Imagine your dad has COPD (chronic obstructive pulmonary disease) and he spends a week in the hospital, finally feels better, and goes home. Then, a few weeks later, he is struggling to breathe again and is back in the emergency room.
If that sounds familiar, you are not alone. About 11-42.4% of people hospitalized for COPD return within 30 days.[1] [2] [3] [4] That is hard on patients, families, and nurses and doctors who want to help people stay home and stay well.
So what can help? A new 2026 study in the American Journal of Speech-Language Pathology looked at one simple idea: training the muscles used for breathing. The hospital in the study used The Breather, a handheld breathing muscle trainer, and the early results were promising: fewer patients came back to the hospital within 30 days of going home. Let's look at why that might have happened, and how this small device could fit into a daily routine.
Why do COPD patients keep getting readmitted to the hospital?
COPD is a long-term lung illness. The airways (the tubes that carry air in and out of your lungs) become swollen and narrow, so it gets harder to breathe, especially breathing out. The World Health Organization lists COPD as the third leading cause of death, causing around 6% (3.4million) of global deaths, and the seventh leading cause of disability around the world.
People with COPD can have flare-ups, and doctors call these exacerbations. A flare-up is when breathing suddenly gets worse, often with more coughing, more mucus (the sticky stuff in your lungs and throat), and more tiredness. Bad flare-ups can require hospitalization.
On average, COPD patients are discharged home after an exacerbation after 4.7-8.7 days [5][6][7]. However, in some cases, the symptoms worsen again soon after having been released from hospital, requiring a return for more treatment.
A 30-day readmission simply means going back to the hospital within 30 days after being sent home. Hospitals track this number closely for three reasons:
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For patients: Being readmitted is linked with a higher risk of death and poorer long-term health.
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For families: Another hospital stay means more worry, more time off work, and more bills.
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For hospitals and the health system: A large study analyzed the US National Readmission Database and found that the charges caused by COPD hospital admissions amounted to 3.15 billion USD in 2022. [4]
The reasons for readmission are mixed, and they include infections, other health problems, and how well someone recovers at home. But one cause is easy to miss.
The overlooked cause: weak breathing muscles
Breathing is done by muscles. Muscles around your ribs, your neck and collarbone, and a big, dome-shaped muscle under your lungs (called the diaphragm) pull air in and push air out, all day and all night.
Like any muscle, breathing muscles can get weak. Think about what happens to your legs after you spend a few weeks in bed with a broken ankle; they get weaker. In COPD, a similar thing happens: breathing muscles are often weak, especially in elderly people. [8][9]Two groups of breathing muscles matter here:
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Breathing-in muscles (inspiratory muscles). When they are weak, you may feel out of breath more easily, and it can be hard to be active.
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Breathing-out muscles (expiratory muscles). When they are weak, your cough is weaker. A strong cough helps clear mucus out of your lungs. If mucus stays in, germs can grow, and infections are more likely.
There is a swallowing link too, as both processes use an overlapping set of muscles. Swallowing and breathing have to take turns. When we swallow, we briefly stop breathing so food and drink go down the right tube. One study found that when this teamwork is off, COPD patients had more flare-ups. [10]
That is one reason speech-language pathologists, the specialists who help with speaking and swallowing, are often part of a COPD care team.
If weak breathing muscles are part of the problem, a natural question is whether making them stronger could help. This is what RMT can do.
What is respiratory muscle training?
Respiratory muscle training (RMT) is exercise for your breathing muscles. It works like lifting weights, but for your breathing muscles. You breathe in or out through a device that provides some resistance, making the breathing muscles work harder. Over time, the muscles can get stronger and more effective.
You may have heard of pulmonary rehabilitation. That is a program of supervised exercise and education for people with lung disease. It is very helpful, but only 2- 5% of COPD patients can get it globally. [11] Common reasons include not having a way to travel there, living far away, or being unsure it is worth it. [12] That is especially true in rural areas.
Most earlier research on breathing muscle training was done with people who were already home. The new study asked a different question: what if training starts in the hospital, right after a flare-up?
Meet The Breather: one device to train breathing in and out
The Breather is a small handheld breathing trainer made by PN Medical. You breathe in and out through it, and dials let you change how hard you train your breathing muscles. Many breathing trainers work on only one direction, either breathing in or breathing out. The Breather trains both in one device. This matters because both groups of breathing muscles can be weak in COPD. [8]
The hospital in the study chose it for two reasons:
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It trains breathing in and out together.
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It can start at a very easy setting, which suits patients who are tired or short of breath. The resistance is raised slowly as they feel able.
The Breather has been looked at before, and a 2019 study tested The Breather in people with COPD, where it increased respiratory muscle strength and exercise capacity in patients with COPD. [13] Another 2019 study also showed that The Breather improved expiratory muscle strength and also improved talking time in COPD patients. [14]
The new study: what happened when a hospital added The Breather
The study took place at Warren Memorial Hospital, a small rural hospital in Virginia with 60 beds. The program was led by two speech-language pathologists (SLPs), the specialists who help with speaking and swallowing.
In this study, researchers tested RMT in 66 adults hospitalized with COPD. Each patient was taught to use The Breather and practiced a simple routine: two sets of 10 breaths, twice a day, starting at the easiest setting and increasing slowly. The study excluded people in intensive care or on breathing machines. [15] After the patients went home, the researchers checked how many COPD patients came back to the hospital within 30 days. They compared those numbers with the same hospital's results from 2019, before the program, and with a larger hospital in the same health system that did not add the program.
What the speech-language pathologists did: After checking each patient's swallowing, they gave eligible patients The Breather. They taught them how to use it, watched them practice, and gave written instructions to take home.
What they found
The results were promising. After the hospital started training COPD patients with The Breather, the share of patients who returned within 30 days dropped by 49.3%, from 14.4% in 2019 to 7.3% in 2022.
At the larger comparison hospital, which did not add the program, the rate stayed about the same (15.6% in 2019 and 17.1% in 2022). All 66 patients finished the training, and no side effects or safety problems were reported.
How to build The Breather into a COPD patient's daily routine
Important first step: Ask your doctor, nurse, respiratory therapist, or speech-language pathologist whether breathing muscle training is right for you. The patients in the study were guided by trained professionals. Check with them, especially if you have a heart condition, are on oxygen, or recently had a flare-up.
Here is the routine used in the study, in everyday terms:
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Get taught first. Have a health professional show you how to hold the device, seal your lips, and set the dials.
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Sit up straight in a comfortable chair.
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Start at the easiest setting. The study began at the lowest level patients could handle.
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Do two sets of 10 breaths. A set is 10 breaths. Rest between sets.
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Do it twice a day. The study used a morning and evening plan.
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Increase slowly. The study aimed for effort that felt about a 5 to 7 on a 0-to-10 scale. Zero is no effort, and 10 is the hardest effort you can imagine. In everyday words, it should feel like hard work, but not “I can't go on.” If it feels much harder, turn the setting down.
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Stop and call your care team if you feel dizzy, very short of breath, or unwell.
Tips to make it a habit
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Link it to something you already do, like after brushing your teeth in the morning and before bed.
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Keep the device somewhere you will see it.
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Ask a family member to practice with you.
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Write each session on a calendar to see your progress.
Remember, a breathing trainer adds to your care. It does not replace medicines, your COPD action plan, or pulmonary rehabilitation.
Final thoughts
COPD readmissions are hard on patients, families, and hospitals, and up to 42.4% of patients return within a month. Weak breathing muscles are one overlooked piece of the puzzle, and strengthening them is a simple, low-tech idea.
In a 2026 study, a rural hospital that taught COPD patients to use The Breather during their stay saw 30-day readmissions fall from 14.4% to 7.3%, while a comparison hospital stayed near 17%. No safety problems were reported.
Medical disclaimer: This article is for education and does not replace advice from your doctor or other qualified health professional. Always ask your care team before starting a new treatment or exercise.
Frequently asked questions
What counts as a 30-day readmission in COPD?
It means returning to the hospital within 30 days after you were sent home from an earlier stay. Hospitals track it as a sign of how well patients are recovering after leaving.
How can I reduce COPD flare-ups at home?
Doctors commonly recommend taking medicines exactly as prescribed, avoiding smoke and other lung irritants, getting recommended vaccines, staying as active as you safely can, and following your COPD action plan. Breathing muscle training is one more tool some care teams are exploring. Ask your doctor what fits you.
Can a breathing muscle trainer help prevent hospital readmission?
In a 2026 hospital study, readmissions fell from 14.4% to 7.3% after a hospital added The Breather to COPD care. But the study was early and could not prove cause and effect, so more research is needed.
Is The Breather safe to use after a hospital stay?
In the study, no side effects or safety problems were reported among 66 patients who trained in the hospital. Safety depends on each person's health, so check with your doctor first, especially after a recent flare-up.
How often should I use it, and how soon will I notice a difference?
The study's routine was two sets of 10 breaths, twice a day, under guidance. The study did not measure how quickly people feel better, so we cannot promise a timeline. Your care team can help you track progress.
What is the difference between breathing-in and breathing-out muscle training?
Breathing-in (inspiratory) training strengthens the muscles that pull air in, which may help with breathlessness. Breathing-out (expiratory) training strengthens the muscles that push air out, which helps with coughing and clearing mucus. The Breather trains both.
References
[2]. Readmission rates within the first 30 and 90 days after severe COPD exacerbations (RACE study)
[5]. Overview of Hospitalizations among Patients with COPD, 2008
[6]. Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit
[7]. Clinical audit of patients hospitalized due to COPD exacerbation. MAG-1 Study
[8]. Respiratory Muscle Strength in Patients With Chronic Obstructive Pulmonary Disease
[9]. Respiratory and Limb Muscle Dysfunction in COPD
[10]. Breathing-swallowing discoordination is associated with frequent exacerbations of COPD
[11]. What still prevents to acknowledge a major role for pulmonary rehabilitation in COPD treatment?
