Which is correct when using an incentive spirometer? A Complete Guide

October 14, 2025 •

5 min read

Post-operative pulmonary complications (PPCs) occur in up to 19% of non-cardiac surgeries, making respiratory health a critical focus of recovery [1.7.1]. Understanding which is correct when using an incentive spirometer is vital for preventing these issues and strengthening your lungs.

Quick Summary

Master the correct technique for using an incentive spirometer. This guide details step-by-step instructions, common mistakes, and key benefits to aid post-surgical recovery and improve overall lung function.

Key Points

Inhale, Don't Exhale: The device works by breathing in slowly and deeply, not blowing out [1.3.2].
Sit Upright: Proper posture is essential. Sit on the edge of your bed or in a chair to allow for maximum lung expansion [1.2.3].
Slow and Steady: Inhale slowly to keep the flow rate indicator in the target zone; breathing too fast is a common mistake [1.3.6].
Hold Your Breath: After inhaling fully, hold your breath for at least 3-5 seconds to help open the air sacs in your lungs [1.2.2].
Frequency is Key: Use the device for about 10 breaths every hour you are awake, or as directed by your provider, to prevent complications [1.2.3].
Cough After Sets: After completing a set of 10 repetitions, cough to clear mucus from your lungs. Splint your incision with a pillow if needed [1.2.1, 1.2.3].
Set and Track Goals: Use the marker on the side to track your progress and aim to improve your lung volume with each session [1.2.3].

What is an Incentive Spirometer?

An incentive spirometer is a handheld medical device designed to help your lungs recover after surgery or illness [1.4.5]. It works by providing a visual incentive to encourage you to take slow, deep breaths. This action helps expand your lungs, strengthen respiratory muscles, and clear mucus [1.4.5, 1.5.4]. It is a fundamental tool in respiratory therapy, frequently recommended after chest or abdominal surgery to prevent serious lung complications like pneumonia and atelectasis (lung collapse) [1.4.2, 1.5.6]. While it seems simple, proper technique is essential to reap its benefits.

Step-by-Step: The Correct Way to Use an Incentive Spirometer

To ensure you are performing the exercise correctly, follow these steps. A healthcare provider will typically set an initial goal marker for you to aim for [1.2.4].

Sit Upright: If possible, sit on the edge of your bed or in a chair. If you must remain in bed, sit up as far as you can to allow your lungs to expand fully [1.2.3].
Hold the Device: Hold the incentive spirometer in an upright position at eye level [1.2.3, 1.8.4].
Exhale Normally: Before you begin, breathe out completely as you normally would [1.2.1].
Seal Your Lips: Place the mouthpiece in your mouth and create a tight seal with your lips to ensure all your inspired air goes through the device [1.2.2]. Do not block the opening with your tongue [1.2.6].
Inhale Slowly and Deeply: Breathe in slowly and as deeply as possible through the mouthpiece, not your nose. Imagine you are sucking a thick milkshake through a straw [1.2.1, 1.2.4]. This slow inhalation is crucial.
Watch the Indicator: As you inhale, you will see a piston or ball rise in the main chamber. At the same time, watch the flow rate indicator—a smaller ball or disk in a separate chamber. Your goal is to keep this indicator in the target range, which shows you are inhaling at the correct speed. If it shoots to the top, you are breathing in too fast; if it stays at the bottom, you are breathing too slowly [1.3.6, 1.9.1].
Reach Your Goal: Continue to inhale until the main piston reaches the goal marked by your provider, or as high as you can manage [1.2.4].
Hold Your Breath: Once you've reached your maximum inhalation, remove the mouthpiece and hold your breath for at least 3 to 5 seconds, or as long as you can comfortably manage [1.2.2, 1.2.3]. This hold allows the air to distribute deep into your lungs and open up the small air sacs (alveoli).
Exhale Slowly: Breathe out normally and allow the piston to fall back to the bottom [1.2.5]. Rest for a few seconds.
Repeat and Cough: Repeat this process for a set of 10 breaths. It's recommended to do this every hour while awake, or as directed by your healthcare provider [1.2.3, 1.8.4]. After each set of 10, it's important to cough a few times to help clear any mucus from your lungs [1.2.1]. If you have a surgical incision, splinting it by holding a pillow firmly against it can reduce discomfort while coughing [1.2.3].

Common Mistakes to Avoid

Correct technique is the difference between an effective treatment and a wasted effort. Here are common errors to avoid:

Breathing Out Instead of In: A frequent mistake is blowing into the device. An incentive spirometer works on inhalation (breathing in) [1.3.2].
Inhaling Too Quickly: A fast breath will cause the flow indicator to shoot to the top and won't effectively expand the deeper parts of your lungs. The key is a slow, sustained breath [1.3.6].
Not Sealing Lips Around the Mouthpiece: A poor seal allows air to leak, resulting in an inaccurate measurement and less effective exercise [1.2.2].
Using Your Nose: The exercise must be done by breathing in through your mouth only [1.2.2].
Not Sitting Upright: Slouching compresses your lungs and prevents full expansion [1.2.3].
Forgetting to Hold Your Breath: The breath-hold is a critical step that helps prevent atelectasis by keeping the alveoli open [1.2.2].

Volume-Oriented vs. Flow-Oriented Spirometers

There are two primary types of incentive spirometers, and understanding their differences can help clarify their function [1.6.2].


Feature	Volume-Oriented Spirometer (VIS)	Flow-Oriented Spirometer (FIS)
Mechanism	Directly measures the volume of air you inhale. A piston rises in a calibrated chamber to show the inspired volume [1.6.5].	Indirectly indicates volume by measuring the flow rate of your breath. Typically uses three chambers with balls that rise at different flow rates (e.g., 600, 900, 1200 cc/sec) [1.6.1].
Patient Effort	Does not require as much work to breathe and is associated with better diaphragmatic movement and less accessory muscle activity [1.6.2, 1.6.3].	Makes you work harder to breathe, which helps strengthen upper chest muscles but can also lead to fatigue [1.6.2, 1.6.6].
Effectiveness	Studies suggest VIS promotes a greater increase in chest wall volume with lower respiratory muscle activity compared to FIS [1.6.3]. It may be more effective in improving pulmonary function [1.6.4, 1.6.5].	Effective for breathing exercises but may stimulate more accessory muscle activity [1.6.6].

The Pharmacological Importance: Preventing Complications

While not a medication, the incentive spirometer is a prescribed therapy with significant pharmacological implications. Its primary role is prophylactic—preventing the need for more intensive medical interventions. After surgery, especially with general anesthesia, breathing patterns become shallow [1.4.1]. This reduced lung volume can lead to atelectasis, where parts of the lung collapse. Trapped secretions in these areas can become a breeding ground for bacteria, leading to pneumonia [1.5.3].

By mechanically keeping the lungs open and active, incentive spirometry reduces the risk of these complications [1.4.3]. This can decrease the need for antibiotics to treat pneumonia, supplemental oxygen, and potentially even re-intubation in severe cases [1.7.2]. It also helps clear anesthesia from the lungs more quickly after an operation [1.5.4]. Therefore, this simple device plays a crucial role in reducing post-operative morbidity, mortality, and healthcare costs [1.7.1, 1.7.2].

Conclusion

Knowing which is correct when using an incentive spirometer is vital for anyone recovering from surgery or managing a chronic lung condition. The correct technique involves a slow, deep inhalation, a sustained breath-hold, and consistent practice. By avoiding common mistakes and understanding the purpose behind the exercise, you can effectively use this tool to strengthen your lungs, prevent serious complications like pneumonia and atelectasis, and take an active role in your recovery [1.4.3, 1.5.4]. Always follow the specific instructions provided by your healthcare team for frequency and goals [1.8.4].

For more information from an authoritative source, you can visit the Cleveland Clinic's page on incentive spirometers [1.2.3].

Frequently Asked Questions

An incentive spirometer is a device used to help keep your lungs healthy after surgery or illness. It encourages you to take slow, deep breaths to expand your lungs, prevent fluid buildup, and avoid complications like pneumonia [1.4.2, 1.4.3].

Typically, you should aim to use it for about 10 repetitions every one to two hours while you are awake, or as specifically instructed by your healthcare provider [1.2.3, 1.8.2].

A normal goal varies greatly depending on your age, sex, height, and overall lung health [1.9.4]. Your doctor or respiratory therapist will set an initial goal for you, often starting around 500 mL post-surgery and increasing as you recover [1.9.4]. The focus is on gradual improvement.

If you inhale too quickly, the flow indicator ball or disk will shoot to the top. This is less effective for deep lung expansion. The goal is a slow, sustained breath that keeps the indicator in the middle of its chamber [1.3.6].

Breathing too quickly or deeply in succession can sometimes cause dizziness or lightheadedness. If this happens, stop, remove the mouthpiece, and take a few normal breaths before continuing at a slower pace [1.3.4, 1.5.5].

You must breathe in through your mouth. The device will not work correctly if you inhale through your nose [1.2.2, 1.4.3].

You breathe IN. A very common mistake is to blow (exhale) into the device. The correct action is to inhale slowly to raise the piston or balls [1.3.2].