OBJECTIVE: To compare the effects of comprehensive directed breathing retraining with traditional diaphragmatic breathing on male smokers with exertional dyspnea but normal spirometry. DESIGN: This is a prospective randomized clinical trial in an exercise laboratory at a university hospital. Twenty-four nonmedicated exertional dyspnea subjects were randomly assigned to experimental (comprehensive directed breathing) and control (traditional diaphragmatic breathing) groups. Forty-four physiologic parameters associated with exertional dyspnea were studied before and after interventions for both groups at rest and at 40-W constant exercise for 10 mins. The interventions for both groups included diaphragmatic breathing exercises, walking, and arm exercises for 90 mins, 5 days/wk for 4 wks. In addition, the comprehensive directed breathing group was taught the anatomy and physiology of ventilation; they observed their ventilatory dyssynchrony in a mirror; they were shown their ventilatory rhythm on a spirogram; diaphragmatic movement was demonstrated in an educational movie; and verbal feedback was used to correct respiratory asynchrony. RESULTS: We compared the relative changes of lung function parameters before and after intervention for each group. The comprehensive directed breathing group improvements were significantly greater (p < 0.05) than those of traditional diaphragmatic breathing for 34 of 44 lung function parameters. CONCLUSIONS: Comprehensive directed breathing training improved exertional dyspnea, Dyspnea Index, and some clinical and functional parameters significantly more than traditional diaphragmatic breathing training.

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