Incentive spirometry for adults with sickle cell disorder : University College London Hospitals NHS Foundation Trust

What is incentive spirometry?

Incentive spirometry is a simple breathing exercise. It is one of the best ways to prevent or stop chest problems from getting worse.

Incentive spirometry helps you take slow, deep breaths, like when you sigh or yawn. You'll use a device called an incentive spirometer, which helps guide your breathing. To use it, you take a deep breath in at a steady pace. We'll then ask you to hold your breath for at least three seconds before slowly breathing out.

Figure 1 is a photo of an incentive spirometer. There are a few companies which make these devices. The one you have may look different to the one in this photo but they all work in the same way.

Incentive spirometer.png — **Figure 1. Incentive spirometer**

In 1995, a trial was done on 29 people who had sickle cell disorder (SCD). The patients were admitted to hospital 38 times with chest or back pain. The study showed that using incentive spirometry helped to prevent lung problems^[1].

This exercise aims to:

increase the amount of air that you breathe in.
increase the pressure in your chest.
improve the way your breathing muscles work.

Doing the exercises helps to prevent or reverse the collapse of small areas of your lungs (a condition called atelectasis). Atelectasis can raise the risk of a serious condition called acute chest syndrome, especially for people with SCD. Acute chest syndrome is a severe, life-threatening complication. By using the spirometer, you can lower this risk, especially if you aren't moving around much or don't usually take deep breaths.

Your hospital doctor may prescribe the incentive spirometer if you have:

chest pain
had surgery
back pain above your diaphragm, the muscle that helps you breathe
acute chest syndrome
a chest infection
worsening chest x-ray results
reduced oxygen saturation (drop of 4% from baseline).

A nurse will show you how to use the device. If you have concerns, a physiotherapist can check you’re using it correctly.

Sit upright in the bed or on a chair. Keep the base of the device about mid-chest level.
Set the dial at the base of the device between 2 and 4 to find a comfortable breathing rate.
Put the mouthpiece in your mouth and seal your lips tightly around it to stop any air from escaping.
As you breathe in, a ball will rise in the tube. Try to breath in deeply to make the ball reach the top of the tube.
Try to keep the ball up at the top for 1, 2, 3 seconds before breathing out.
Repeat this 10 times.
If you find this exercise easy, increase the flow rate to 6 or higher. Increase the rate until you find it hard to keep the ball up.
If you feel any pain while you’re breathing in, let your doctor know so that they find the cause and reassure you.

This simple breathing exercise can improve your current sickle cell crisis or stop chest problems. That's why it's important to use your incentive spirometer every hour when you are awake, taking 10 breaths each time.

To avoid feeling light-headed, you can split the 10 breaths into smaller sets, such as 2 or 3 deep breaths at a time.

Haematology admin team:

uclh.redcelladminteam@nhs.net

Haematology clinical nurse specialists (CNSs):

uclh.redcell.cnsteam@nhs.net

Haematology advice line (office hours, adults and children):

020 3447 7359

Adult haematology advice line (out of hours):

07852 220 900

Paediatric helpline (out of hours):