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A huff (also called the forced expiration technique [FET] when combined with
breathing control) is a manoeuvre used to move secretions, mobilised by thoracic
expansion exercises, downstream towards the mouth.
It can be used as a stand-alone technique but should always be included in any
airway clearance routine.
first described in 1968 by Thompson and Thompson, a New Zealand physician
and therapist team working with patients with asthma. They described the use of
1 or 2 huffs from middle to low lung volumes, with the glottis open, preceded and
followed by a period of relaxed, controlled diaphragmatic breathing, with slow
deep breaths. Secretions mobilized from the lower to upper airways were
expectorated, and the process was repeated
A modification of the normal directed cough. FET, or huff cough, consists of one or two forced

expirations of middle to low lung volume without closure of the glottis, followed by a period of
diaphragmatic breathing and relaxation.

The goal of this method is to help clear secretions with less change in pleural pressure and

less likelihood of bronchiolar collapse.

To help keep the glottis open during FET, the patient is taught to phonate or huff during

expiration. The period of diaphragmatic breathing and relaxation following the forced expiration
is essential in restoring lung volume and minimizing fatigue.
Benefits of FET

Once perfected, FET can be carried out independently as an alternative to

coughing with a number of benefits:
Less painful than coughing
Less tiring than coughing
Has less effect on pressure inside the skull than coughing
Many patients may be taught this technique as part of their active cycle of breathing
regime, however it is particularly beneficial in people who find coughing painful
and/or tiring for example those who have had recent surgery.

The forced expiratory technique is also the method of choice for secretion removal in
patients who have a head injury as it has less effect on the pressures within the skull
than coughing.

Other respiratory conditions in which FET may prove beneficial include:

Chronic bronchitis
Current chest infection
Chronic obstructive pulmonary disease (COPD)
Cystic fibrosis
Surgery cardiac, thoracic, abdominal
Procedure for Huff Forced Exhalation

1. Take 35 slow deep breaths, inhaling through the nose, exhaling through pursed lips,
using diaphragmatic breathing.

2. Take a deep breath and hold it for 13 seconds.

3. Exhale from mid-to-low lung volume (to clear secretions from

peripheral airways).

4. Take a normal breath in and then squeeze it out by contracting the abdominal and chest
wall muscles, with the mouth and glottis open, while whispering the word huff (sounds
like a forced sigh) during exhalation. Repeat several times.

5. As secretions enter the larger airways, exhale from high-to-mid lung volume to clear
secretions from more proximal airways. Repeat maneuver 23 times.

6. Take several relaxed diaphragmatic breaths before the next cough effort.

7. Clinician documents teaching accomplished, procedures performed, and patient

response in the patient record.