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.

Voice Treatment

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.

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

Voice Aerobics the heART and Science of Voice Practice