Breath Stacking (Lung Volume Recruitment)

Breath stacking is a way to fill a person’s lungs with more air than the person can usually take in when breathing naturally. Breath stacking helps people who have: 

• Diminished lung capacity due to muscle weakness 
• Restricted chest movement.

• Shallow breathing means less air is moving in and out of the lungs. When more air is taken into the lungs, the ability to cough, speak and eat improves.
• Expanding the lungs helps move secretions, and it can lower the risk of illness.
• Breath stacking helps keep the lungs open.
• Lungs that are too stiff make it harder to breath.

You do breath stacking with a modified resuscitator. Shaped like a bag or balloon, a resuscitator is a simple device that delivers artificial breaths to people who are unable to adequately breathe on their own.

To modify a resuscitator for breath stacking, you attach:

• An extension tube
• Either a mask or a mouthpiece

With the attachments, the device is no longer suitable for resuscitation; it can ONLY be used for breath stacking.

1. Sit upright if possible. Reclining or lying flat is also acceptable, as long as you’re not slouching.
2. It’s helpful to put on a nose clip to keep air from escaping through your nose.
3. Place your lips tightly around the mouthpiece, or have your caregiver hold the mask firmly on your face.
4. Have your caregiver squeeze the resuscitator bag. As the bag is squeezed, take a deep breath and hold it. (Don’t breathe out.)
5. Repeat step 4 two to four more times (without exhaling between breaths). Inhale more air each time the bag is squeezed. (Try to take in a greater amount of air each time.) This is “stacking” your breaths. Continue until you fill your lungs to a comfortable level. You should feel a stretch across the front of your chest.
6. After your lungs feel full, hold your breath as long as it’s comfortable to do so. (Count to five, if possible.) If needed, you can use the air you’ve taken in to generate a cough.
7. Exhale. That completes one cycle of breath stacking.
8. Complete three to five cycles of breath stacking in a row, if possible.

Complete a series of three to five cycles of breath stacking at least twice per day. You may do it more often if you like.

It’s best to do breath stacking before meals and at bedtime. The muscles used for breathing have more room to move when the stomach is empty. 

When the resuscitator bag needs cleaning, wipe it down but never submerge it in water. Wash all other equipment pieces daily in warm, soapy water, and let them air dry.

If the bag isn’t supplying breaths that are large enough, look for a leak. You might need a new mask, mouthpiece or extension tube.

If any equipment needs to be replaced, contact your home care provider.

Stop breath stacking and rest for a while if you experience: 

• Dizziness
• Chest discomfort
• Chest pain

If you resume breath stacking and any of those symptoms continue, stop breath stacking and contact your health care provider.