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B.E.S.T. breathing exercises are designed to keep your lungs healthy and strong.

Your breathing exercises should be performed using an incentive spirometer. This device measures how much air you are inhaling with each deep breath. Try to increase the amount of air you inhale each day and how long you can hold it.

How To Use Your Incentive Spirometer

Kelly Merluzzi, RN, Clinical Coordinator of St. Luke’s Surgical Optimization Program explains how to use your incentive spirometer.

Begin using your incentive spirometer at least 2 weeks before your surgery and as instructed following your procedure. If you are a smoker or your surgery is less than two weeks away, please begin using your incentive spriometer now. Use our tracking log to log your breathing exercises.

Using your incentive spirometer

  1. Attach the mouthpiece and flexible tubing to the outlet on the right side of the spirometer base.
  2. Sit straight and do not bend your head forward or backward. Holding the handle in your left hand, insert the mouthpiece in your mouth so it sits comfortably inside your lips and in the front of your teeth.
  3. With the mouth piece in your mouth, breathe out normally. Then, close your lips tightly around the mouthpiece and inhale slowly and deeply through your mouth. As you inhale, try to keep the small indicator on the right side in between the two indicator arrows while also trying to move the piston up the chamber as far as you can. Continue to move the piston as high in the chamber as you can, while keeping the indicator between the two arrows on the right (goal range). This will feel like sucking a thick milkshake through a straw.
  4. If the indicator doesn’t stay between the two arrows you are either breathing too fast or too slow.
  5. When you cannot inhale any further, remove the mouthpiece and hold your breath as long as possible, or for at least 3 seconds. Then exhale slowly and allow the piston to fall to the bottom of the column. This may make you cough which is normal and helps to open your lungs.
  6. Move the marker on the left side of the spirometer to show your B.E.S.T. effort. Use this as a goal to work toward during each slow deep breath.

Each day you use your incentive spirometer you should see improvement in how deep a breath you can take. Remember to put your marker to the highest level the piston reached on your incentive spirometer. After each set of 10 deep breaths, cough to be sure your lungs are clear. If you start feeling dizzy slow your breathing down and give yourself more time with normal breaths between deep breaths. Be sure to clean your mouthpiece with soap and water after each use.

When able, take frequent walks and practice coughing to keep your lungs clear.

Remember to do 10 breaths, 4 times a day or more if you can and be sure to log everything in your breathing log.

Spirometer infographic

Don’t Forget

  • Put your marker to the highest level the puck/piston reached on your incentive spirometer.
  • After each set of 10 deep breaths, cough to be sure your lungs are clear.
  • If you start feeling dizzy slow your breathing down and give yourself more time with normal breaths between deep breaths.
  • Be sure to clean your mouthpiece with soap and water after each use.


If you smoke, now is the time to quit.

Smoking can be detrimental to your health in ways that go beyond disease, such as how your body handles surgery. Smoking increases the mucus in your airways and decreases your ability to fight infections. The nicotine from cigarettes can increase your blood pressure; heart rate and risk of irregular heartbeats. The carbon dioxide in cigarettes decreases the amount of oxygen in your blood.

  • Your body needs a healthy supply of oxygen to help heal after surgery. When you smoke, the molecules that transport oxygen throughout your body, called hemoglobin, are unable to carry the needed amount of oxygen to your organs and tissues. As a result, your body becomes deprived of the oxygen it needs to repair wounds and build healthy new tissue. Smoking also causes narrowing of the blood vessels, which can prevent blood, oxygen and nutrients from reaching your healing wound.
  • Smoking thickens your blood which makes it more difficult for blood to travel through your blood vessels. Thickened blood raises your risk of developing a blood clot in your legs. If a blood clot travels from your legs to another part of your body, it could cause a heart attack, stroke, or pulmonary embolism (a blood clot in your lungs).
  • Smoking raises your risk of infection. Your blood contains cells called neutrophils that help fight infection. Smoking causes these cells to lose some of their infection-fighting power, which can double your chances of getting an infection after surgery compared to a non-smoker. If you develop an infection, it will not only slow your recovery, but you may need to take antibiotics, have another surgery, or spend more time in the hospital.
  • Smoking increases inflammation and sometimes pain. The chemicals found in cigarettes can increase the amount of inflammation, or swelling, throughout your body. After surgery, this extra swelling can cause smokers to experience more pain than non-smokers.

Knowing this doesn’t make it easier to quit. You may have tried to quit in the past and gone back to smoking or chewing tobacco. We understand this and can support you through a plan for quitting now. Once a quit data is set, review your options and find the best one that will work for you. Quitting even 4-6 weeks before your surgery and staying smoke free 4 weeks afterwards can reduce the risk of complications (such as heart attack, pneumonia, wound infection, breathing problems, stroke) and help your body heal better and faster after your operation.

  • Use the surgery date as a motivator to set a quit date. Once a quit date is set there are several options to go about quitting.
  • Talk with your physician/anesthesiologist to determine the best method for you which could include the use of medications such as a nicotine replacement therapy. Nicotine replacement and other medicines can help reduce many of the physical symptoms of withdrawal.
  • Most smokers find that the bigger challenge is the mental part of quitting. If you have been smoking for any length of time, smoking has become linked with nearly everything you do—waking up in the morning, eating, and drinking coffee. It will take time to “un-link” smoking from these activities, which are why, even if you are using a nicotine replacement, you may still have strong urges to smoke.

  • There are smoking cessation counselors with in the surgical optimization program and within the St. Luke’s Network. If determined that you need additional assistance, you will be referred to the Network’s Smoking Cessation Program.
  • The American Lung Association has a program called “Freedom from Smoking” program, an online program that takes you through modules and provides you with the tools you need to quit.
  • The American Cancer Society has helpful information and a hotline number on its website on how to quit smoking. Call the American Cancer Society at 1-800-227-2345 or visit
  • Extensive resources from government and professional associations offering quit help can be found at
  • Support by phone or Internet including “talk to an expert” can be found at
  • The National Tobacco Cessation Collaborative (NTCC) identifies organizations and web sites that provides the latest information on how to quit smoking. One of those programs is called “Become an EX”. This web site includes proven methods to teach smokers how to quit and stay smoke free.

Remember, do at least 10 breaths, 4 times a day for a total of 40 breaths. Use our tracking log to log your breathing exercises.