From time to time I am contacted by a customer, patient, or speech-language pathologist with questions about using the Breather®, respiratory muscle trainer (RMT) device.
Recently, I heard from a customer who I’ll call Linda, who shared in an email that she has suffered from a chronic cough for years, recurrent bronchitis, including a recent bad bout in February, and eventually a voice disorder resulting from the constellation of problems and symptoms. She stated:” I ran across The Breather and decided to add that to my daily regimen. I’m hoping to expand my lungs and am willing to work hard to do so. Can you please answer some questions for me before I order the accessory kit from you?”
It occurred to me that the information provided might benefit other users, so I have posted her questions below and I have put my responses in blue.
1. What count or how long should I breath in and how long or what count should I breath out? Doesn’t it make sense to breath in as long as I can so I will get a bigger breath and then breath out for as long as I can to expand my lungs? I haven’t found any information that says what to shoot for. Like a count. Breath in for 5 or 6, breath out for 8 as an example.
Many years ago, in response to questions from other speech pathologists, I developed a protocol that I now also provide to my own patients. An example of the first week of training is as follows:
Week 1: Demonstrate proper technique at settings 1/1. Important do not puff your cheeks and maintain a tight lip seal. Shoulder and neck muscles should be relaxed. Emphasize use of diaphragm and abdominal muscles. Use the manometer, to record the highest number the dial moves to on exhalation following 3 trials (Maximum expiratory effort/MEP). This is the target for week 1. Train at 70% of the target. Some patients can advance to a higher I/E setting of 2/2 on the initial visit. Compete 5 sets of 5reps=25 breaths twice daily. Rest ½-1minute between sets. If a patient is using the device because of documented aspiration, a set 1hr post eating may be beneficial for pulmonary hygiene, and before bedtime for a final sweep of the lungs.
I advise customers to always consult with their therapist or physician for any additional guidelines specific to you or your diagnosis.
2. How do I know when to go up in the dial?
Each week you will advance your settings, which may be inspiratory only, expiratory only, or both. Your MEP from the previous week will provide some guidance, and with an increase in resistance, your new MEP will likely be equal to or greater than the previous week. On weeks 3 and 4 I offer an alternate protocol:
Week 3: Check technique. No cheek puffing and tight lip seal. Increase I/E resistance to 3/3, if tolerated. Use prior or new MEP as target. (The patient is their own referent point and some patients may not advance so quickly). Begin alternative protocol of 2sets of 10reps/twice daily.
Week 4/5: Check technique. No cheek puffing and tight lip seal. Increase I/E resistance to 3/4, if tolerated. Use prior or current MEP as target. (The patient is their own referent point and some patients may not advance so quickly). If tolerated, continue 2 sets of 10 reps twice daily or 3sets of 10reps (30 breaths) once daily.
**Commit to 5 weeks of training as anything less will unlikely yield an exercise or training effect. If patients have a chronic condition or neurodegenerative disease like Parkinson’s, it is suggested they incorporate The Breather® into a daily exercise program.
If using The Breather® with voice patients, I generally follow the same protocol. In some instances, however, for example cough hypersensitivity or PVFD, the emphasis may be more on technique and diaphragmatic breathing than strengthening per se., with a slower advancement of resistance.
3. When would a person not ever have the dials the same?
Depending on what I observe with patients, I will sometimes increase one dial before the other. Exhalation is the breath we use for speech production, cough, and co-ordination with swallowing, so, often, I will have patients increase exhalation first, but it honestly depends on YOU, there are no rules here, as YOU are the referent point. Technique is important so I try to make sure patients are using the device correctly and optimally.
4. When I buy the RMT kit, what is a goal to shoot for to increase expansion? This will give me more accurate information.
The manometer included with the RMT kit will measure the exhaled breath flow/pressure and measurements on the dial go from 0-60cm H2O pressure. A healthy user would likely reach 60cm even at higher settings, while many of my Parkinson’s patients can barely generate a MEP of 15 when they first begin using the device. If used regularly, you should expect to see the pressure generation increase, and more importantly, should feel some functional benefit, such as less shortness of breath or improved sustained phonation. For patients with dysphagia and known aspiration, the Breather is a great tool for pulmonary hygiene, and I often describe it to patients like using a shop vac for the lungs. Using it daily and before bedtime can help sweep debris from the lower airways and help resist the development of aspiration pneumonia or other pulmonary symptoms.
5. What is a good number on The Breather to reach for, for a 64 year old woman?
A “good” number is your number. Everyone has a different health and lung status, so, compare your progress to your own starting point, and if you are working with a speech-language pathologist or other therapist ask for their guidance.
6. How often do I clean The Breather if used 2x daily? Should it be cleaned everyday?
Clean the Breather daily, and during this time of COVID, use a few other precautions like using the device in a room by yourself. NEVER share the device. Instructions for cleaning the Breather® can be found on the manufacturer’s website, and there, you will also find training videos and other educational material. https://www.pnmedical.com/cleaning/
When you order a Breather and RMT kit or any other product from Voice Aerobics, you are always eligible for a no cost online coaching session. Visit our website to view the Voice Aerobics family of products.
My MissionTo enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower. Mary Spremulli, MA, CCC-SLP * FiTOUR® Group Exercise Instructor * Voice Aerobics® A Whole Body Approach to Voice Practice
I am unfamiliar with the device you mention. I would suggest you reach out to the manufacturer
Hello, Catherine. There can be various reasons why someone elects to use and RMT device. It may be to strengthen breathing muscles that have become weak from age, and underlying disease or following a prolonged hospitalization. Individuals with COPD have been shown to have a higher rate of aspiration when eating (food or liquid getting into the airway), so, often I will recommend the Breather to help with co-ordination of breathing and swallowing. And, finally, yes, an RMT device can help with pulmonary hygiene, helping to strengthen the cough mechanism which is necessary to clear mucus from the airways. For a better understanding of the many applications, I would direct you to the manufacturers website: PN Medical. There you will find numerous educational videos. The RMT kit contains a manometer (pressure guage) which is helpful for feedback and targeted training. Unfortunately, it is currently unavailable due to discontinued production of one of the components by the manufacturer. I do not know if or when it will be available.
I purchased “The Breather” a month ago & thought it would be a God-send. Maybe I’m slow…but I’m still not clear on how to get maximum use of it. Is the device to rid the lungs of mucus? And by coughing it up after using? Others talk about a RMT kit.. which I don’t have & didn’t realize I needed. I would not want to make another purchase until I understand this one. Incidentally, I have COPD & was hoping along with Trelegy “the Breather” would work for me. Where can I find a clearer demo on how to use “The Breather”.. when to change settings and why do I need a RMT kit, etc.
Re: Hetari Hand Held Air fit Lung Exerciser Device
Does this device have a small ball inside which vibrates when used?
Should the ball be heard when devise is shaken?
Hi, Donald, thank you for your question and I apologize for the delay in responding. I would suggest you wait about 30 mintues after eating. Because you are increasing intra-abdominal pressure, it can promote some reflux if that is a problem for you. If you have documented aspiration on a swallowing study, I would suggest a few sets or your usual training protocol about an hour after eating and again before bedtime for a final sweep of the lungs.
How long should I wait to use breather after eating breakfast or dinner
Joyce, depending on your underlying lung health and muscle strength you might start training on 1-1 which is the lowest setting or 2-2. Most of my patients start at Inspiratory-Expiratory settings of of 2-2.How quickly you advance depends also on your underlying strength. If you are a healthy adult, then, yes you will probably adjust settings weekly. If you have Parkinson’s or related diagnosis, you might not progress as quickly. The RMT kit, includes a manometer, which is a pressure guage. When connected to the Breather, it provides feedback to you regarding how much pressure you are generating and is helpful for feedback and more targeted training. You can find a video of a patient using the manometer on my website.https://voiceaerobicsdvd.com/product/rmt-accessory-kit/
Anytime you order an item from my webiste, including the Breather, you are eligible for a no cost consult via ZOOM, so if that is something you would like to schedule feel free to reach out via email at: email@example.com
Do I start on setting 1 then work to setting 5 6 7 an what is a RMT I only have the breather
Hello, Mary, thank you for your comment. Are you using the Breather with the manometer that is packaged with the RMT kit?https://voiceaerobicsdvd.com/product/rmt-accessory-kit/ If not, I would recommend it as it helps in setting training targets and provides feedback during your training, helping you use the same effort on all of your reps and sets. Technique is important when using an RMT device, and that includes NOT puffing cheeks particularly at the higher settings. With COPD as an underlying diagnosis, your perceived level of effort and work of breathing should be a good guide. I would speak with your physician before moving on to a higher resistance device. Depending on your goals for device use, you may be fine using the device at lower settings.
I”ve been using the breather for several weeks.i am up to setting 5 just a couple days ago,It is a little difficult but hoping it will become easier as i use it.I have copd,is it harmful to continue on that high setting,inhale and exhale are both on setting 5
Thank you, Laura, for your feedback. It was a pleasure working with you. I feel it’s important when people purchase products that they have an opportunity to ask questions,and obtain some coaching if needed. I am looking forward to hearing about your progress!
I was left with a cough due to severe allergies that weakened my vocal chords. The cough caused inflammation in my lungs and this went on for about three years. I work on keeping the allergies in control, but have found I needed some coaching on the vocal chords and expanding my lungs. I purchased The Breather and also the Respiratory Muscle Trainer and it has been a God sent. I reached out to Mary and she has been wonderful answering every question I have put out to her and she also did a live chat with me to go over everything. I highly recommend her! I’ve seen speech pathologist in the past, but Mary surpassed my expectations. I am planning on purchasing more of Mary’s products to even enhance my daily regimen and keep moving forward. Thank you so much Mary for your products and the time you put into what you do.