An elderly male complains of difficulty in breathing. He is chronic smoker with 40 packs/year. He has been facing such problems on and off. A chest x ray was done which showed the following abnormalities. Which of the following positions serve as most comfoable for a patient facing difficulty in breathing?

Clinical history with chest x ray showing- hyperinflated lung fields, flattened diaphragm with tubular hea is s/o COPD. In dyspnoea or difficulty in breathing, the patients are most comfoable on sitting up position, leaning forwards with fixed arms. Sitting posture: position of diaphragm is lowest allowing maximum ventilation. Fixation of the arms and scapulae help serratus anterior and pectoralis minor to act on the ribs for an advantage. The height of the diaphragm varies according to : the position of the body tone of the abdominal muscles. It is highest on lying supine (extremely uncomfoable), as he/she needs to increase work of respiration (for inspiration). The diaphragm is lowest in sitting posture. Therefore, patient is comfoable.