Active Cycle of Breathing Technique


Original Editor ­- Faye Underwood

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Introduction

Active cycle of breathing (ACBT) is an active breathing technique performed by the patient to help clear their sputum. It is a technique which uses breathing exercises to  improves the effectiveness of cough, lossen and clear secreations and improve the ventilation.

ACBT consists of three MAIN phases

1. Breathing Control
2. Deep Breathing Exercises or thoracic expansion exercises
3. Huffing OR Forced expiratory technique (F.E.T)

Additionally a manual technique (MT) or positive pressure can be added if and when indicated, to create a more complex cycle.

Breathing Control

Breathing control is used to relax the airways and relieve the symptoms. of wheez and tighness which normally occur after coughing or breathlesness. Breathing should be done by nose gently and if not possible then breathing should be done by mouth.If you breathe out through your mouth you can use breathing control with ‘pursed lips breathing’.It is very important to do Breathing Control in between the more active exercises of ACBT as it allows your airways to relax. Breathing control can also help you when you are short of breath or feeling fearful, anxious or in a panic. The length of time spend doing breathing control will vary depending on how breathless patient feels.

Normal breathing to relax the airways, usually 6 breaths. Instructions to patient: Rest one hand on your stomach and keep your shoulders relaxed to drop down. Feel your stomach rise as you breathe in and fall when you breathe out.

Deep Breathing Exercises

Deep breathing is used to get air behind the sputum stuck in small airways

• Relax your upper chest
• Breathe in slowly and deeply
• Breathe out gently until your lungs are empty – don’t force the air out
• Repeat 3 – 4 times, if you feel light headed go back to relaxed breathing.
  
• At the end of the breath in, hold the air in your lungs for 3 seconds (This is an inspiratory hold).
  

Deep breathing/Thoracic expansion exercises recruit the collateral ventilatory system assisting, the movement of air distal to mucus plugs in the peripheral airways.

Deep breaths to utilise collateral channels and get air behind sputum to mobilise it towards larger airways and towards the mouth. Instructions to patient: Relax your shoulders, place both hands on either side of ribs. Breathe in deeply feeling as your ribs expand, breathe out gently as far as you can until your lungs feel empty. Usually repeated 4 times.

Huffing or FET

The FET is an integral part of the Active Cycle of Breathing Technique described by Pryor and Webber .

A huff is exhaling through an open mouth and throat instead of coughing.Huffing moves sputum from the small airways to the larger airways, from where they are removed by coughing. Coughing alone does not remove sputum from small airways.

• Take a medium sized breath in
• Squeeze the breath out by contracting your tummy muscles and keep your mouth and throat open. The breath should be prolonged, but don’t continue until the lungs are empty
• Take a large breath in
  
• Squeeze the air out as before
• Cough and expectorate any sputum. If you don’t produce any sputum with 1 or 2 coughs, try to stop coughing by using your breathing control
• Allow your breathing to settle with breathing control and then repeat the cycle until your chest feels clear
  

Small long huffs move sputum from low down into chest whereas big short huffs moves sputum from higher up into chest, so use this huff when it feels ready to come out, but not before; huffs work via dynamic compression.

To expel sputum. Instructions to patient: Take a medium sized breath in. Squeeze the breath out fairly hard and fast keeping mouth and throat open. Imagine trying to steam up a mirror or blow a tissue held out in front of you. Attempt to clear sputum 2-3 times then return to breathing control (Phase one) to relax airways.

Indication

• Post surgical /pain (rib fracture/ICC)
• Chronic increased sputum production e.g in Chronic bronchitis,cystic fibrosi
• Acute increase sputum production
• Poor expansion
• Sputum Retention
• SOBAR/SOBOE
• Cystic Fibrosis
• Bronchiectasis
• Atelectasis
• Respiratory muscle weakness
• Mechanical Ventilation
• Asthma

Clinical Presentation

It is important to constantly assess for dizzyness or increased shortness of breath throughout ACBT. If patient feels dizzy during deep breathing decrease the number of deep breaths taken during each cycle and return to normal breathing to reduce dizzyness.

Procedure

ACBT can be performed in sitting, lying or side-lying positions. Initially you should start in a sitting position until you are comfortable and confident to try different ones.Extensive evidence supports its effectiveness in sitting or gravity assisted positions. A minimum of ten minutes in each productive position is recommended. The ACBT may be performed with or without an assistant providing vibration, percussion and shaking. Self percussion/compression may be included by the patient.

                                              

Guidelines:

•  Maintain a good breathing pattern with relaxed shoulders and neck.
•  Breathe in through nose and out through mouth. Breathing should be slow, like “sighing out”. This can help minimise any wheezing.
•  Remember the principles of Diaphragmatic breathing.
  

 

Resources

www.brit-thoracic.org.uk

www.lunguk.org

Recent Related Research (from Pubmed)

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