📚 Deeper Dive · Scenario 28 of 57

The Incentive Spirometer, In Depth

Post-op breathing & lung expansion — the why behind the little breathing game (and what it can and can't promise)
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Coach Katie
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Why a little breathing game helps — and what it can't do alone

After surgery, three things push a patient toward shallow breathing: pain (especially with an abdominal or chest incision), the lingering effects of anesthesia, and immobility. Mr. Fitzgerald is taking small, shallow breaths and holding very still because his incision hurts. It feels protective. It is quietly setting up a lung problem.

Think of the lungs as a room full of tiny balloons (the alveoli). Deep breaths keep them inflated. Breathe shallow for hours and the balloons at the bottom start to sag and collapse — that is atelectasis. Collapsed, damp, airless balloons are the perfect place for infection to settle: post-op pneumonia.

The fix has two halves: the tool and the pain

The incentive spirometer encourages slow, deep, sustained breaths that help re-expand the alveoli and keep the lungs clear. Keep the physiology in mind, but be honest about the evidence: the spirometer is only one of several lung-expansion techniques, and recent evidence does not show that incentive spirometry alone prevents postoperative pulmonary complications. Deep breathing, early mobilization, and coughing are at least as important. And it only works if the patient can actually take those deep breaths — which is why controlling the pain (and having him splint the incision) is part of the same plan. Telling someone to breathe deeply without addressing the pain sets them up to fail. Enable it.

The technique students get backwards

The incentive spirometer works on a slow, deep inhalation — not a forceful blow-out. Correct technique: sit upright, seal the lips on the mouthpiece, inhale slowly and deeply to raise the piston to the marked goal, hold a few seconds, then relax — repeated per protocol/order (a common order is about 10 times per hour while awake). The hold at the top is what helps keep the small airways and alveoli open.

"Why am I doing this little breathing game?" Tell him plainly: the slow deep breaths help keep the air sacs at the bottom of his lungs open and clear. It is not busywork — but it works as part of a bundle. Pair it with deep breathing, coughing, and getting up to walk, which matter just as much.

It's a bundle, not a single device

The spirometer is just one part of the lung-protection bundle — and deep breathing, early mobilization, and coughing are at least as important: deep breathing and coughing (splinting the incision), early mobility (walking re-expands the lung bases), good pain control, and hydration to keep secretions thin. Do not lean on the device alone.