What is the orthopneic position used for: A comprehensive guide

September 21, 2025 •

4 min read

According to the Cleveland Clinic, the orthopneic position is a natural reflex many people adopt to help them breathe better when experiencing shortness of breath. This guide will explain what is the orthopneic position used for, detailing its purpose, benefits, and how to properly assume this helpful posture.

Quick Summary

The orthopneic position is used to help individuals experiencing severe shortness of breath (dyspnea) breathe more easily by maximizing lung expansion and reducing the work of breathing. It is often a spontaneous response to respiratory distress caused by conditions like heart failure, COPD, and asthma attacks.

Key Points

Purpose: The orthopneic position, also known as the tripod position, is used to relieve severe shortness of breath by maximizing lung expansion.
Mechanism: It works by fixing the arms to provide leverage for accessory breathing muscles and improving the efficiency of the diaphragm.
Common Conditions: It is particularly helpful for individuals with conditions like COPD, asthma, and congestive heart failure, especially when experiencing orthopnea (difficulty breathing when lying down).
Proper Technique: To assume the position, sit or stand while leaning forward, supporting your upper body with your arms on a solid surface or your knees.
Medical Context: While it offers immediate relief, it is a temporary measure and often indicates an underlying condition that requires proper medical treatment.

Understanding the Orthopneic Position

Also known as the tripod position, the orthopneic position is a sitting or standing posture where an individual leans forward and supports their upper body with their hands or elbows resting on a surface, such as their knees or a table. This position is not just a comfort choice but a crucial maneuver used in medical settings and instinctively by patients to manage respiratory distress. The term originates from the Greek words 'ortho' (straight) and 'pnea' (breathe), literally meaning to breathe easier when straight or upright. For many, the need to assume this position signals an underlying health issue that requires attention from a healthcare provider.

How to Assume the Orthopneic Position

Whether in a clinical environment or at home, assuming the orthopneic position correctly is key to its effectiveness. Here is a simple, step-by-step guide:

Find a Stable Surface: Sit on a sturdy chair or on the side of a bed with your feet flat on the floor.
Lean Forward: Bend your torso forward from your hips, positioning your chest slightly over your knees.
Provide Support: Place your hands, palms down, on your knees or a table in front of you. You can also rest your elbows on your knees for more support. If a table is available, place pillows on it to rest your head on your folded arms.
Relax and Breathe: With your neck and shoulders relaxed, focus on deep, steady breathing. The supported lean opens up your chest cavity, making it easier to inhale and exhale.

The Science Behind the Breathing Relief

The orthopneic position is physiologically beneficial for several reasons, primarily by optimizing the mechanics of respiration. When you lean forward and support your upper body, you change the dynamics of your respiratory system in a few key ways:

Maximized Chest Expansion: By fixing the position of the shoulder girdle and arms, you increase the anteroposterior diameter of the chest. This allows the accessory muscles in the neck and chest, such as the scalenes and pectoralis minor, to assist the diaphragm, pulling the chest wall upwards and outwards to increase lung volume.
Improved Diaphragm Function: Leaning forward allows the diaphragm to descend more fully during inhalation. This improved length-tension relationship makes the diaphragm more efficient, reducing the overall effort required to breathe.
Reduced Fluid Shift: In conditions like heart failure, lying flat causes fluid from the extremities to shift back into the heart and lungs, causing pulmonary congestion and shortness of breath (orthopnea). Sitting upright shifts this fluid back towards the lower body, relieving pressure on the lungs.

Conditions Managed with the Orthopneic Position

The orthopneic position is a temporary, symptomatic relief tool rather than a cure, but its effectiveness makes it a go-to strategy for managing episodes of breathlessness. It is particularly valuable for people with the following conditions:

Chronic Obstructive Pulmonary Disease (COPD)

Patients with COPD often experience air trapping (hyperinflation) in their lungs, which flattens the diaphragm and makes breathing difficult. Leaning forward in the orthopneic position helps to reposition the diaphragm into a more functional, piston-like shape, making it easier to expel stale air and take in new oxygen. It is a commonly taught technique during pulmonary rehabilitation.

Congestive Heart Failure

For individuals with heart failure, a weakened heart struggles to pump blood effectively, leading to fluid buildup in the lungs and shortness of breath, especially when lying down. The orthopneic position helps manage this symptom by using gravity to pull excess fluid away from the lungs, easing the strain on the heart and improving respiratory function.

Asthma Exacerbations

During an asthma attack, the airways narrow, causing wheezing and shortness of breath. Assuming the orthopneic position can help by giving the chest muscles more leverage, allowing the individual to put more effort into each breath and increasing the amount of air that enters the lungs.

Orthopneic Position vs. Other Breathing Positions


Feature	Orthopneic Position	High Fowler's Position	Prone Position
Body Posture	Seated, leaning forward on a support.	Semi-sitting, with the head of the bed elevated 60-90 degrees.	Lying on the stomach with the head turned to one side.
Mechanism	Maximizes chest expansion by fixing the arms and using accessory muscles.	Uses gravity to lower abdominal organs, allowing for easier breathing.	Reduces compression on the lungs by redistributing weight.
Targeted Relief	Shortness of breath, especially when lying down (orthopnea).	General breathing difficulty and high blood pressure.	Improves gas exchange and oxygenation, especially in ARDS.
Muscles Used	Primarily accessory respiratory muscles and diaphragm.	Primarily diaphragm.	Redistributes weight on the thoracic cavity to improve ventilation.

Benefits and Considerations

The orthopneic position offers several immediate benefits, such as reducing the sensation of breathlessness, decreasing the work of breathing, and increasing comfort during respiratory distress. However, it is a temporary solution, and the underlying cause of the breathing difficulties must be addressed medically. Nurses and other caregivers must also be aware of potential issues like fatigue from maintaining the position and the risk of skin breakdown with prolonged use. Regular repositioning and monitoring are vital for patient comfort and safety.

A Valuable Tool in Respiratory Care

Ultimately, understanding the application and function of the orthopneic position is valuable for both patients and caregivers. It provides a non-invasive, immediate way to manage acute shortness of breath and plays a significant role in improving the quality of life for individuals with chronic respiratory or cardiac conditions. While it is often an instinctive action, being knowledgeable about how and why it works can enhance its effectiveness and provide a greater sense of control during distressing moments. For those with chronic breathing issues, discussing proper positioning with a healthcare provider during pulmonary rehabilitation is highly recommended.

For further information on respiratory health, visit the American Lung Association.

Frequently Asked Questions

The primary purpose is to help individuals with severe shortness of breath (dyspnea) breathe more easily and efficiently. The position expands the chest cavity and optimizes the diaphragm's function.

People with COPD often use this position because it helps counteract the effects of air trapping (hyperinflation), allowing for better diaphragm movement and easier exhalation. This reduces the work of breathing during exacerbations.

While generally safe and often assumed instinctively, it is a temporary measure. Patients should be monitored for fatigue or discomfort, and the position is not a substitute for proper medical care for the underlying cause of breathlessness.

The orthopneic position involves leaning forward to maximize chest expansion, while the Fowler's position is a semi-sitting posture with the head of the bed elevated. The key difference is the forward lean, which provides mechanical advantages for breathing.

Yes, if you experience sudden breathlessness during an asthma attack, assuming this position can help ease your breathing. However, you should follow your asthma action plan and seek medical help if your symptoms don't improve with medication.

In heart failure, fluid can accumulate in the lungs when lying flat. The orthopneic position helps by using gravity to shift this fluid away from the lungs and back towards the lower body, relieving pressure and improving breathing.

If you find yourself needing to assume this position frequently, it is a sign that your underlying condition is not well-managed. You should contact your healthcare provider for an evaluation and potential adjustment of your treatment plan.