Do you breathe in quickly and expel slowly or other way around?

You should breathe in quickly and forcefully through the POWERbreathe (enabling you to ‘lift’ the weight/resistance), and then breathe out naturally as you would normally. Do this 30 times, twice a day. When you feel it getting easier, and you can easily manage the 30 breaths without reaching the point of failure, then increase the resistance a quarter turn. This will be your new training load. 

Do I have to train twice a day for ever more?

No, after 4-6 weeks of regular training your breathing muscles will have improved substantially and you should feel less breathless. At this stage the recommended training regimen of 30 breaths twice a day can be undertaken every other day, to maintain your improved breathing. If you are using POWERbreathe Medic, please follow the advice provided by your consultant.