This is an interesting verse! Recall that in Genesis (Bereshit), the creation process always begins with the words "and God said". This is a hint that we can start the process of creation in our own lives by vocalizing our intentions. If nothing else, verbalizing what we hope to accomplish adds clarity to our will, and it brings things one step closer to physical reality. It is also written in Pirkei Avot (Chapters of the Fathers) that "With ten utterances was the world created." This refers to the ten times that "and God said" appears in Genesis. Observe also that the word for voice (Kol, Kuph-Vav-Lamed) has a numerical value of 136, and 1+3+6=10. This further confirms the link between voice and the creative process.
Recall now that the word for breath (Ruach) also means spirit. The implication we wish to make here is that the vocalization of our will helps set the spirit in motion. For example, by having a clear intention of what we want to do, our minds automatically set to work on both conscious and subconscious levels in order to make it happen. However, sometimes what we think we want is not what we really want, and so things may be blocked at other levels.
The five locations in which the twenty-two letters of the Hebrew alphabet are placed may to be a reference to the five world levels of Kabbalah. The highest level is Adam Kadmon, primordial man, the will of God from which all manifestation is proceeds. Next is Atzilut, the world of nearness to God, a point of contemplation that is difficult to attain. Following this is Beriyah, the world of creation, that point where a creative thought emerges out of the Nothingness. The fourth world is Yetzirah, the world of formation where we create by manipulating and rearranging what already is. God is able to create something from nothing (yesh m'ayin), but we say that man creates something from something (yesh m'yesh). Thus, the Book of Formation (Sefer Yetzirah) describes a creation process that may be utilized by man. The final world is Asiyah, the world of physical doing. It is here that our creations manifest, and it is here that we are given the opportunity to choose between the blessing and the curse.
"I call heaven and earth to record this day against you, that I have set before you life and death, blessing and cursing; therefore choose life, that both you and your seed may live. -Deuteronomy 30:19"