalation. This mindfulness practice helps anchor your attention, creating a sense of calm and mental clarity.

6. Equal Breathing:

Inhale and exhale for an equal count, such as four counts for each. This harmonises your breath, promoting balance and a tranquil state of mind.

7. Sighing Breath:

Take a deep breath in through your nose and audibly sigh it out. Repeat a few times, releasing tension and promoting relaxation.

8. Morning Breath of Fire:

Sit comfortably and take rapid, rhythmic breaths through your nose. This energising technique helps clear the mind and invigorate your body.

9. Pursed Lip Breathing:

Inhale through your nose for two counts, then exhale through pursed lips for four counts. This slows down your breath and helps release stress.

10. Bamboo Breathing:

Visualise your body as a flexible bamboo stalk, swaying gently with each breath. Inhale, imagining the stalk bending, and exhale as it straightens. This encourages a fluid, calming rhythm.

11. Body Scan Breath:

Inhale, directing your breath to different parts of your body. As you exhale, release tension from those areas. This technique promotes both physical and mental relaxation.

12. Guided Visualisation Breathing:

Close your eyes and envision a peaceful scene. Inhale positive energy from this environment, and exhale any stress or tension. Combine visualisation with intentional breathing for a soothing experience.

When life becomes overwhelming, these breathing exercises offer a lifeline to instant calm. Remember, the power to find tranquility is within your breath – a simple yet profound tool is available to you at any moment, in the supermarket, checking in at the airport, even before you fall asleep. 

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The human lungs are remarkable organs that work tirelessly to ensure our bodies receive the oxygen they need to thrive. However, various factors like pollution, smoking, or certain diseases can weaken them over time.

Thankfully, there are natural ways to strengthen your lungs and boost their capacity.

By adopting certain lifestyle changes, dietary habits, and exercises, you can significantly improve your lung health.

In this article, we will analyze ten effective strategies to keep your lungs healthy naturally. These methods are not only beneficial for people with lung conditions but also essential for maintaining overall respiratory health.

Get Regular Exercise:

Physical activity is among the most effective methods to enhance lung strength. Consistent exercise boosts lung capacity, facilitating the body’s oxygen intake and utilization.

Sports activities like swimming, walking, cycling, and jogging can boost your lung health by a decent margin. If this becomes difficult, do some simple breathing exercises such as yoga.

It is known that regular exercising also decreases one’s chance of contracting lung diseases such as asthma or chronic bronchitis. Secondly, it enhances blood circulation in order for your organs to function perfectly.

Stop Smoking:

Exposure of your lungs to carcinogens and chemicals is one of the worst things you can do to yourself. Smoking leads to lesions in air sacs and airways, thereby compromising one’s lung capacity and heightening the chances of contracting chronic respiratory disorders.

Non-small cell lung cancer is highly associated with smoking.

You must be wondering, “What is non-small cell lung cancer?”

This is a disease that entails the formation of malignant cells within your lung tissue cells. This is the most common sort of lung cancer caused by smoking, as indicated by Medscape.

Throw away the cigarettes and have a long, healthy life. Nicotine patches and gums will assist in reducing the cravings that may crop up as you quit smoking entirely.

Keep your Weight in Check:

Losing some pounds can make things better for your lungs. This is because being overweight causes a burden on the lungs. This burden makes breathing difficult, and your lungs need to work harder to combat it.

A good nutritious diet coupled with regular exercise helps reduce excessive body weight, which could also improve lung function and reduce the chances of developing respiratory diseases.

Obesity also contributes to obstructive sleep apnea, a common cause of lung issues that causes breathing obstruction. Therefore, staying in a good weight position is important for better respiratory strength.

Practice Deep Breathing:

Deep breathing exercise is an essential technique that can help strengthen the lungs.

Try this simple exercise to know what we’re talking about:

  • Breathe in slowly
  • Hold your breath for several seconds
  • Exhale slowly
  • Feeling better?

Deep breathing helps expand the lungs and remove mucosal material.

You can perform various types of deep breathing exercises. Here are some that you can look up:

  • Pursed-lip breathing
  • Diaphragmatic breathing
  • Belly or abdominal breathing.

Another approach is to try integrating a few deep breaths into your everyday life, like perhaps taking some deep breaths in the morning and during your lunch break at work.

Steam Therapy:

Steam therapy is a holistic approach that enhances lung health by expanding the airways and loosening mucus. This technique entails inhaling warm, moist air, which effectively alleviates congestion in the lungs and nasal passages, promoting clearer breathing.

Relax in the comfort of your home with steam therapy. Begin by placing a hot bowl of water containing some pleasant essential oils, such as eucalyptus or peppermint. Using a towel, cover your head while bending low above the bowl and inhale. Once in a while, take 5-10-minute breaks and breathe in the steam for five minutes each time. Adopt this simple tool for improved well-being.

Staying Hydrated:

Maintaining optimal lung health requires proper hydration throughout the day. Adequate hydration helps to thin out the mucus in the lungs, facilitating easier clearance. It also keeps the airways moist, protecting against irritation and inflammation. Ensuring adequate hydration plays a vital role in supporting respiratory function.

In addition to consuming plain water, enhancing your hydration routine with herbal teas and fresh juices can provide additional benefits. Green tea is particularly advantageous for promoting lung health due to its abundant antioxidants. These powerful compounds work to safeguard the lungs against damage caused by harmful free radicals.

Avoid Air Pollution:

Pollutants like smoke, dust, and chemicals can irritate the respiratory system, causing damage and inflammation to lung tissue. This can lead to various respiratory diseases and worsen existing conditions.

To avoid air pollution, try to minimize the time you spend outdoors on heavily polluted days. Use a mask when necessary and ensure proper ventilation in your home to prevent the buildup of indoor air pollutants.

Get Enough Vitamin D:

One of the basic nutrients that growing and strong lungs should have includes vitamin D. The research shows that a low level of vitamin D makes a person susceptible to respiratory tract infections as well as asthma and various kinds of lung diseases.

Enjoy the sun daily even though it is rich in vitamin D. Otherwise, take other supplements.

Practice Good Posture:

Slouching tends to reduce lung expansion, thus limiting deep breathing. It also exerts pressure on the diaphragm, which is important for respiration.

Good posture with upright sitting and standing can help promote good breathing mechanisms for healthy lungs. Proper posture can also be attained through stretching and strength-building exercises, thus increasing lung capacity.

Eat Healthy:

A healthy meal plan is very essential for staying healthy and maintaining good lung health. Eating healthy vitamins, minerals, and antioxidants improves the functioning of the lungs. These types of food products include fruits, vegetables, wheat, and lean white meat like chicken and fish.

Opt for fresh fruits and avoid eating processed foods or sugary treats that may compromise your lungs.

Furthermore, a diet of healthy foods, especially those that are rich in anti-inflammatory agents like turmeric, garlic, and ginger, can also be helpful in promoting the longevity of the lungs. You can flavor your milk with turmeric and put garlic and ginger in your stew.


Nurturing your lungs naturally is a blend of mindful habits, dietary shifts, and lifestyle modifications. From quitting smoking to incorporating regular exercise, every step contributes significantly to lung health. Steering clear of harmful foods while embracing an anti-inflammatory diet can also make a noticeable difference.

Remember, your lungs are important for you to be strong and stay well, so it is never too late to improve your lung health. 

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The 2024 GOLD Report, “Global Strategy for Prevention Diagnosis and Management of COPD,” not only includes guideline updates that reflect the latest research on chronic obstructive pulmonary disease (COPD); it also reflects some shifts in thinking about what’s important in COPD treatment, according to Claus Vogelmeier, MD, a lead report author and science committee chair for the Global Initiative for Chronic Obstructive Lung Disease (GOLD), which just released its 6th major update of the report.  

Vogelmeier, who heads the Department of Medicine, Pulmonary and Critical Care Medicine at the University Medical Center of the Philipps-University of Marburg, Germany, summarized key changes in the 2024 GOLD COPD guidelines for clinicians at the 2023 GOLD COPD International Conference in Philadelphia on November 14.

These changes include:

  • expanded information regarding preserved ratio impaired spirometry (PRISm);
  • a new section on hyperinflation;
  • clarification about prebronchodilator spirometry;
  • a new section on screening for COPD in targeted populations;
  • analysis of interstitial lung abnormalities;
  • an expanded section on managing inhaled therapy;
  • updated vaccination recommendations for patients with COPD; and
  • a revised smoking cessation section and new information on smoking cessation pharmacotherapies.

The 2024 GOLD report reflects a sea change in thinking about smoking cessation.

Shifts in Thinking About COPD

Although many changes in the 2024 report reflect new research released from January 2022 to July 2023 (148 new references in total), the updated report does more than just incorporate this new research, said Dr Vogelmeier.

The new “consolidated” report continues to refine the definition of COPD and pre-COPD, he noted, saying that report authors “have been discussing intensely how to define COPD,” including whether the definition should be spirometry-based. Other topics actively discussed by the GOLD science committee members who authored the report were when to do post-bronchodilator spirometry, reducing the carbon footprint of inhalers, COPD-asthma overlap, and the continued non-use of biologics for COPD.

Hyperinflation warranted a new section in the 2024 report because committee members saw it as an “underrated” condition, said Dr Vogelmeier. “Right now, we don’t really know how to address hyperinflation, but overall we think it’s a very important topic,” he explained.

The 2024 GOLD report reflects a sea change in thinking about smoking cessation. Vaping, which may in itself lead to long-term respiratory issues, is discouraged as a smoking cessation tool. Instead, the report puts new focus on the use of pharmacotherapies for smoking cessation, said Dr Vogelmeier.

Key Updates for 2024

COPD Diagnosis

A diagnosis of COPD is confirmed with the presence of nonfully reversible airflow obstruction (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] <0.7 postbronchodilation) measured by spirometry. Symptoms generally include dyspnea, wheezing, chest tightness, fatigue, activity limitation, and/or cough with or without sputum production.

Pre-COPD and PRISm

Patients considered as having pre-COPD or PRISm have a risk for developing airflow obstruction over time. Pre-COPD was recently proposed to include individuals of any age with respiratory symptoms and/or other detectable structural and/or functional abnormalities, without airflow obstruction on forced spirometry. The report authors noted that randomized controlled trials are needed in patients with pre-COPD and young patients with COPD.

PRISm refers to patients with preserved ratio (FEV1/FVC ≥0.7 after bronchodilation) but impaired spirometry (FEV1 <80% of reference after bronchodilation). PRISm is increased among those who currently smoke and formerly smoked and is associated with high and low body mass index, female sex, obesity, and multimorbidity, and it also may lead to a greater risk for cardiopulmonary disease, all-cause and cardiovascular mortality, hospitalization, and airway obstruction.

Up to about one-third of patients with PRISm may transition to having obstructed spirometry, with predictors such as lower baseline FEV1%, increased age, and current smoking status. Overall, the pathogenesis and treatment of PRISm have significant knowledge gaps, according to the committee.

“Not all individuals with pre-COPD or PRISm will eventually develop fixed airflow obstruction over time (and hence COPD) but they should be considered ‘patients’ (because they already suffer symptoms and/or have functional and/or structural abnormalities) and, as such, they deserve care and treatment,” the report authors stated. “The challenge is that there is no evidence on what the best treatment is for these patients yet.”


Hyperinflation refers to gas volume in the lungs increasing relative to normal values at the end of spontaneous expiration. It is clinically relevant among patients with COPD and may lead to dyspnea, impaired exercise tolerance, increased hospitalizations, respiratory failure, and increased mortality. Hyperinflation in patients with COPD occurs after the loss of elastic recoil and expiratory flow obstruction.

“The lung can be hyperinflated at rest (static hyperinflation due to the loss of elastic lung recoil as a consequence of emphysema) and/or during exercise (dynamic hyperinflation as a consequence of airflow obstruction) when ventilatory demands are increased and expiratory times are reduced,” the report authors noted.

Lung volumes from body plethysmography or gas dilution are reference measurements for evaluating hyperinflation, although these measures may vary owing to differences in compressible gas volumes or communicating gas volumes. Hyperinflation in patients may be managed with bronchodilators, supplemental oxygen, heliox, pulmonary rehabilitation, pursed lip breathing, or inspiratory muscle training.  In some cases of emphysema, where severe hyperinflation may occur, the condition may warrant lung reduction surgery or bronchoscopic lung reduction techniques.

Prebronchodilator Spirometry

According to the 2024 GOLD report, prebronchodilator spirometry may be used to initially assess whether symptomatic patients have airflow obstruction. If this does not show obstruction, postbronchodilator spirometry is not needed unless a very high clinical suspicion of COPD occurs, in which case an FVC volume response may show FEV1/FVC is less than 0.7. Additional tests to evaluate the cause of a patient’s symptoms and follow-up, including repeat spirometry, may be needed.

“If the prebronchodilator values show obstruction the diagnosis of COPD should be confirmed using postbronchodilator measurements,” noted the report authors. “Individuals with a prebronchodilator FEV1/FVC ratio <0.7 that increases to ≥0.7 postbronchodilator have been shown to have an increased risk of future development of COPD, and should be followed closely.”

The report authors noted that interpreting lung function impairment severity relies on having appropriate reference values and that lung reference values change over time and require revising.

COPD Screening

Evaluating symptoms and conducting spirometry in patients having low-dose chest computed tomography for lung cancer screening provides an opportunity to screen individuals for unrecognized COPD symptoms and airflow obstruction, noted the report authors. Male sex, younger age, shorter smoking duration, and being asymptomatic have been linked to detection of airflow obstruction without a previous diagnosis of COPD.

In addition to cigarette smoking, developmental, genetic, and environmental exposures and childhood infections also may increase the risk for COPD, and patients with these risk factors may have chest imaging for assessment of respiratory symptoms. Computed tomography (CT) scans can help identify patients with an increased risk for COPD and for whom spirometry may be considered in the non-lung cancer screening population.

“The use of spirometry in targeted patients undergoing lung cancer screening or when incidental imaging abnormalities are found consistent with parenchymal or airway manifestations of airways disorders is recommended by GOLD,” stated the report authors.

Blood Eosinophil Count-Guided ICS

Blood eosinophil counts are recommended by GOLD to guide the use of inhaled corticosteroids (ICS) in pharmacologic management. Evidence has shown that patients with COPD may have increased average blood eosinophil counts, which may be associated with increased lung eosinophil numbers and levels of markers of type-2 inflammation in the airways. “Blood eosinophil counts can help clinicians estimate the likelihood of a beneficial preventive response to the addition of ICS to regular bronchodilator treatment, and thus can be used as a biomarker in conjunction with clinical assessment when making decisions regarding ICS use,” according to the committee.

Interstitial Lung Abnormalities

Interstitial lung abnormalities (ILA) refer to findings suggestive of parenchymal lung fibrosis or inflammation from CT imaging in individuals who smoke or those who don’t smoke when observed incidentally among patients without known interstitial lung disease. Fibrotic ILA have an increased likelihood of progressing and are associated with poor outcomes, particularly in patients with emphysema. Evidence supports clinical assessment, risk stratification, and follow-up in patients with these findings.

Smoking Cessation and Vaping

The GOLD report advises clinicians to identify patients using tobacco at every visit, to strongly urge these patients to quit, and to assess each patient’s willingness to attempt to quit. Providing a quit plan and practical counseling as well as scheduling follow-up are also key steps to aid patients. Research has shown that a combination of counseling and pharmacotherapy is the most effective smoking cessation therapy for patients with COPD, noted the committee.

The Tobacco Use & Dependence Clinical Practice Guideline Panel found that brief smoking cessation counseling is effective, and that patients who use tobacco should be offered advice at each contact. Effective forms of counseling include practical counseling, social support of family and friends as part of treatment, and social support outside of treatment. Recommended first-line pharmacotherapies for tobacco dependence include varenicline, nortriptyline, bupropion sustained release, nicotine gum, nicotine inhaler, nicotine nasal spray, and nicotine patch, and the panel recommends that at least 1 of these medications should be prescribed when no contraindications occur.

Vaping is not recommended as a smoking cessation strategy. Electronic cigarettes contain nicotine and other chemicals, and their long-term effects in those who smoke and patients with COPD are largely unknown, noted the report authors. “Based on the available evidence, and the lack of knowledge about the long-term effects of e-cigarettes on respiratory health, it is not possible to recommend this intervention for smoking cessation in patients with COPD,” said the report authors.

In a meta-analysis that compared nicotine replacement therapy, bupropion, nortriptyline, and varenicline with placebo in patients with COPD who smoke, all pharmacotherapies except nortriptyline increased the likelihood for smoking cessation.

Among the available pharmacotherapies for smoking cessation, nicotine replacement therapy in the form of gum, inhaler, nasal spray, transdermal patch, tablet, or lozenge can reliably increase long-term smoking abstinence rates, although it also can cause irritation at the administration site, according to the committee.

Managing Inhaled Therapy

Managing inhaled therapy requires appropriate use of inhaler devices to maximize the benefits and lower the risks. At least 33 inhaled therapies have different bronchodilators and inhaled corticosteroids alone or in combinations, and at least 22 inhaler devices are available. Each device has its own set of instructions, and more than two-thirds of patients make at least 1 error in using a device, noted the authors.

Selecting the right inhaler device depends on drug availability, device characteristics, the patient’s abilities and preferences, and clinicians’ knowledge in caring for the patient. The report authors advised that device types should be minimized and not be switched without clinical justification. “Shared decision-making is the most appropriate strategy for inhalation device choice,” stated the report authors. “Patients’ cognition, dexterity, and strength must be taken into account.”


GOLD advises that patients with COPD should receive all recommended vaccinations according to relevant guidelines. Influenza vaccination is recommended in patients with stable COPD, and the World Health Organization and US Centers for Disease Control (CDC) recommend SARS-CoV-2 vaccination. The CDC also recommends 1 dose of the 20-valent pneumococcal conjugate vaccine or 1 dose of 15-valent pneumococcal conjugate vaccine followed by the 23-valent pneumococcal polysaccharide vaccine for those with stable COPD. The CDC recommends the respiratory syncytial virus (RSV) vaccine in individuals over 60 years of age and/or with chronic heart or lung disease, as well as the Tdap vaccine for protection against pertussis in patients with COPD who did not receive the vaccination in adolescence and the herpes zoster vaccine for shingles protection in individuals with COPD who are over 50 years of age.

Raising COPD Awareness

Raising awareness of COPD and the importance of early detection and prevention of this diseases is an ongoing priority for GOLD, said report authors. “The GOLD initiative will continue to work with national leaders and other interested health care professionals to bring COPD to the attention of governments, public health officials, health care workers, and the general public to raise awareness of the burden of COPD and to develop programs for early detection, prevention, and approaches to management,” the report authors stated.

Disclosure: Some 2024 GOLD Report authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

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By: Damaris Ababio, PTA, MSCS, Barnabas Health Ambulatory Care Center 

You may be wondering, how does breathing and pain go hand in hand? Good question! Before we delve into how breathing affects pain, let’s talk more about breathing in general. We all breathe because it’s essential to our very existence. Thankfully, breathing is an involuntary reflex that happens without conscious effort.

Now, take a quick moment to observe your breathing, is it shallow? Do you only see your chest and shoulders rising when you inhale? If so, that’s okay. However, with education and self-awareness, we can harness the power of proper diaphragmatic breathing to address things like pain, stress and anxiety.

Diaphragmatic breathing is breathing that engages your diaphragm, which is an important, and key, respiration muscle, that is shaped like a dome that contracts and relaxes with breathing. Although we don’t have to think about breathing, we do have to put forth a conscious effort when it comes to diaphragmatic breathing. This is because when we suffer from chronic pain, anxiety, and stress, breathing “our normal” way is not enough to produce a therapeutic response.

Deep breathing has been proven through research to quiet the sympathetic nervous system, which is our “fight or flight” response to a perceived threat, whether internal or external. With deep breathing, we activate our parasympathetic nervous system which allows the brain to “cool down” or relax after a period of stress of danger. When we experience pain, this can lead to stress and anxiety, which causes our brain to be on high alert, causing muscle tension, grumpiness, and more pain. However, you can take advantage of harnessing your own breathing, which is free of charge and readily available, to help you cope with chronic pain, stress and anxiety.

Here are a few tips to help you breathe diaphragmatically:

Lying down:

  1. Place a pillow under your knees and close your eyes.
  2. Place one hand on your upper abdomen, right under your ribcage and your other hand on your chest.
  3. Now take a slow and deep breath through your nose, allow your abdomen, lungs, and ribcage to expand. Do this while keeping your chest still. Do not be surprised if you feel stiff and tight with the first couple of reps, your muscles will gradually respond to this type of breathing with practice.
  4. Gently tighten your abdominals as you exhale slowly through your pursed lip.

In sitting:

  1. Sitting comfortably with an upright posture and your knees bent (feel free to use a pillow to support your back)
  2. Repeat steps 2-4 above.

Try practicing diaphragmatic breathing for about 5 minutes daily.

Damaris Ababio, PTA, MSCS, is a Physical Therapist Assistant at the Barnabas Health Ambulatory Care Center. She treats patients with neurological and orthopedic conditions as well as balance and gait deficits. Damaris completed her education at Essex County Community College in May 2011 and has been working at the ACC since October 2011. Damaris is currently a Multiple Sclerosis Certified Specialist (2018) and an LSVT BIG certified therapist (2020). She also serves as a member of the International Organization of Multiple Sclerosis Rehabilitation Professionals and the American Physical Therapy Association. When she’s not working, Damaris enjoys spending time with her family, participating in philanthropic work or carrying out DIY projects.

The experienced and compassionate staff at Cooperman Barnabas Medical Center Rehabilitation centers, with locations in West Orange and Livingston, offers adults and children the specialized care they need to resume an active life after surgery, injury or illness. Staff is committed to providing patients with the most advanced services in a safe, caring and soothing environment. For high-risk patients who are unable to visit in person, telehealth is an option. Patients do not need a prescription for physical therapy services.

For more information, or to schedule an appointment, call 973-322-7500.

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COLUMBIA, S.C. (WIS) - Music to maximize the lungs. That’s the idea behind Harmonicas for Health.

The nationwide program-- created by respiratory therapists with the COPD Foundation-- teaches patients to mimic pursed-lip breathing, which helps ease the stress of the discomfort they feel when exhaling.

Dr. Erin Hays with Lexington Medical center says COPD is the third leading cause of death in South Carolina, and effects up to 15 percent of the adult population.

“It helps in several ways, it helps build up their breathing muscle strength. It helps them get rid of all the access flehm, and helps them cough and clear their airways much more effectively. It also allows patients to mix and mingle with a support group of individuals who have similar issues that they do,” says Dr. Hays.

The group at Lexington Medical Center started meeting about 6 years ago—and took a slight pause during the pandemic

Natalie Ashnefelter found out about her COPD diagnoses a few years ago.

“They mentioned it and I said hmm I used to have a harmonica as a child—I’ll try it. And sure enough it works—it really does. And you have the support of other people too. Not just the therapist, but the other patients, we support each other,” says Ashenfelter.

Samara Hart is a respiratory therapist at the hospital who says the social aspects of the bi weekly meetings are needed.

“I think they build life long friendships and have a great time. They become social butterflies, which is part of the whole process. We want them to be more attuned with being out and being with people. Because a lot of times the stigma of having oxygen or having lung disease and therefore maybe some extra coughing—folks tend to shy away from activity and being out in public so they find comradery in that.”

And although these patients share a life long challenge---one things for sure---the smiles and laughter are contagious.

Hart says being diagnosed with COPD doesn’t mean one can’t live a full life.

“We have a really strong team of people that work with patients. And they’re not just patients to us. Come learn what you need to learn. COPD doesn’t have to be a final type of sentence. It’s a life sentence in a sense, but it doesn’t have to be something that completely limits your abilities to function and thrive.”

If you or a loved one would like to join the Harmonicas for Health program at Lexington Medical Center, the group meets twice a month at the hospitals main campus.

To RSVP call  (803) 935-8260

Notice a spelling or grammar error in this article? Click or tap here to report it. Please include the article's headline.

Stay up to date with WIS News 10. Get the app from the Apple App Store or Google Play Store and Stream us on Roku, YouTube, Amazon Fire, or Apple TV.

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One of the most common prevailing myths about Chronic Obstructive Pulmonary Disease (COPD) is that exercise could be harmful for those living with the condition. This is not only misleading but can also hinder the overall management and progress in coping with COPD. Understanding the role of physical activity in COPD management is crucial.

Doctors South First spoke to, on account of World COPD Day (15 November), explained that the myth likely stems from the fact that COPD patients often experience shortness of breath, coughing, and fatigue, leading to the belief that physical exertion could exacerbate these symptoms.

“However, avoiding exercise can actually result in a decline in physical fitness and lung function, making daily activities more challenging and potentially worsen COPD symptoms in the long run,” Dr Suma B, a pulmonologist at Excel Care Hospital in Bengaluru, tells South First.

What is COPD?

Healthy vs COPD lungs. (Medical Research Institute of New Zealand)Healthy vs COPD lungs. (Medical Research Institute of New Zealand)
Healthy vs COPD lungs. (Medical Research Institute of New Zealand)

The World Health Organisation defines COPD as a group of progressive lung diseases, most commonly including emphysema and chronic bronchitis. COPD causes obstructed airflow from the lungs. Emphysema involves damage to the air sacs (alveoli) in the lungs.

Over time, the inner walls of the air sacs weaken and rupture, creating larger air spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream.

Another condition that can cause COPD is chronic bronchitis where it involves inflammation and narrowing of the bronchial tubes, which allows mucus to build up. This condition is defined by a long-term cough with mucus.

COPD is most commonly seen in smokers, people with long-term exposure to lung irritants like air pollution, chemical fumes, dust, genetic factors, and even in those with a history of repeated respiratory infections.

Also read: Urgent call for specialised pulmonary care and rehabilitation

‘Exercise can be better than medications’

Dr Suma informs us that the theme for World COPD Day 2023 is “Breathing is Life — Act Earlier”. It aims to highlight the importance of early lung health, early diagnosis, and early interventions.

While taking measures to ensure one does not develop COPD is key, early intervention is also important for those who have already been diagnosed with COPD.

Pulmonary rehabilitation is a comprehensive exercise programme that is taught to patients with chronic lung diseases, especially COPD, to improve their lung capacity, lung efficiency, and also to minimise flare-ups and prevent hospitalisation.

This programme also educates people with COPD and their family about the disease, nutritional aspects, and how to socially integrate with this condition.

Vaayu Chest and Sleep Specialists, clinic which works towards holistic pulmonary rehabilitation. This clinic is set up in Bengaluru.Vaayu Chest and Sleep Specialists, clinic which works towards holistic pulmonary rehabilitation. This clinic is set up in Bengaluru.
Vaayu Chest and Sleep Specialists, clinic which works towards holistic pulmonary rehabilitation. This clinic is set up in Bengaluru. (supplied)

Weighing in, Dr Ravindra Mehta, renowned pulmonologist and founder of Vaayu Pulmonary Wellness and Rehabilitation Centre in Bengaluru, tells South First, “Management of COPD involves a comprehensive, multidisciplinary approach. The GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines suggest that individuals with early-stage COPD and limited exercise capacity can benefit from supplementary exercises and pulmonary rehabilitation.”

Explaining further, he says that exercise is absolutely important as it enhances the current lung function, optimises muscle use (which often deteriorates in COPD), improves cardiorespiratory dynamics, and addresses psychological and nutritional aspects.

“Many people think that pulmonary wellness rehabilitation is just yoga or pranayama but it is much more than that and it involves a tailored programme that can span 12-36 sessions, offering significant improvement, often surpassing the effects of medication alone,” Dr Mehta opines.

Also read: Study finds link between low Vitamin K level and poor lung function

The DREAM programme

Dr AJ Rajendran, Senior Consultant and Clinical Lead of the Department of Rehabilitation Medicine at Chennai’s MGM Healthcare, has introduced an innovative programme called DREAM for COPD patients.

The programme’s acronym stands for Diet, Relaxation, Exercise, Attitude, Motivation, each component targeting a critical aspect of COPD management.

Diet: Recognising the increased energy needs of COPD patients, who often breathe at a rate significantly higher than the normal 18 breaths per minute, the programme emphasises a nutritious diet rich in protein and multivitamins to give them energy.

Pursed-lip breathing techniques for COPD patients. (Supplied)Pursed-lip breathing techniques for COPD patients. (Supplied)
Pursed-lip breathing techniques for COPD patients. (Supplied)

Relaxation: To tackle the high stress levels associated with chronic diseases, the programme incorporates strategies from the American Heart Association.

“This includes breathing retraining with prolonged expiration and pursed-lip breathing to improve breathing patterns and reduce carbon dioxide build-up. Additionally, guided meditation sessions lasting 2-3 minutes are offered, aimed at reducing stress chemicals and promoting relaxation,” Dr Rajendran explains to South First.

Exercise: Focused on correct breathing techniques, the programme educates patients on using the diaphragm effectively instead of accessory muscles. Exercise sessions are brief (3-5 minutes) and scheduled throughout the day, with a gap of 55 minutes each to maximise efficacy.

“For instance, a patient is asked to perform these exercises for only five minutes at 9 am, 10 am, and 11 am intervals. Next, at 4 pm, 5 pm, and 6 pm intervals. This would ensure a good 30 minutes of exercise in the day, making the patient feel energised and relaxed the next day,” explains Dr Rajendran.

Attitude: The programme also addresses behavioural aspects, like smoking and alcohol consumption, helping patients identify and modify detrimental habits.

Motivation: Emphasising the interconnectivity of all components, the programme motivates patients to engage in each aspect equally, using a scoring system for progress tracking.

The DREAM programme. The DREAM programme.
The DREAM programme.

The DREAM programme represents a holistic approach to COPD management, promising a better quality of life for patients by addressing both physical and mental health aspects of the condition.

However, doctors warn that it’s crucial for COPD patients to consult with their doctors before starting any exercise regimen. The exercises and rehabilitation programme should be tailored to their individual health status and abilities. Overexertion can be harmful, so it’s important to start slowly and gradually increase the intensity and duration of exercises as tolerated.

Also read: 12 key symptoms commonly associated with long Covid-19

Some exercises patients can do 

  • Walking at home with small steps and for a short duration
  • Strength training using light weights or resistance bands
  • Breathing techniques like pursed-lip breathing and diaphragmatic breathing
  • Gentle stretching exercises
  • Chair exercises that can be done sitting down, like leg lifts and arm raises
  • Meditation

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Air pollution can have adverse effects on your respiratory health. To counter the impact and boost lung function, incorporating deep breathing exercises into your daily routine can be beneficial.

Air Pollution: 7 Deep Breathing Exercises to Cleanse And Boost Your Lungs
Air Pollution: 7 Deep Breathing Exercises to Cleanse And Boost Your Lungs

A combination of natural and man-made factors have come together to blanket large parts of the country under a thick layer of toxic smog. Especially post-Diwali, air pollution tends to spike due to the widespread use of fireworks during the celebrations. The combustion of firecrackers releases pollutants that can have severe health implications and contribute to the overall degradation of air quality in the region. Breathing under such conditions is thought to be hazardous to the body. When the outdoor air quality is poor, practice breathing exercises to prevent pollutants from hurting your respiratory system. Here are 7 simple breathing exercises to combat the impacts of air pollution.

Deep Breathing Exercises to Boost Lung Health Amid Rising Air Pollution

Diaphragmatic Breathing

  • Sit or Lie Comfortably
  • Place one hand on your chest and the other on your abdomen
  • Inhale deeply through your nose, allowing your abdomen to expand
  • Exhale slowly through pursed lips, feeling your abdomen contract
  • Repeat for several breaths, focusing on deep, slow breaths

Pursed-Lip Breathing

  • Inhale through your nose for two counts
  • Exhale through pursed lips for four counts
  • This technique helps regulate your breathing and keeps airways open longer

Alternate Nostril Breathing

  • Sit comfortably with a straight spine
  • Use your right thumb to close your right nostril
  • Inhale deeply through your left nostril
  • Close your left nostril with your right ring finger, releasing your right nostril
  • Exhale through your right nostril
  • Inhale through your right nostril
  • Close your right nostril and exhale through your left nostril
  • Repeat for several cycles

Chest Breathing

  • Sit or Stand Comfortably
  • Inhale Deeply through nose, allowing your chest to rise
  • Exhale completely through your mouth
  • Focus one expanding your chest while breathing deeply

Lion’s Breath

  • Kneel or sit comfortably
  • Inhale deeply through your nose
  • Exhale forcefully through your mouth, sticking out your tongue and roaring like a lion
  • This exercise helps release tension in the chest and throat.

Bamboo Breathing

  • Stand with your feet shoulder-width apart
  • Inhale deeply through your nose, raising your arms overhead
  • Exhale slowly through pursed lips, lowering your arms
  • Imagine your body bending like a bamboo in the wind

Deep Breathing With Breath Retention

  • Inhale Deeply through your nose
  • Hold your breath for a comfortable duration
  • Exhale slowly through your mouth
  • This exercise improves lung capacity and oxygen absorption

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1. Introduction

With the rise of modern industrialized cities, fossil fuel emissions have also increased air pollution, seriously endangering the health of the respiratory system [1]. In China, the number of patients with chronic obstructive pulmonary disease (COPD) has exceeded 100 million, and is still on the rise, according to the “China Adult Lung Health Study” released in 2022. According to the World Health Organization, COPD is the third leading cause of death in the world [2]. So far, the global prevalence and mortality rates have further increased [3], seriously affecting patients’ daily travel problems [4], which shows that it is extremely harmful. As the number of COPD patients increases year by year, research on the prevention of respiratory diseases is particularly important.
The improvement of people’s awareness of prevention has led to a greater development of preventive science and rehabilitation, among which respiratory rehabilitation treatment is a branch of rehabilitation medicine. Respiratory rehabilitation application [5] refers to the use of active and effective respiratory exercise training to reduce the symptoms of patients’ dyspnea and improve the patient’s lung function, thereby improving the patient’s quality of life. Therefore, rehabilitation training for respiratory diseases is very necessary.
Conventional respiratory function training includes cough training, pursed-lip breathing, abdominal breathing, balloon breathing training, etc. [6]. Xiaoyan Liu [7] and others conducted pulmonary function training on patients with COPD through pursed-lip breathing and abdominal breathing training, which effectively improved the patients’ pulmonary function. Liu Guofang [8] used abdominal breathing training combined with balloon training in the treatment of patients with chronic persistent asthma, and Zheng Liping [9] used intensive cough breathing training for patients undergoing pulmonary drainage surgery, which significantly improved lung function and various physical conditions. Noman Sadiq [10] and others studied the problem of breathing exercise regulating heart rate variability and found that the breathing exercise of blowing a balloon enhanced lung function.

Through the analysis of the above studies, it is found that regular breathing training can improve the lung function and symptoms of dyspnea in people with breathing disorders. However, the breathing training process is monotonous and boring, and there are problems such as unquantified breathing data and poor feedback of breathing training results. The effect of the patient’s breathing training and the real-time breathing training data cannot be reflected in time.

With the development of virtual reality technology, people have introduced it into rehabilitation training. This study applies virtual reality technology combined with biofeedback to respiratory rehabilitation training to visualize respiratory training data and intuitively understand the effect of respiratory rehabilitation training. This system can not only improve users’ attention and enthusiasm for training, but also enable users to train efficiently and orderly through personal training tasks.

2. Related Work

2.1. Application of Virtual Reality Technology in Medical Field

With the development of virtual reality technology, virtual reality technology has penetrated into many medical fields. In the rehabilitation training of neuromotor injuries [11], the use of virtual reality scenes can provide patients with sensory experience and play an important role in their rehabilitation training. In psychotherapy [12], the use of virtual reality technology for mindfulness intervention can distract attention and reduce anxiety and stress. In respiratory rehabilitation training, KC Lan [13] studied multi-modal virtual reality for respiratory training, which improved the enthusiasm of patients for respiratory rehabilitation training. Colombo [14] and others summarized and analyzed the latest technology in the rehabilitation of COPD patients using virtual reality technology, which can distract patients from fatigue and dyspnea. Mitsea et al. [15] introduced a virtual slow breathing training system that provides immersive relaxation scenes to achieve a stable breathing rate. Irini Patsaki [16] applied VR rehabilitation training in the treatment of COPD patients to effectively increase the treatment effect. In rehabilitation training after musculoskeletal injuries [17], scholars have developed virtual reality-based rehabilitation training to help athletes recover from musculoskeletal injuries. In low vision rehabilitation [18], researchers summarized the application of virtual reality technology in visual field expansion and visual acuity improvement in the rehabilitation of low vision people, and found that virtual reality equipment can expand the visual field and improve visual acuity. In the rehabilitation training of children with autism [19], virtual reality technology has good effects in training language skills, life skills, and emotional expression. In the rehabilitation treatment of stroke patients [20], the designed virtual scene is used for rehabilitation treatment, so that the patient’s neuromotor system begins to recover its functions.

In the above research, virtual reality technology can provide an immersive virtual scene, using the advantages of the virtual scene to make the originally boring content lively and interesting, and improve the enthusiasm and participation of participants. In the process of rehabilitation training, the patient’s attention is improved, mental stress is relieved, and the effect of rehabilitation training is improved.

2.2. Biofeedback Technology

Biofeedback is the breathing data detected by sensors and fed back to the user in real time. It can observe one’s own breathing data in real time and improve the user’s behavior through feedback [21]. Biofeedback is also a form of stress reduction, providing physical and psychological comfort. Sebastian Rutkowski et al. [22] have shown that training parameters that provide feedback will increase patients’ motivation to actively achieve health. Zhou Lina [23] and others studied that stress reduction therapy combined with music biofeedback therapy can reduce patients’ negative emotions and improve their sleep quality. The combination of virtual reality technology and biofeedback has shown better results. The virtual reality game designed by Rakesh Patibanda [24] and others is combined with biofeedback. Changes in breathing rhythm drive the color changes of trees and the lushness of branches, thereby giving feedback to the patient’s own breathing status. Robert Greinacher [25] and others have significant effects on adjusting the user’s breathing rhythm through tactile and visual feedback of virtual scenes. Johannes Blum [26] and others proved that in VR-based breathing training, the feedback method of environmental biological changes has lower cost and better effectiveness in increasing breathing awareness and promoting diaphragmatic breathing.
Through the analysis of the above studies, it is found that biofeedback technology has been widely used in the field of medical rehabilitation. It increases the patient’s awareness of breathing, helps them assess their current breathing pattern, can improve the patient’s breathing pattern if necessary, and provides patient learning through sensory feedback stimulation. When biofeedback is combined with virtual reality technology, the effect of feedback will be more obvious and vivid, which can improve the effect of self-feeling during rehabilitation training. But so far, during rehabilitation training, most patients with virtual reality need to wear heavy physiological sensors. For patients who are physically inconvenient or recovering in hospital beds, there will be movement restrictions and physical burdens, which prevent them from fully achieving a high degree of immersion and easy and natural interaction [27].

3. System Architecture

In order to overcome the above obstacles, a biofeedback respiratory training rehabilitation system based on virtual reality technology is designed to improve the patient’s respiratory function and achieve visual biofeedback to obtain the patient’s own real-time respiratory training effects and data. The system is designed to be an intuitive and portable breathing training system that does not require expensive and heavy measurement sensors. A portable vital capacity sensor is used combined with HTC Vive pro2 VR equipment to form a respiratory rehabilitation training system that uses respiratory data to drive virtual scene changes. The respiratory training effect is presented in the form of visual feedback in biofeedback. This paper provides an overview of the designed respiratory rehabilitation training system and conducts an empirical evaluation of its experience and training effects.

3.1. System Framework Structure

This system is a set of rehabilitation training system built to simulate the real environment for the rehabilitation needs of patients with respiratory disorders. The system uses the virtual reality scene developed by Unity 3D as the core, and builds a scene processing system. Respiratory data are used as the input part of the training system, and the head-mounted display is used as the output part of the system data. Patients can be immersed in the virtual environment for respiratory rehabilitation training. The respiration data are collected through the respiration sensor, and the respiration data are sent to the PC and interacts with the virtual scene through the interactive processing unit. The spatial locator recognizes the position of the person through the handle controller and the sensor in the head-mounted display, and maps the recognition result to the virtual training scene to obtain the spatial position in the current virtual scene. Finally, the virtual scene is output through the head-mounted display, and the respiratory data are presented to the patient in the form of visual feedback. Finally, wecomplete the task of system design. The system framework structure is shown in Figure 1.

3.2. Hardware Equipment

The VR device used in this study is HTC Vive pro2 device. HTC Vive pro2.0 equipment includes handle controller, head-mounted display, base station and HDMI equipment, as shown in Figure 2. The device is equipped with ultra-high resolution, allowing users to enjoy more delicate images in the virtual reality experience, while providing 3D spatial sound effects and an immersive sound experience, allowing users to better immerse themselves in virtual reality.
The HTC Vive pro2.0 device uses infrared tracking technology, which emits infrared rays from the base station transmitter and covers the entire room. Since the handle controller and the head-mounted display are equipped with a large number of sensors, the base station recognizes the sensors through infrared rays, so as to obtain the current external location of the handle controller and the head-mounted display. Data transmission and tracking technology are shown in Figure 3.
The respiratory data sensor used is the HKF-20C vital capacity sensor. The HKF-20C vital capacity sensor is a sensor used to measure vital capacity and respiratory function. It introduces the breathing gas of the measured person into the sensor through the breathing tube for analysis and calculation. The sensor will measure the flow rate, volume and time of the subject’s inhalation and exhalation, thereby calculating vital capacity, respiratory rate, breathing depth and other indicators. Figure 4 shows the HKF-20C vital capacity sensor.

The respiratory data sensor mainly collects respiratory signals and transmits the data to the PC in real time, which is used as a basis for judging the effect of rehabilitation training. The head-mounted display maps the virtual scene onto the display, providing patients with a realistic and immersive virtual environment. The hand controller serves as a controller in the virtual environment, performing functions such as selecting virtual scenes and moving virtual characters. The base station sets the size range of the real environment occupied by the virtual scene to standardize the movable range of breathing training. At the same time, the locator performs real-time data transmission with the head-mounted display and hand controller to track the user’s real-time location.

3.3. Interaction between Breathing Data and Virtual Scenes

Patients with respiratory disorders wear a respiratory data sensor and a head-mounted display to collect respiratory signals synchronously. At the same time, the respiratory data sensor will send the collected data to the PC, and then send the data to the training scene to interact with the training scene. Among them, various breathing training methods are built into the VR breathing training game scene. During the breathing interactive training process, patients can observe changes in the surrounding environment according to their own breathing rhythm. At the same time, the patient’s respiratory data will be detected, the respiratory information parameters will be calculated and the characteristic values of the respiratory airflow will be extracted to realize the visualization of the respiratory data. After the training is over, visual feedback is given to the patient in the form of quantification and visualization, which is conducive to discussing the shortcomings of their own breathing training, and improving it. The interaction between breathing data and virtual scenes is shown in Figure 5.

3.4. Virtual Scene Design

Playful feedback relieves patient fatigue during training and prevents overly tedious therapy, which is crucial for long-lasting rehabilitation. This article designs a simple and interesting biofeedback virtual environment to meet the needs of people with different degrees of respiratory impairment. It provides users with training conditions for deep breathing and shallow breathing. Through approachable and easy-to-operate training scenarios, it makes user training operations convenient and concise. When developing the system, this article designed two virtual scenes of “blowing candles” or “blowing dandelions”, as shown in Figure 6 and Figure 7. After the system completes “blowing candles” or “blowing dandelions”, the data after breathing training is presented to the patient in the form of visual feedback to evaluate the training effect of the patient.

The “blow out candles” scene is designed based on the indoor environment. The scene includes tables, chairs, corridors, halls, bathrooms, furniture and other items. The user performs breathing training according to the voice prompt instructions, walks to the candle and blows on the candle. When the maximum forced respiratory volume (FVC) reaches the set threshold, the candle is extinguished.

The “Dandelion Blowing” scene is designed with the theme of a park, which contains a variety of trees, buildings, vegetation, rockeries, etc. Users can walk freely in the park. There are many dandelions in the grass. According to the task prompt, the user picks up the dandelions for breathing training, and blows on the dandelions after picking them up. When FVC reaches the set threshold, the dandelions are blown away, and the trained data is visually output. The system sets that the user needs to complete five breathing exercises to complete the task. At the same time, it is equipped with a voice prompt function, which can increase the fun and experience of the user.

3.5. Breathing Data Collection Interaction and Visualization

3.5.1. Respiratory Data Collection

The respiratory data are collected through the sensor, the data signal output of the vital capacity sensor is connected to the computer through the serial port, and the data are transmitted to the PC in the form of serial communication. First establish the communication format between the sensor and the scene-driven engine Unity3D, initialize the serial port, and configure the virtual serial port, baud rate, parity bit, data bit, and stop bit. Then, connect the disposable blowpipe to the sensor and hold the lower end of the sensor. After the preparation is completed, start to blow air. After blowing, data will be transmitted to the computer. When the breath stops or intermittent breath occurs during the blowing process, the sensor will determine that the data transmission has ended. At the same time, when collecting respiratory data, do not block the exhaust hole, otherwise it will affect the current vital capacity collection results. During use, avoid debris blocking the sensor’s internal detector, otherwise it will affect the accuracy of the sensor’s respiratory data collection.

3.5.2. Analysis of Respiratory Data

Functional data parsing enables the study of complex data and can be applied to observations of functions that vary on a continuum that appear in reality [28]. In order to realize the visualization and digitization of data, it is necessary to analyze the respiratory signal data and extract its eigenvalues. First, after the respiratory data are uploaded, the sensor will detect the respiratory data, and then the computer will analyze the respiratory data according to the communication protocol, so as to obtain the waveform data during the sensor testing process. From the extracted waveform data, the characteristic points, peaks, etc. of the signal can be observed. At the same time, the signal characteristic values are extracted and stored, and then the measurement parameters, namely breathing time, vital capacity, flow rate, etc., are output at a sampling frequency of 100 HZ. After the parsing is completed, the data characteristic value is returned to the array for storage. Algorithm 1 shows the respiratory data parsing algorithm.
First, the respiratory data collected are cached in the cache as a byte array. If the cache contains data, the contained data are traversed. When the start measurement command 0xc1 of the respiration sensor and the end command 0xf0 of the respiration sensor are detected, the data in the cache cache are sequentially imported into endData for storage. Secondly, the byte type number endData is converted into a hexadecimal, and the collected data contain 25 bytes, as shown in Table 1. Among them, the first 21 bits obtain the high and low bytes of each type of breathing data, and the size of each measured data type is the combination of high and low bytes. Therefore, when i < 22, take an even number to combine the high and low bits. Then, use the ToString(“X2”) function to convert it to a hexadecimal, and finally output 16 for the lungData collection of breathing data.

Algorithm 1: Respiratory data analysis algorithm.

Input: collected respiratory data collection “cache”

Output: Hexadecimal respiratory data set “lungData”

1. if cache.Count!=0 then

2.      for int i = cache.Count-1; i >= 0; i– do

3.        if i! = 0 then

4.            if cache[i] == 0xc1&&cache[i-1] == 0xf0 then

5.                Array.Copy(cache.ToArray(),i + 1,endData,0,endData.Length)

6.                isReceived = true

7.                cache.Clear()

8.      if isReceived then

9.          for int i = 0; i < endData.Length; i++ do

10.              if i < 22 &&i % 2 == 0 then

11.                  hex += endData[i].ToString(“X2”)

12.                  hex += endData[i + 1].ToString(“X2”)


14.              else if i < 25 then

15.                  hex += endData[i].ToString(“X2”)

16.                  data.Add(Explain(hex))

17. lungData.GetDetail()

3.5.3. Analysis of Respiratory Data

In the virtual scene, the trainee performs breathing training according to the instructions. When the FVC exceeds the set threshold (1000), the candle will go out. This is because the image waveform cannot intuitively and better reflect the size of the data change each time. Therefore, the data of each breathing training is analyzed. While the breathing data drives the scene changes, the analyzed data are called and the data are presented in a visual and digital form, so that the trainees can observe the data more clearly. Algorithm 2 shows the respiratory data interaction and visualization algorithm, and Figure 8 shows the visualization of respiratory data. The data types include the duration of insufflation (TIME), vital capacity (FVC), peak flow rate (FEF), flow rate at 25% vital capacity (MEF25), flow rate at 50% vital capacity (MEF50), and flow rate at 75% vital capacity (MEF75), flow velocity difference (FEF), 25–75% average flow velocity (PEF), vital capacity in the previous second (FEV1), vital capacity in the first two seconds (FEV2), vital capacity in the first three seconds (FEV3), vital capacity ratio in one second (V1F), vital capacity in two seconds (V2F) and vital capacity in three seconds (V3F).
First, assign values to the fields, fill the data data before assigning values, and store 14 data collected by the breath sensor into data. When the vital capacity is greater than the set threshold of 1000 mL (data.fvc > 1000), since the fire of the candle and the fluff of the dandelion are special effects, item.Stop() will turn off their special effects, and will use SetActive to turn off their active status. Then, determine whether the virtual target Target of the breathing training is the same as the original one. If the target changes, that is, the candle goes out or the dandelion fluff blows away, use StartPort() to visually output the blowing data locally, as shown in Figure 8.

Algorithm 2: Respiratory data interaction and visualization algorithm.

1. if data.Count == 14 then

2.      time = data[0],fvc = data[1],fef = data[2],mef25 = data[3],mef50 = data[4],

         mef75 = data[5],fef25–75 = data[6],pef25-75 = data[7],fev1 = data[8],

         fev2 = data[9],fev3 = data[10],v1f = data[11],v2f = data[12],v3f = data[13]

3.       data.Clear()

4. if data.fvc > 1000 then

5.      foreach var item in particle then

6.         item.Stop()

7.         item.transform.GetChild(0).gameObject.SetActive(false)

8. if Target ! = null then

9.      if flag == false then

10.         StartPort port = new StartPort()

11.         byte[] data = GetData(port)

12.         localClient.Send(data)

13.         StartPort()

14. DebugMessage.Log()

15. Break

4. Experiments and Results

4.1. Participants

In order to understand the effectiveness of the system, this paper recruited 10 volunteers to participate in the test, and at the same time equipped two staff members to instruct how to use the research system; then, we trained the participants, distributed the equipment and managed the results of breathing training. The participants were divided into two groups: the first group was the control group, and 5 participants were given routine breathing training, blowing out candles and dandelion breathing training. The second observation group, the remaining 5 participants, performed breathing training in the virtual scene designed in this paper. The diagnosis of COPD was made according to a set of criteria developed by the Global Initiative for Chronic Obstructive Lung Disease (GPLD) [29]. To determine whether a person’s airway is blocked, clinicians compare the amount of air a patient can exhale in one second, known as forced expiratory volume (FEV1), to the total amount of air they can exhale, known as forced vital capacity (FVC). According to GOLD, a person can be diagnosed with COPD if their ratio of FEV1 to FVC is below 0.7, which means that a person exhales less than 70 percent of the air in their lungs in one second [30].

To ensure the validity of the assessment of effect, excluding patients with other lung function, participants met the following criteria:

  • Meet the diagnostic criteria for COPD;

  • During the rehabilitation training period, there is no resistance to cooperate with training and other behaviors;

  • Good compliance during rehabilitation training and tolerance during training.

Table 2 shows the participants’ information. Participant screening is based on the fact that COPD patients are mainly concentrated in middle-aged and elderly people, and the age distribution is between 55 and 65 years old. At the same time, the prevalence of COPD in men is more than twice that of women in the same age group [31]. In order to eliminate the interference of participants with other medical conditions on the experiment, participants with no other medical conditions and who were able to perform breathing training on their own were selected for the experiment.

4.2. Experimental Process

After each breathing session, each participant will receive a questionnaire to fill out regarding the training experience. This scale examines participants’ feelings about training through the following questions:

  • During training, do you feel bored?

  • During the training process, are you distracted and have trouble concentrating?

  • During the training process, are you able to keep up with the training pace?

Each item in this experimental survey adopts a five-point Likert scale, with options ranging from 1 to 5, that is, strongly agree to strongly disagree. Each item is scored from 1 to 5 points, and the score is multiplied by the corresponding weight to obtain the final score, as shown in Table 3.

4.3. Experimental Results and Analysis

During this respiratory rehabilitation training, the changes in respiratory data parameters of each participant before and after training were recorded to measure the effectiveness of the training system. The experiment found that the breathing training effect of each participant has improved. In this article, the breathing data of each participant before and after training are used as a measure of the effect of this experiment. At the same time, the mean values of the data before and after training for the two groups of participants were obtained for comparison.

Table 4 and Table 5 are the breathing data parameters before and after the rehabilitation training of the control group, and Table 6 and Table 7 are the breathing data parameters of the observation group before and after the rehabilitation training. Figure 9 and Figure 10 show the average breathing data of the control group before and after training, and Figure 11 and Figure 12 show the average breathing data of the observation group before and after training. Through Figure 9 and Figure 11, it can be found that the breathing data of the participants in the control group and the observation group have obvious changes before and after. Compared with the vital capacity and average flow rate in a short period of time, there are obvious improvements. The diagnosis of COPD patients is based on the ventilation volume in a short period of time, that is, the proportion of vital capacity in one second. From Figure 10 and Figure 12, it can be observed that the proportion of the vital capacity of the participants in the first second after training was significantly improved. It shows that both the traditional breathing training and the research system have significantly improved the respiratory function of the lungs of COPD patients. However, the flow rate (MEF75) at 75% vital capacity of the two groups of participants decreased to varying degrees. From Table 4, Table 5, Table 6 and Table 7, it can be observed that the MEF75 of individual participants decreased to varying degrees, because the sensor collected breathing data. The participants have insufficient strength, and the equipment produces corresponding noise and heat loss. In the later research, the respiratory data collection process and rehabilitation training process will be improved and optimized to improve the accuracy of the data.
It is observed in Table 4 and Table 5 that the vital capacity in the first second of all patients is low, but the vital capacity in the second and third seconds is high. This is because diseases such as pulmonary obstruction, emphysema, asthma, etc., can cause airway obstruction, making the lungs unable to exhale the full lung capacity in the first second. However, over time, lung capacity gradually increases in the second and third seconds, and the patient tries to expel as much gas as possible by increasing their breathing rate or changing their breathing pattern.
By observing Figure 13 and Figure 14, it is found that the training effect of the control group is significantly lower than that of the observation group. At the same time, the first-second vital capacity of the observation group increased by 5% compared with that before training, while the first-second vital capacity of the control group increased by 2% compared with that before training. It can be observed that the respiratory rehabilitation training of this research system is superior to the traditional respiratory rehabilitation training.
This experiment statistically summarizes the feelings of each participant during the training process, as shown in Figure 15, Figure 16 and Figure 17. From the figure, it can be observed that the observation group had high scores for feeling bored and bored after the first week of training, and low scores for inattention and ability to keep up with the rhythm, which may be caused by unfamiliarity with the system for the first time. Over the next few weeks, as the user mastered the use of the system, the scores for feelings of boredom also decreased, while the scores for feelings of lack of concentration and failure to keep up with the rhythm also gradually increased. In the control group, after the first week of training, the feeling of boredom was relatively low, and the scores of inattention and inability to keep up with the rhythm were higher. As the training progressed, the feeling of boredom increased during training, resulting in inattention and so on. This leads to an increase in the feeling score of boredom and a gradual decrease in the feeling score of the lack of concentration. On the whole, as the experiment progresses, this research system has a better sense of experience and provides users with a higher sense of immersion, participation and fun.

5. Conclusions

Traditional rehabilitation training lacks clear breathing data, and the training process is very tedious. In contrast, this article studies a biofeedback respiratory rehabilitation training system based on virtual reality technology, which reflects the interaction between respiratory data and virtual scenes during the rehabilitation training process, and realizes the quantification and visualization of respiratory data. At the same time, the effect of the user’s rehabilitation training is improved, and the enthusiasm and interest of the user are increased.

The purpose of this research system is to improve the lung function of patients with respiratory disorders and relieve symptoms such as dyspnea. Through VR equipment and respiratory data sensors, the interactive virtual scene of human breathing in the form of biofeedback is realized. We perform data analysis on the respiratory data, use the respiratory data to drive changes in the virtual scene, and realize the interaction between the respiratory data and the virtual scene. We use data visualization algorithms to quantify and visualize respiratory data to evaluate the effectiveness of patient breathing training. In the virtual scene of breathing training, interesting ways such as music and stories are used to guide patients to continuously perform breathing training in a comfortable process, so as to complete specific rehabilitation training tasks and goals. The system is evaluated from two aspects, including training effectiveness and user experience. Comparing the experimental results and experiences of 10 participants, the results show that compared with traditional respiratory rehabilitation training, this research system has better training effects and experience, and rehabilitation training is more positive.

The system enables patients with respiratory disorders to improve their respiratory function by completing training tasks in a virtual scene. It is easy to operate and has no restrictions on site and usage time, making it possible to incorporate it into a long-term pulmonary rehabilitation plan. Due to the interference of respiratory equipment in the process of respiratory data transmission, certain Gaussian white noise and random noise will be generated. The focus of follow-up research is to further improve and perfect the respiratory data collection and improve the accuracy of respiratory data transmission.

Author Contributions

Conceptualization, F.L.; Methodology, F.L.; Software, F.L. and Y.L.; Validation, F.L.; Resources, R.W.; Data curation, J.Z. (Jing Zhang); Writing—original draft preparation, F.L.; Writing—review and editing, L.S. and J.Z. (Jian Zhao); Visualization, Z.Z.; Project administration, L.S. All authors have read and agreed to the published version of the manuscript.


This work was supported in part by the Jilin Provincial Department of Science and Technology (Grant/Award Number: No. YDZJ202301ZYTS496), Jilin Provincial Department of Human Resources and Social Security (2022QN05), and The Education Department of Jilin Province (No. JJKH20230673KJ).

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest.


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Figure 1.
System frame structure diagram.

Figure 1.
System frame structure diagram.

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Figure 2.
HTC Vive pro2 device.

Figure 2.
HTC Vive pro2 device.

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Figure 3.
Data transmission and tracking technology.

Figure 3.
Data transmission and tracking technology.

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Figure 4.
HKF-20C vital capacity sensor.

Figure 4.
HKF-20C vital capacity sensor.

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Figure 5.
Interaction between respiratory data and virtual scene.

Figure 5.
Interaction between respiratory data and virtual scene.

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Figure 6.
Blowing out the candle scene.

Figure 6.
Blowing out the candle scene.

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Figure 7.
Blowing dandelion scene.

Figure 7.
Blowing dandelion scene.

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Figure 8.
Respiration data visualization.

Figure 8.
Respiration data visualization.

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Figure 9.
Average respiratory data before and after training in the control group.

Figure 9.
Average respiratory data before and after training in the control group.

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Figure 10.
Average vital capacity ratio before and after training in the control group.

Figure 10.
Average vital capacity ratio before and after training in the control group.

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Figure 11.
Average respiratory data of the observation group before and after training.

Figure 11.
Average respiratory data of the observation group before and after training.

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Figure 12.
The average vital capacity ratio of the observation group before and after training.

Figure 12.
The average vital capacity ratio of the observation group before and after training.

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Figure 13.
Respiration data before and after training of the control group and observation group.

Figure 13.
Respiration data before and after training of the control group and observation group.

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Figure 14.
The ratio of lung capacity before and after training in the control group and the observation group.

Figure 14.
The ratio of lung capacity before and after training in the control group and the observation group.

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Figure 15.
Total score of boredom per week.

Figure 15.
Total score of boredom per week.

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Figure 16.
Total Weekly Inattention Scores.

Figure 16.
Total Weekly Inattention Scores.

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Figure 17.
Total score for failing to keep up with the rhythm every week.

Figure 17.
Total score for failing to keep up with the rhythm every week.

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Table 1.
Twenty-five respiratory data type bytes.

Table 1.
Twenty-five respiratory data type bytes.

Byte Number High and Low Byte Types Respiration Data Type
0 TIMEH     Exhalation time high byte Exhalation time TIME
1 TIMEL     Expiration time low byte
2 FVCH     Vital Capacity FVC High Byte Forced vital capacity FVC
3 FVCL     Vital Capacity FVC Low Byte
4 FEEH    Peak flow rate high byte Peak flow rate FEF
5 FEEL    Peak flow rate low byte
6 MEF25H     Flow rate high byte Flow rate at 25% vital capacity MEF25
7 MEF25L     Flow rate low byte
8 MEF50H     Flow rate high byte Flow rate at 50% vital capacity MEF25
9 MEF50L     Flow rate low byte
10 MEF75H     Flow rate high byte Flow rate at 75% vital capacity MEF25
11 MEF75L     Flow rate low byte
12 FEF25-75H
25–75% flow rate difference high byte
Exhalation time FEF25-75
13 FEF25-75L
25–75% flow rate difference low byte
14 PEF25-75H
25–75% average velocity high byte
Average flow rate PEF25-75
15 PEF25-75L
25–75% average flow rate low byte
16 FEV1H
Vital capacity high byte in the previous second
Vital capacity in one second FEV1
17 FEV1L
Vital capacity low byte in the previous second
18 FEV2H
Vital capacity high byte in the first two seconds
Two-second vital capacity FEV2
19 FEV2L
Vital capacity low byte in the first two seconds
20 FEV3H
Vital capacity high byte in the first three seconds
Three-second vital capacity FEV3
21 FEV3L
Vital capacity low byte in the first three seconds
22 V1F
Vital capacity in one second as a percentage of FEV1/FVC
23 V2F
Vital capacity in two seconds as a percentage of FEV2/FVC
24 V3F
Three-second vital capacity as a percentage of FEV3/FVC

Table 2.
Participant information.

Table 2.
Participant information.

Participant ID Gender Age Other Medical History Tolerance V1F
1 Man 60 NO Well <70%
2 Woman 63 NO Well <70%
3 Woman 64 NO Well <70%
4 Man 59 NO Well <70%
5 Man 57 NO Well <70%
6 Man 64 NO Well <70%
7 Man 65 NO Well <70%
8 Woman 56 NO Well <70%
9 Woman 62 NO Well <70%
10 Man 58 NO Well <70%

Table 3.
Experimental Training Feeling Scale.

Table 3.
Experimental Training Feeling Scale.

Serial Number Question Very Much Agree Agree General Disagree Strongly Disagree
1 During training, do you feel bored? 1 2 3 4 5
2 During training, are you distracted and unable to concentrate? 1 2 3 4 5
3 During training, are you unable to keep up with the training pace? 1 2 3 4 5

Table 4.
The breathing data of the participants in the control group before training.

Table 4.
The breathing data of the participants in the control group before training.

(ms) (mL) (mL/s) (mL/s) (mL/s) (mL/s) (mL/s) (mL/s) (mL) (mL) (mL) (%) (%) (%)
1 1810 2311 1529 1297 1161 1487 190 1298 1244 2311 2311 53 100 100
2 1910 2497 1615 1601 1399 1001 600 1314 1494 2497 2497 59 100 100
3 1690 2689 1860 1729 1614 1605 124 1680 1700 2689 2689 63 100 100
4 1590 2420 1909 1667 1432 1274 393 1440 1585 2420 2420 65 100 100
5 1620 2431 1883 1747 1578 1757 290 1599 1668 2431 2431 68 100 100
AVG 1724 2470 1760 1609 1437 1425 319 1466 1538 2470 2470 62 100 100

Table 5.
Breathing data of participants in the control group after training.

Table 5.
Breathing data of participants in the control group after training.

(ms) (mL) (mL/s) (mL/s) (mL/s) (mL/s) (mL/s) (mL/s) (mL) (mL) (mL) (%) (%) (%)
1 1870 2719 1980 1652 1372 1312 340 1373 1555 2791 2791 57 100 100
2 1790 2686 2247 1825 1599 1244 581 1444 1688 2686 2686 62 100 100
3 1730 2582 1862 1712 1544 1355 357 1555 1649 2582 2582 63 100 100
4 1620 3379 2653 2396 2537 1646 750 2252 2341 3379 3379 69 100 100
5 1640 2432 2118 2010 1642 1335 675 1621 1724 2432 2432 70 100 100
AVG 1730 2760 2172 1919 1739 1378 540 1649 1791 2774 2774 64 100 100

Table 6.
Respiration data of participants in the observation group before training.

Table 6.
Respiration data of participants in the observation group before training.

(ms) (mL) (mL/s) (mL/s) (mL/s) (mL/s) (mL/s) (mL/s) (mL) (mL) (mL) (%) (%) (%)
6 1640 2543 1771 1708 1614 1489 219 1609 1665 2543 2543 65 100 100
7 1970 2393 1544 1410 1223 1078 332 1208 1360 2393 2393 56 100 100
8 1590 2908 2634 1941 1710 2634 639 1964 1870 2908 2908 64 100 100
9 1740 2833 1975 1539 1901 1716 177 1839 1685 2833 2833 59 100 100
10 1840 2244 1614 1509 1138 1129 380 1246 1381 2244 2244 61 100 100
AVG 1756 2584 1908 1621 1517 1609 349 1573 1592 2584 2584 61 100 100

Table 7.
Respiration data of participants in the observation group after training.

Table 7.
Respiration data of participants in the observation group after training.

(ms) (mL) (mL/s) (mL/s) (mL/s) (mL/s) (mL/s) (mL/s) (mL) (mL) (mL) (%) (%) (%)
6 1590 2777 2327 2291 1785 1735 556 1851 1957 2777 2777 70 100 100
7 2180 3471 2620 2461 1751 1287 1174 1770 2117 3418 3471 60 100 100
8 1820 2903 2226 2062 1786 1418 644 1748 1918 2903 2903 66 100 100
9 1990 3160 2497 2134 1779 1396 738 1736 1990 3160 3160 62 100 100
10 1870 3205 3013 2864 2025 1382 1482 1978 2251 3205 3205 70 100 100
AVG 1890 3103 2537 2362 1825 1444 919 1817 2047 3072 3103 66 100 100

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Oxidant air pollutants such as ozone, particulate matter, and nitrogen dioxide can affect lung function. They can also lead to difficulty in breathing, allergy flare-ups, asthma, and other lung issues. It is important to take care of your lungs by adopting the right lifestyle practices and eating a balanced diet with a lot of antioxidants and nutrients. Consuming adequate liquids, fruits, vegetables, and regular physical activity can also enhance lung capacity.

Winter Air Pollution and its Impact on Lung Health

Winter air pollution can significantly impact lung health. During this season, there are elevated concentrations of harmful substances like particulate matter, nitrogen dioxide, sulfur dioxide, and carbon monoxide in the air. Individuals with pre-existing lung diseases like asthma, bronchitis, COPD, or respiratory infections are at a high risk due to exposure to poor-quality air. This exposure can manifest as an increase in breathlessness, cough, fever, a change in the color of sputum to yellow, or a drop in oxygen saturation (SpO2), along with throat irritation.

Expert Advice: Protecting Lungs from Pollution and Ensuring Proper Nutrition

“To protect your lungs from increasing air pollution, prioritize antioxidant-rich foods like berries and leafy greens, along with Omega-3 sources such as fatty fish and seeds. Incorporate herbal teas like green tea for their anti-inflammatory benefits. Stay hydrated to maintain respiratory mucus. Including all types of fruits in your diet can also help prevent lung damage from rising pollution levels. These dietary adjustments, coupled with reducing exposure during peak pollution hours and quitting smoking, can significantly improve lung health,” says Dr. Nikhil Modi, Senior Consultant, Respiratory and Critical Care Medicine, Indraprastha Apollo Hospitals.

Mitigating Risks: General Lifestyle Changes for Lung Health Protection

“Now is the season when pollution is at its peak, and with winter approaching, it becomes a crucial time for our lung health. Patients suffering from lung diseases, allergies, COPD, or interstitial lung disease are more susceptible to the adverse effects of increased pollution levels and changing weather. During this time, viral infections are also prevalent, which can further impact these patients. To mitigate these risks, there are a few general lifestyle changes and dietary adjustments we can make,” says Dr. Sourabh Pahuja, Senior Consultant, Dept of Pulmonary Medicine, Amrita Hospital, Faridabad.

Preventing Exposure and Enhancing Lung Function

It is imperative to prevent pollution exposure as much as possible, and wearing masks and using air fresheners can help. It is important to keep doing physical activities and Yoga or deep breathing exercises to enhance lung function.

“During peak pollution hours i.e. early mornings and evenings, it is advisable to limit outdoor activities and consider wearing protective masks preferably N95 over surgical to safeguard your lungs amid increasing air pollution. Manage interior air quality by minimizing the use of chemical cleaners and air fresheners. Regular physical activity, such as brisk walking, yoga, or swimming, can enhance lung capacity and overall respiratory function. Quitting smoking is imperative, as it greatly impacts lung health and exacerbates the effects of air pollution. Additionally, practicing deep breathing exercises like pursed-lip breathing and diaphragmatic breathing can improve lung function and clear the airways. Maintaining a clean, dust-free home is also essential to prevent indoor allergens and irritants that can worsen respiratory issues. You can also consider incorporating air-purifying plants to improve indoor air quality. Optionally, air purifiers can be used as well,” says Dr. Modi.

Utilizing Natural Air Purifiers and Protective Measures

“People can also improve indoor air quality by using a good-quality air purifier or by introducing certain plants like Areca palm, snake plant, money plant, and aloe vera, which significantly clean the air inside the home. When going outside, it’s advisable to limit outdoor activities to the afternoon and avoid outdoor work or exercise during early morning and late evening hours. Wearing a good-quality N95 mask can help prevent exposure to poor air quality, especially during morning and evening hours,” says Dr. Gupta.

Balanced Diet and Hydration for Combating Pollution

Dr. Pahuja advises a balanced diet, multivitamins, proper hydration to help prepare the body for battling pollution. “In terms of diet, it’s essential to maintain a healthy, well-balanced diet that includes adequate carbohydrates, fats, and proteins. Additionally, for individuals with vitamin deficiencies, such as vitamin D or vitamin B, it’s advisable to incorporate multivitamins into their diet. Hydration is another critical factor to consider during this season. Everyone should ensure they remain adequately hydrated by increasing their fluid intake to maintain normal hydration levels in the body,” says the expert.

Guidelines for Individuals with Pre-existing Respiratory Disorders

“Individuals with respiratory or allergic disorders are recommended to avoid going outside during peak pollution times, such as early mornings and late nights. Exercising outdoors in heavily polluted weather should also be avoided. Wearing an N-95 mask while venturing outside can help prevent viral infections and minimize exposure to pollution. For individuals with respiratory disorders, it’s important to continue taking their prescribed medications before going out. To prevent viral infections, consider getting vaccinated, especially for influenza and pneumococcal vaccines. This is particularly crucial for individuals over the age of 65 and those with chronic conditions like chronic kidney disease, chronic liver disease, chronic respiratory diseases, or chronic heart disease,” says Dr. Pahuja. If anyone develops respiratory symptoms like cough, breathlessness, or fever lasting more than three to five days, it is advisable to consult with a healthcare professional.

Preventive Measures for Diwali and Beyond

“With the upcoming Diwali festival, the air quality is expected to worsen due to firecracker burning and increased vehicle pollution. Hence, it’s crucial to implement preventive measures and stay hydrated by consuming plenty of liquids and seasonal fruits over the next month,” says Dr. Gupta.

Prioritizing Lung Health Amidst Challenging Environmental Conditions

The deteriorating air quality in Delhi-NCR poses a significant threat to lung health, especially for those with pre-existing respiratory conditions. By implementing the aforementioned lifestyle changes, dietary adjustments, and protective measures, individuals can reduce the risk of adverse effects caused by pollution and promote better lung health. It is essential to prioritize lung protection to safeguard overall well-being in the face of escalating environmental challenges.

1. What are the most effective dietary changes to protect lungs from air pollution?

Answer: Including antioxidant-rich foods like berries and leafy greens, along with Omega-3 sources such as fatty fish and seeds, can be beneficial. Herbal teas like green tea for their anti-inflammatory benefits, hydration to maintain respiratory mucus, and a diverse range of fruits in the diet can help prevent lung damage from rising pollution levels.

2. How can individuals with pre-existing respiratory disorders protect themselves during high pollution periods?

Answer: It is recommended to avoid outdoor activities during peak pollution times, wear N95 masks while outside, and continue taking prescribed medications. Vaccination against respiratory viruses is also advisable, especially for vulnerable individuals with chronic conditions.

3. What are some practical lifestyle changes to mitigate the risks of pollution during the winter season?

Answer: Limiting outdoor activities during peak pollution hours, using air purifiers and air-purifying plants indoors, practicing deep breathing exercises, and maintaining a clean, dust-free home are effective strategies. Quitting smoking and staying hydrated are also essential for reducing the impact of pollution.

4. How can individuals prepare for the upcoming Diwali festival and its impact on air quality?

Answer: Implementing preventive measures such as staying hydrated by consuming plenty of liquids and seasonal fruits can help mitigate the effects of increased air pollution due to firecracker burning and heightened vehicle pollution during the Diwali festival.

5. What steps can individuals take to enhance indoor air quality and protect themselves from pollutants at home?

Answer: Using a good-quality air purifier and introducing air-purifying plants like Areca palm, snake plant, money plant, and aloe vera can significantly clean the air inside the home. Minimizing the use of chemical cleaners and air fresheners, keeping the home dust-free, and wearing N95 masks during peak pollution hours when going outside are also recommended practices.

-by Kashvi Gala

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