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US3710780A - Respiratory device with variable expiratory pressure resistance - Google Patents

Respiratory device with variable expiratory pressure resistance Download PDF

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US3710780A
US3710780A US00169252A US3710780DA US3710780A US 3710780 A US3710780 A US 3710780A US 00169252 A US00169252 A US 00169252A US 3710780D A US3710780D A US 3710780DA US 3710780 A US3710780 A US 3710780A
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conduit
outlet
liquid
mouthpiece
respiratory apparatus
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US00169252A
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R Milch
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    • A—HUMAN NECESSITIES
    • A63—SPORTS; GAMES; AMUSEMENTS
    • A63B—APPARATUS FOR PHYSICAL TRAINING, GYMNASTICS, SWIMMING, CLIMBING, OR FENCING; BALL GAMES; TRAINING EQUIPMENT
    • A63B23/00—Exercising apparatus specially adapted for particular parts of the body
    • A63B23/18—Exercising apparatus specially adapted for particular parts of the body for improving respiratory function

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  • ABSTRACT A device to permit more efficient breathing by medical patients comprising a mouthpiece having a passage portion for communication with the patients mouth and inlet and outlet passages communicating with the first passage portion.
  • the inlet and outlet passages are provided, respectively, with inlet and outlet check valves.
  • a flexible conduit extends from the outlet check valve portion of the mouthpiece to a receptacle containing a liquid and the, outlet end of the flexible conduit is immersed in the liquid to an adjusted depth to interpose a predetermined variable fluid resistance to air flow from said mouthpiece outlet passage by way of said conduit.
  • This invention relates to apparatus particularly for use by patients with respiratory problems, as for instance, post-operative patients, and those with atelectasis, pneumonia, chronic bronchitis, and emphysema.
  • the patient uses a mouthpiece for breathing and forced blasts of air under pressure are introduced into the mouthpiece during inspiration to promote deeper inhalation.
  • This method is known in the medical arts as intermittent positive pressure breathing and is objectionable for several reasons: it requires costly and complicated equipment and trained personnel to administer, it is frequently uncomfortable and distressing to the patient, air maybe driven into the stomach instead of into the lungs and secretions may be pushed deeper into the air passages.
  • the apparatus of the present invention includes a mouthpiece through which the patient breathes.
  • the mouthpiece has air inlet and outlet portions and the inlet portion is provided with an. inwardly directed check valve which opens freely when the patient inhales to permit inhalation of ambient air for breathing.
  • the outlet portion has an outwardly directed check valve which opens freely when the patient exhales to permit free passage of exhalation.
  • the outlet portion of the mouthpiece includes a tube or conduit which leads from just beyond the outwardly directed expiratoryvalve and has its discharge end immersed in a body of water.
  • the patient upon exhalation, the patient must produce sufficient expiratory pressure to discharge exhalation from the tube into the body of water against the head of liquid which is present between the bottom discharge end of the tube and the surface of the body of water.
  • the depth of immersion of the tube in the water is controlled and adjustable to provide accurately regulated fluid resistance to exhalation.
  • the patient must exert a predetermined controlled degree of expiratory pressure in order to move the exhalation out of the discharge tube and through the head of water.
  • the exhalatory pressure thus generated dilates the patients bronchi,.thus permitting better mixture and absorption of inspired air, and'more efficient clearing of trapped secretions.
  • top plan view with portions shown in crosssection for v clearer illustration and an associated receptacle adapted to contain an open body of water into which the outlet conduit from the mouthpiece discharges.
  • the numeral 1 designates a cylindrical valve body having a conduit portion 2 extending medially therefrom.
  • a mouthpiece 3 is fitted over conduit portion 2 and has a mouth-engaging portion 4 with opposed arcuate channels 5 into which the patients teeth fit in gripping the mouthpiece orally.
  • the portion of mouthpiece 3 which fits over conduit portion 2 of valve body 1 is preferably of somewhat elastic material so as to stretch over and fit snugly about conduit portion 2.
  • Valvebody 1 has an inlet' end 6 and an outlet end 7. Inlet end 6 is provided with a freely flexible disc valve 8 which is fixed medially in a tubular insert 9 by means of a transverse pin 10. The two halves of valve 8 may flex freely to the right as viewed in the drawing under external air pressure but seat against a bushing or collar 11 under air pressure from within the valve body.
  • valve body 1 The outlet end 7 of valve body 1 is provided with a freely flexible disc valve 12 which is fixed along a diametral line to a cylindrical insert 13 by a transversely extending pin 14.
  • the two halves of valve 12 may 7 flex freely to the right as viewed in the drawing under air pressure from within valve body 1 but seat against a' collar 15 under pressure from the right-hand side of valve 12 as viewed in the drawing.
  • a flexible conduit 16 extends from the outlet end of valve body 1 and in the present instance has an enlarged end portion 17 which fits snugly thereovenConduit 16 extends to a receptacle 18 which may comprise a graduated transparent cylinder containing water to a predetermined level as indicated at 19.
  • the outletconduit 16 from the valve body extends into the water 19 and is supported at the upper end of receptacle 18 by a bracket 20 which permits free vertical adjustment of conduit 16 to determine the depth of immersion of the end of conduit 16 in the water.
  • valve body 1 may be accurately the underlying principles of the invention but it is to be passage for mouth breathing, a check valve in said inletpassage permitting air flow into said mouthpiece but 2.
  • check valve comprises a flexible disconnected to said inlet passage at opposite diametral points whereby the two halves thereof flex freely in the direction of fluid flow, and an annular seat portion adjacent to said valve at the outer side thereof to the opposite direction.
  • check valve comprises flexible disc s connected to said passages at opposite diametral points whereby the two halves of each valve flex freely in the direction of air flow, and annularseat portions in said passages adprevent flexure thereof in 'jace'nt to said valves to prevent flexure thereof in the opposite direction.
  • Respiratory apparatus as in claim 5 wherein said receptacle includes adjustable means for supporting said outlet conduit to support the same for immersion f to various depths in said liquid.

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  • Health & Medical Sciences (AREA)
  • Pulmonology (AREA)
  • General Health & Medical Sciences (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Respiratory Apparatuses And Protective Means (AREA)

Abstract

A device to permit more efficient breathing by medical patients comprising a mouthpiece having a passage portion for communication with the patient''s mouth and inlet and outlet passages communicating with the first passage portion. The inlet and outlet passages are provided, respectively, with inlet and outlet check valves. A flexible conduit extends from the outlet check valve portion of the mouthpiece to a receptacle containing a liquid and the outlet end of the flexible conduit is immersed in the liquid to an adjusted depth to interpose a predetermined variable fluid resistance to air flow from said mouthpiece outlet passage by way of said conduit.

Description

United States Patent 1 Milch I [111 3,710,780 [451' Jan. 1 ,1973
[541 RESPIRATORY DEVICE WITH VARIABLE EXPIRATORY PRESSURE RESISTANCE [76] Inventor: Robert A. Milch, 1405 North Forest Rd., Buffalo, NY 14221 22 Filed: Aug.5. 1971 211 Appl.N0.: 169,252
[52] U.S. Cl ..128/25 R, 272/57 F [51] Int. Cl. ..A6lh 1/02 [58] Field of Search ..l28/2, 25 R; 272/57 R, 57 F {56] References Cited UNITED STATES PATENTS 3,511,228 5/1970 Lundgren et al ..l28/25 R FOREIGN PATENTS OR APPLICATIONS 779,571 l/l935 France ..272/57 F Primary Examinef-Lawrence W. Trapp Attorney-Conrad Christel et al.
[57] ABSTRACT A device to permit more efficient breathing by medical patients comprising a mouthpiece having a passage portion for communication with the patients mouth and inlet and outlet passages communicating with the first passage portion. The inlet and outlet passages are provided, respectively, with inlet and outlet check valves. A flexible conduit extends from the outlet check valve portion of the mouthpiece to a receptacle containing a liquid and the, outlet end of the flexible conduit is immersed in the liquid to an adjusted depth to interpose a predetermined variable fluid resistance to air flow from said mouthpiece outlet passage by way of said conduit. I v Claims, 1 Drawing Figure PATENTED JAN 1 6 I975 INVENTOR v ROBERT A. MILCH l llll|lllllllllll|||l|||lll ATTOR N EYS RESPIRATORY DEVICE WITH VARIABLE EXPIRATORY' PRESSURE RESISTANCE BACKGROUND OF THE INVENTION This invention relates to apparatus particularly for use by patients with respiratory problems, as for instance, post-operative patients, and those with atelectasis, pneumonia, chronic bronchitis, and emphysema.
In certain medical cases patients tend to breathe shallowly, clear their pulmonary secretions poorly, or have some obstruction to satisfactory oxygenation of their blood, and there is a need to promote more efficient breathing. Present methods with this end in view are makeshift and unsatisfactory. For instance, there is what is known as a rebreathing device wherein the patient inhales from and exhales into a closed chamber, such as a bag. Since the air supply thus available increases rapidly in carbon dioxide content, and lowers in oxygen content, the patient must breathe more to survive. However, it usually results in the patient breathing faster rather than deeper,-and this technique is actually dangerous in some cases due to the limited oxygen supply.
In another method the patient uses a mouthpiece for breathing and forced blasts of air under pressure are introduced into the mouthpiece during inspiration to promote deeper inhalation. This method is known in the medical arts as intermittent positive pressure breathing and is objectionable for several reasons: it requires costly and complicated equipment and trained personnel to administer, it is frequently uncomfortable and distressing to the patient, air maybe driven into the stomach instead of into the lungs and secretions may be pushed deeper into the air passages.
SUMMARY OF THE INVENTION The apparatus of the present invention includes a mouthpiece through which the patient breathes. The mouthpiece has air inlet and outlet portions and the inlet portion is provided with an. inwardly directed check valve which opens freely when the patient inhales to permit inhalation of ambient air for breathing. The outlet portion has an outwardly directed check valve which opens freely when the patient exhales to permit free passage of exhalation. In addition to the outwardly directed check valve the outlet portion of the mouthpiece includes a tube or conduit which leads from just beyond the outwardly directed expiratoryvalve and has its discharge end immersed in a body of water. Thus, upon exhalation, the patient must produce sufficient expiratory pressure to discharge exhalation from the tube into the body of water against the head of liquid which is present between the bottom discharge end of the tube and the surface of the body of water. The depth of immersion of the tube in the water is controlled and adjustable to provide accurately regulated fluid resistance to exhalation.
Thus the patient must exert a predetermined controlled degree of expiratory pressure in order to move the exhalation out of the discharge tube and through the head of water. The exhalatory pressure thus generated dilates the patients bronchi,.thus permitting better mixture and absorption of inspired air, and'more efficient clearing of trapped secretions.
top plan view with portions shown in crosssection for v clearer illustration and an associated receptacle adapted to contain an open body of water into which the outlet conduit from the mouthpiece discharges.
DESCRIPTION OF THE ILLUSTRATED EMBODIMENT In the drawing the numeral 1 designates a cylindrical valve body having a conduit portion 2 extending medially therefrom. A mouthpiece 3 is fitted over conduit portion 2 and has a mouth-engaging portion 4 with opposed arcuate channels 5 into which the patients teeth fit in gripping the mouthpiece orally. The portion of mouthpiece 3 which fits over conduit portion 2 of valve body 1 is preferably of somewhat elastic material so as to stretch over and fit snugly about conduit portion 2.
Valvebody 1 has an inlet' end 6 and an outlet end 7. Inlet end 6 is provided with a freely flexible disc valve 8 which is fixed medially in a tubular insert 9 by means of a transverse pin 10. The two halves of valve 8 may flex freely to the right as viewed in the drawing under external air pressure but seat against a bushing or collar 11 under air pressure from within the valve body.
The outlet end 7 of valve body 1 is provided with a freely flexible disc valve 12 which is fixed along a diametral line to a cylindrical insert 13 by a transversely extending pin 14. The two halves of valve 12 may 7 flex freely to the right as viewed in the drawing under air pressure from within valve body 1 but seat against a' collar 15 under pressure from the right-hand side of valve 12 as viewed in the drawing.
A flexible conduit 16 extends from the outlet end of valve body 1 and in the present instance has an enlarged end portion 17 which fits snugly thereovenConduit 16 extends to a receptacle 18 which may comprise a graduated transparent cylinder containing water to a predetermined level as indicated at 19. The outletconduit 16 from the valve body extends into the water 19 and is supported at the upper end of receptacle 18 by a bracket 20 which permits free vertical adjustment of conduit 16 to determine the depth of immersion of the end of conduit 16 in the water. I
Since the fluid resistance to discharge-of air into the water from conduit 16 is directly proportional to' thehead of water above the discharge end of conduit 16, the resistance to discharge of air from conduit 16, and
consequently from valve body 1,, may be accurately the underlying principles of the invention but it is to be passage for mouth breathing, a check valve in said inletpassage permitting air flow into said mouthpiece but 2. Respiratory apparatus as in claim 1 wherein said means for preventing retrograde fluid flow from said conduit to said outlet passage comprises a check valve in said outlet passage.
3. Respiratory apparatus as in claim 1 wherein said check valve comprises a flexible disconnected to said inlet passage at opposite diametral points whereby the two halves thereof flex freely in the direction of fluid flow, and an annular seat portion adjacent to said valve at the outer side thereof to the opposite direction.
4. Respiratory apparatus as in claim 2 wherein said check valve comprises flexible disc s connected to said passages at opposite diametral points whereby the two halves of each valve flex freely in the direction of air flow, and annularseat portions in said passages adprevent flexure thereof in 'jace'nt to said valves to prevent flexure thereof in the opposite direction.
5. Respiratory apparatus as in claim 1 wherein said receptacle-is graduated to show the depth of liquid therein and the depth of immersion of said outlet conduit terminal portion.
6. Respiratory apparatus as in claim 5 wherein said receptacle includes adjustable means for supporting said outlet conduit to support the same for immersion f to various depths in said liquid.
a a a a: 4 I

Claims (6)

1. Respiratory apparatus for conducing more efficient breathing by medical patients, said apparatus comprising a mouthpiece having an inlet and an outlet passage for mouth breathing, a check valve in said inlet passage permitting air flow into said mouthpiece but closable under retrograde flow, a liquid containing receptacle, a conduit leading from said outlet passage and terminating in a portion projecting into the liquid in said receptacle to a predetermined depth, whereby exhalation by the patient through said mouthpiece and said conduit is effected against a liquid head as measured by the depth of immersion of said outlet conduit terminal portion in said liquid, and means preventing retrograde fluid flow from said conduit to said outlet passage.
2. Respiratory apparatus as in claim 1 wherein said means for preventing retrograde fluid flow from said conduit to said outlet passage comprises a Check valve in said outlet passage.
3. Respiratory apparatus as in claim 1 wherein said check valve comprises a flexible disconnected to said inlet passage at opposite diametral points whereby the two halves thereof flex freely in the direction of fluid flow, and an annular seat portion adjacent to said valve at the outer side thereof to prevent flexure thereof in the opposite direction.
4. Respiratory apparatus as in claim 2 wherein said check valve comprises flexible discs connected to said passages at opposite diametral points whereby the two halves of each valve flex freely in the direction of air flow, and annular seat portions in said passages adjacent to said valves to prevent flexure thereof in the opposite direction.
5. Respiratory apparatus as in claim 1 wherein said receptacle is graduated to show the depth of liquid therein and the depth of immersion of said outlet conduit terminal portion.
6. Respiratory apparatus as in claim 5 wherein said receptacle includes adjustable means for supporting said outlet conduit to support the same for immersion to various depths in said liquid.
US00169252A 1971-08-05 1971-08-05 Respiratory device with variable expiratory pressure resistance Expired - Lifetime US3710780A (en)

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Cited By (43)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3977399A (en) * 1974-06-05 1976-08-31 Peter Nelson Brawn Positive pressure and volume measure respiratory device
US3977395A (en) * 1974-02-27 1976-08-31 Peter Nelson Brawn Combination inhalation and exhalation respiratory therapy device
USD242956S (en) 1975-06-11 1977-01-04 Owens-Illinois, Inc. Lung exercise device
US4533137A (en) * 1982-01-19 1985-08-06 Healthscan Inc. Pulmonary training method
US4739987A (en) * 1985-10-28 1988-04-26 Nicholson Marguerite K Respiratory exerciser
US5109840A (en) * 1991-02-14 1992-05-05 Specialty Packaging Licensing Company Resuscitator having directional control valve with internal "PEEP" adjustment valve
AU677839B2 (en) * 1993-06-07 1997-05-08 Nathan Oren A therapeutic respiration device
US6581598B1 (en) * 1999-11-24 2003-06-24 Dhd Healthcare Corporation Positive expiratory pressure device
US6631716B1 (en) * 1998-07-17 2003-10-14 The Board Of Trustees Of The Leland Stanford Junior University Dynamic respiratory control
US20030234017A1 (en) * 1999-11-24 2003-12-25 Dhd Healthcare Corporation Positive expiratory pressure device with bypass
US6776159B2 (en) 1999-11-24 2004-08-17 Dhd Healthcare Corporation Positive expiratory pressure device with bypass
US20050109133A1 (en) * 2003-11-13 2005-05-26 John Lamb Adaptor means
US20090056719A1 (en) * 2007-08-31 2009-03-05 Newman Jr Lionel Exhalatory pressure device and system thereof
US20090062751A1 (en) * 2007-09-01 2009-03-05 Newman Jr Lionel Medical apparatus for suction and combination irrigation and suction
US20090194108A1 (en) * 2007-08-31 2009-08-06 Newman Jr Lionel Adjustable pressure device and system thereof
WO2009126739A1 (en) * 2008-04-10 2009-10-15 Seattle Children's Hospital Research Institute Broad-band, low frequency, high-amplitude, long time duration, oscillating airway pressure breathing apparatus and method utilizing bubbles
US20090264256A1 (en) * 2008-04-22 2009-10-22 Boerst Chad M Breathing exercise apparatus
US20100282253A1 (en) * 2009-02-04 2010-11-11 Wet Nose Technologies, Llc. Pressure release systems, apparatus and methods
WO2011004274A1 (en) * 2009-07-09 2011-01-13 Koninklijke Philips Electronics, N.V. System and method for entraining the breathing of a subject
US8327849B2 (en) 2008-10-28 2012-12-11 Trudell Medical International Oscillating positive expiratory pressure device
US8485179B1 (en) 2009-02-23 2013-07-16 Trudell Medical International Oscillating positive expiratory pressure device
AU2013202645B1 (en) * 2012-08-14 2013-09-05 Physiotherapydynamics Pty. Ltd. Oscillatory positive expiratory pressure apparatus
US8539951B1 (en) 2008-05-27 2013-09-24 Trudell Medical International Oscillating positive respiratory pressure device
US20150107595A1 (en) * 2011-12-31 2015-04-23 Kathryn Potter Respiratory physiotherapy device
USD731050S1 (en) 2011-06-06 2015-06-02 Trudell Medical International Oscillating positive expiratory pressure device
US9149589B2 (en) 2009-02-23 2015-10-06 Trudell Medical International Method and device for performing orientation dependent oscillating positive expiratory pressure therapy
US20150292676A1 (en) * 2014-04-15 2015-10-15 Besmed Health Business Corp. Pressure regulating oxygen bottle
US9180271B2 (en) 2012-03-05 2015-11-10 Hill-Rom Services Pte. Ltd. Respiratory therapy device having standard and oscillatory PEP with nebulizer
US9345850B2 (en) 2013-09-05 2016-05-24 Eupnea Technologies, Inc. Apparatus and method to provide breathing support
US9517315B2 (en) 2012-11-30 2016-12-13 Trudell Medical International Oscillating positive expiratory pressure device
USD778429S1 (en) 2015-09-02 2017-02-07 Trudell Medical International Respiratory treatment device
USD780906S1 (en) 2015-09-02 2017-03-07 Trudell Medical International Respiratory treatment device
US9656114B1 (en) * 2015-12-09 2017-05-23 Jamal Hafeez-Bey Jaw-strengthening device
US20170157461A1 (en) * 2014-05-06 2017-06-08 Mykola Lyapko Breathing exerciser
US9849257B2 (en) 2013-08-22 2017-12-26 Trudell Medical International Oscillating positive respiratory pressure device
US10004872B1 (en) 2015-03-06 2018-06-26 D R Burton Healthcare, Llc Positive expiratory pressure device having an oscillating valve
US10272224B2 (en) 2013-07-12 2019-04-30 Trudell Medical International Huff cough simulation device
US10363383B2 (en) 2014-02-07 2019-07-30 Trudell Medical International Pressure indicator for an oscillating positive expiratory pressure device
US10449324B2 (en) 2015-07-30 2019-10-22 Trudell Medical International Combined respiratory muscle training and oscillating positive expiratory pressure device
US10857317B2 (en) 2015-12-04 2020-12-08 Trudell Medical International Huff cough simulation device
US10953278B2 (en) 2018-02-02 2021-03-23 Trudell Medical International Oscillating positive expiratory pressure device
US11123514B2 (en) 2013-09-05 2021-09-21 Eupnea Technologies Inc. Apparatus and method to provide breathing support
US11559723B2 (en) 2017-05-03 2023-01-24 Trudell Medical International Combined oscillating positive expiratory pressure therapy and Huff Cough simulation device

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Patent Citations (2)

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FR779571A (en) * 1934-10-11 1935-04-09 Breathing exercise apparatus
US3511228A (en) * 1964-06-04 1970-05-12 Claes Erik Gunnar Lundgren Bronchial dilator for patients suffering from emphysema and asthma or the like

Cited By (108)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3977395A (en) * 1974-02-27 1976-08-31 Peter Nelson Brawn Combination inhalation and exhalation respiratory therapy device
US3977399A (en) * 1974-06-05 1976-08-31 Peter Nelson Brawn Positive pressure and volume measure respiratory device
USD242956S (en) 1975-06-11 1977-01-04 Owens-Illinois, Inc. Lung exercise device
US4533137A (en) * 1982-01-19 1985-08-06 Healthscan Inc. Pulmonary training method
US4739987A (en) * 1985-10-28 1988-04-26 Nicholson Marguerite K Respiratory exerciser
US5109840A (en) * 1991-02-14 1992-05-05 Specialty Packaging Licensing Company Resuscitator having directional control valve with internal "PEEP" adjustment valve
AU677839B2 (en) * 1993-06-07 1997-05-08 Nathan Oren A therapeutic respiration device
US5649533A (en) * 1993-06-07 1997-07-22 Oren; Nathan Therapeutic respiration device
US6631716B1 (en) * 1998-07-17 2003-10-14 The Board Of Trustees Of The Leland Stanford Junior University Dynamic respiratory control
US6581598B1 (en) * 1999-11-24 2003-06-24 Dhd Healthcare Corporation Positive expiratory pressure device
US20030234017A1 (en) * 1999-11-24 2003-12-25 Dhd Healthcare Corporation Positive expiratory pressure device with bypass
US6776159B2 (en) 1999-11-24 2004-08-17 Dhd Healthcare Corporation Positive expiratory pressure device with bypass
US7059324B2 (en) 1999-11-24 2006-06-13 Smiths Medical Asd, Inc. Positive expiratory pressure device with bypass
US20050109133A1 (en) * 2003-11-13 2005-05-26 John Lamb Adaptor means
US8235042B2 (en) 2007-08-31 2012-08-07 Wet Nose Technologies, Llc Exhalatory pressure device and system thereof
US8225787B2 (en) 2007-08-31 2012-07-24 Wet Nose Technologies, Llc Adjustable pressure device and system thereof
US20090194108A1 (en) * 2007-08-31 2009-08-06 Newman Jr Lionel Adjustable pressure device and system thereof
US20090056719A1 (en) * 2007-08-31 2009-03-05 Newman Jr Lionel Exhalatory pressure device and system thereof
US9427504B2 (en) 2007-09-01 2016-08-30 Wet Nose Technologies, Llc Medical apparatus for suction and combination irrigation and suction
US20090062751A1 (en) * 2007-09-01 2009-03-05 Newman Jr Lionel Medical apparatus for suction and combination irrigation and suction
US8381723B2 (en) 2008-04-10 2013-02-26 Seattle Children's Hospital Broad-band, low frequency, high-amplitude, long time duration, oscillating airway pressure breathing apparatus and method utilizing bubbles
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AU2010241205A8 (en) * 2008-04-10 2010-12-09 Seattle Children's Hospital D/B/A Seattle Children's Research Institute Broad-band, low frequency, high-amplitude, long time duration, oscillating airway pressure breathing apparatus and method utilizing bubbles
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US20090264256A1 (en) * 2008-04-22 2009-10-22 Boerst Chad M Breathing exercise apparatus
US8251876B2 (en) 2008-04-22 2012-08-28 Hill-Rom Services, Inc. Breathing exercise apparatus
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