A playful new twist on breathing exercises could help patients with chronic obstructive pulmonary disease (COPD) manage their condition — and many clinicians might not know about it yet.

Results from a new clinical trial presented at the European Respiratory Society Congress in Barcelona, Spain, showed that “laughter therapy” — using deliberate laughter in breathing exercises — helps patients breathe easier and stay healthier just as effectively as pursed-lip breathing, a commonly recommended technique used in COPD where you blow air out of your mouth slowly through pursed, O-shaped lips.

Though not published yet, the findings highlight the promise of low-cost breathing techniques and other pulmonary rehabilitation exercises that tend to be overlooked.

“Clinicians can view structured laughter therapy and pursed-lip breathing as accessible, equipment-free complementary tools that empower patients in their daily self-care,” said lead study author Goncagul Aldan, PhD, RN, a lecturer and nurse who graduated from Hacettepe University Faculty of Nursing in Ankara, Türkiye. “Rather than replacing pulmonary rehabilitation or pharmacotherapy, these zero-cost practices can be integrated into routine clinical care or telehealth programs.”

What the Study Showed

A total of 63 patients were randomly assigned to laughter therapy, pursed-lip breathing, or education alone. Following an in-person training session, participants practiced 30 minutes, three times weekly for 12 weeks, supported by regular texts, check-in calls, and weekly video sessions with researchers.

During pursed-lip breathing, patients inhale through the nose and exhale slowly through puckered lips, releasing trapped air from the lungs to make room for fresh oxygen. The laughter therapy protocol — adapted from the Laughter Yoga framework developed by Madan Kataria, MD, in 1995 — combined deep breathing exercises, rhythmic warm-ups (such as clapping accompanied by vocal sounds), soft simulated laughter, and laughter meditation.

“We consulted expert laughter therapists to refine and adapt the traditional protocol specifically for COPD patients,” Aldan said. “Slight modifications were made to ensure the exercises were gentle, safe, and tailored to avoid overexertion or respiratory distress.”

Researchers assessed breathlessness using the Dyspnea-12 scale, where higher scores (up to 36) indicate worse symptoms. After 8 weeks, patients in the pursed-lip breathing group lowered their scores by an average of 2.87 points, whereas those in the laughter therapy group lowered theirs by 3.84 points.

To measure the overall impact of symptoms on daily life, researchers used the COPD Assessment Test (scored up to 40, with higher scores reflecting greater impact). After 8 weeks, pursed-lip breathing patients reduced their scores by an average of 2.81 points, and the laughter therapy group improved by 2.49 points.

In both assessments, patients in the education-only group saw little to no improvement.

Although the researchers anticipated that laughter therapy would offer benefits, seeing its efficacy hold at week 8 of the intervention — and again at week 12 — was particularly encouraging, Aldan noted.

“While these findings are promising, further studies with larger cohorts are necessary to confirm these longitudinal effects,” Aldan said.

Why Laughter Therapy Works

One possibility is that it engages the muscles used in breathing.

“Forced exhalations demand active contractions of the diaphragm and abdominal muscles, followed by deeper inhalations,” Aldan said. This cycle may promote prolonged exhalation — much like pursed-lip breathing — to help expel trapped air.

Laughter therapy might also help manage the sensation of breathlessness. Genuine laughter triggers the release of endorphins, which act on central opioid receptors to reduce stress and inhibit pain. Researchers aim to evoke the same effects with laughter therapy.

“In respiratory conditions, dyspnea and anxiety often create a vicious cycle where breathlessness induces panic, which further worsens shallow breathing,” Aldan said. “The release of endorphins might help break this cycle by dampening the central perception of breathlessness and supporting physical relaxation, thereby potentially reducing the psychological burden of dyspnea.”

The findings don’t surprise MeiLan Han, MD, MS, a professor of medicine and chief of the Division of Pulmonary and Critical Care at University of Michigan Medical School in Ann Arbor, who was not involved in the study. “It sheds light on the fact that there are low cost, potentially easy interventions that can have a huge impact,” she said.

Other traditional breathing exercises have shown similar benefits for this population. The University of Michigan Health and several other medical centers have incorporated harmonica therapy — which requires deep breathing and focused exhalation — into pulmonary rehabilitation for more than a decade. Research suggests playing the instrument can improve lung function in patients with COPD.

“I think there’s a combination of breathing exercises in a social setting, plus sort of this added factor of joy, that, if nothing else, improves quality of life for patients with COPD,” Han said.

The psychological benefits should not be overlooked. Anxiety and depression are common in people with COPD and linked to worse health outcomes, partly because breathing limitations often restrict a patient’s ability to stay socially connected, Han said.

“We sometimes forget the psychosocial impact that not being able to go out and do some of the normal daily activities that others would do impacts overall health,” Han said.

The Role of Breathing Exercises in Pulmonary Rehabilitation

Experts said that breathing exercises — when combined with aerobic training and education as part of a comprehensive pulmonary rehabilitation program — are an essential yet underused part of COPD management.

“Patients find pulmonary rehab possibly one of the most important and impactful things that we do,” Han said.

During pulmonary rehabilitation, highly trained nurses, respiratory therapists, and exercise physiologists dedicate time to teaching patients how their lungs function and how targeted exercises can improve respiratory performance.

Yet despite its evidence-backed benefits, pulmonary rehabilitation remains widely underutilized among patients with COPD in the US, research showed — largely because many clinicians are unaware of its value or hesitate to refer patients.

“For some people, it may be just lack of knowledge, or concern over the details of prescribing and coverage, but if they do have questions or concerns, I am certain that there are pulmonologists who can help them with that,” Han said.

Laughter Therapy in Practice

The approach sounds fun, but did patients agree? Not at first. Many were initially skeptical or hesitant, requiring ongoing guidance and follow-up.

“Once patients moved past their initial skepticism and experienced the exercises, the playful and mood-boosting nature of the protocol did help improve engagement,” Aldan said. “However, addressing patient doubts and building trust remain critical factors in ensuring long-term adherence to integrative care.”

For patients interested in trying laughter therapy, simply bursting into a fit of giggles at home isn’t the right approach.

“In severe COPD, intense or unguided laughing (such as watching intense comedy) can sometimes trigger acute coughing or airway collapse,” Aldan said.

To practice safely, patients should follow a gentle, controlled sequence:

1. Preparation: “Begin with deep diaphragmatic breathing and gentle, rhythmic clapping while vocalizing rhythmically (eg, ‘Ho-Ho, Ha-Ha-Ha’) to warm up the lungs,” Aldan said.
2. Playful Exercises: “Transition to light, simulated laughter exercises — such as the ‘lion’s roar’ or smiling with soft exhalations — which patients found easy and approachable at first because they do not require immediate genuine laughter,” Aldan said.
3. Cool-down: “End with quiet, calm breathing and gentle smiling to relax the respiratory muscles,” Aldan said.

Aldan reported having no disclosures. Han reported having no disclosures related to laughter therapy. Her general disclosures included receiving personal fees from Aerogen, Altesa Biopharma, Amgen, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Chiesi, CSL Behring, DevPro, GlaxoSmithKline, Integrity, Lilly, MDBriefcase, Medscape, Merck, NACE, Pulmonx, Regeneron, Roche, Sanofi, UCB, Uniquity, UpToDate, Verona, Windward Bio, and Zymeworks; receiving either in-kind research support or funds paid to the institution from the American Lung Association, AstraZeneca, Biodesix, Boehringer Ingelheim, the COPD Foundation, Galvanize Therapeutics, the National Institutes of Health, Nuvaira, and Sanofi; and holding stock options in Altesa Biopharma, Meissa Vaccines, and Roon.