Incentive spirometry or bubbles: Encouraging deep breathing to clear the lungs

An incentive spirometer is a device that provides exercise to the lungs. It does this by encouraging deep breaths with the movement of the diaphragm, the muscle between the lungs and abdomen (tummy).

Deep breathing exercises help open the air sacs in the lungs and may reduce the risk of:

• breathing problems such as pneumonia after surgery
• acute chest syndrome in patients with sickle cell disease.

When a physiotherapist should assess your child before using an incentive spirometer

Sometimes a physiotherapist will first need to check that an incentive spirometer is the right option for your child. Your child will be assessed if:

• they are wheezing
• they have a history of asthma
• they have pneumothorax (air around the lungs) when they are due to use the device
• there is not enough oxygen in their lungs (the oxygen level is 90 per cent or less when they are breathing room air, without receiving extra oxygen).

If your child is under age five or cannot use the spirometer for one of the reasons listed above, bubbles might be more appropriate for them.

How to use an incentive spirometer

1. Have your child sit up straight.
2. Hold the incentive spirometer in an upright position. The incentive spirometer has different levels and contains a ball that rises when your child takes a deep breath in.
3. Have your child place the mouthpiece in their mouth and hold it there with their lips closed tightly.
4. Starting at level 0, have your child take 10 slow, deep belly breaths while they keep their head and shoulders still. For each breath, your child should raise the ball in the incentive spirometer to the top and hold it there for two seconds before breathing out.
5. After your child takes the 10 deep breaths in and out, have them cough to help clear any mucus. If it hurts your child to cough, you can hold a pillow firmly against their chest to help ease any pain.

Your child should take 10 breaths every hour that they are awake.

When it may not be appropriate to use an incentive spirometer

Your child may need to avoid using an incentive spirometer if:

• their breathing is more difficult when they use the device
• they need more oxygen after using the device
• they are in too much pain
• they do not know how to use the device.

How to use bubbles to exercise the lungs

1. Have your child take a deep breath in and blow bubbles out slowly. Continue this for two to three minutes.
2. After they blow out the bubbles, have your child cough to clear any mucus.

Your child should blow bubbles for two or three minutes every hour.

What else your child can do to help clear their lungs

When your child can get out of bed safely, they should try sitting in a chair for all their meals and take frequent walks within their room or in the hallway. Any activity will help your child to breathe deeply and cough to clear any mucus.

Deep breathing exercises at home

Your child may need to do breathing exercises at home. Their health care team will give you exact instructions for using the incentive spirometer or bubbles at home.