ACTIVE CYCLE OF BREATHING

TECHNIQUE (ACBT)

Bipin Ghimire
4 t h year BPT
 MUCOCILIARY ESCALATOR

Production of mucus-100ml/day
Composition of mucus-95%water
5%mucin(glycoprotein , RNA, Fats
etc)
Unidirectional beating of cilia-15strokes/sec
Mucus propulsion rate-2cm/min
Total time to clear the secretions-20min
• Hence, 100ml/day tracheobronchial secretions are
produced and excreted semiconsciously through
respiratory tract.
• The amount of secretion that needs effective coughing
or huffing(FET) for excretion is known as sputum.
• Coughing is a procedure in which deep inspiration is
followed by forced expiration against a closed glottis
with rise in intrathoracic pressure. It is a reflex
mechanism that helps in excretion of secretion.

STAGES OF EFFECTIVE COUGHING

IRRITATION
INSPIRATION
COMPRESSION
EXPULSION
• Huffing is a procedure in which deep
inspiration is followed by forced expiration
with open glottis without much rise in
intrathoracic pressure. It also helps in
excretion of secretion.
• In bronchial tree there are 0-23 segments. 0-16
are conducting segments and 17-23 are
respiratory(gaseous exchange takes place)
segments .
• Cough is effective only upto 7th generation ,
lower level needs huff.
Clapping , Hacking , Flutter , Acapella , HFCWO
loosening secretions.
Cough , Huff , ACBT , AD , PD mobilizing
secretion.

GOALS OF AIRWAY CLEARANCE:

• To reduce airway obstruction.
• To improve mucociliary clearance.
• To improve ventillation and gaseous
exchange.
 INDICATION FOR AIRWAY CLEARANCE

• Cystic fibrosis
• Bronchiectasis
• Atelectasis (Collapse of alveoli)
• Respiratory muscle weakness
• Mechanical ventilation
• Neonatal RDS
• Asthma
 ACBT
• Definition :
As described by WEBBER & PRYOR “
ACBT is a airway clearance technique that
consists of repeated cycle of three ventilatory
phase:
1) Breathing Control
2) Thoracic expansion exercise &
3) Forced expiratory technique(FET)”
 BREATHING CONTROL
• Upper chest and shoulders should remain relaxed
while the lower chest and abdomen should be
active.
• Ask the patient breathe in a relaxed manner with
tidal volume breathing.
• This phase may last as long as patient requires to
relax and prepare himself for the next phase.
• Breathing control may require in between the
cycle in order to prevent bronchospasm.
 THORACIC EXPANSION EXERCISE
• After breathing control patient is instructed to take in
a deep breathe to the inspiratory reserve volume ,
expiration is passive and relaxed .
• Chest percussion, vibration, shaking may be
performed as the patient exhales.
• For surgical patients or those with lung collapse a
breathe hold or a sniff at the end of inspiration
encourages collateral ventilation to redistribute air
into collapsed segment and assist in re-expansion of
lung.
 FORCED EXPIRATORY TECHNIQUE
• It consist of huffing with breathing control.
• To mobilize secretion from peripheral airways,
a huff after a medium sized inspiration will be
effective. This huff will be longer and quieter.
• To clear secretion that have reach the larger,
proximal airways, a huff after a deep
inspiration will be effective. This huff will be
shorter and louder.
 The sequence of ACBT
BREATHING CONTROL

1-2 HUFF 3-4 THORACIC EXPANSION

EXERCISE

BREATHING CONTROL BREATHING CONTROL

3-4 THORACIC
EXPANSION EXERCISE
 PHYSIOLOGICAL RATIONALE BEHIND ACBT
• The period of thoracic expansion, which increases lung
volume and promotes collateral ventilation allows air to
get behind secretions and assist in their mobilization.
Fig: Collateral Ventilation

1
2
3
Where:-
1 Interbronchial (Channel of Martin)
2 Bronchoalveolar (Channel of Lambert)
3 Interalveolar (Channel of Kohn)
• Mead described the physiological theory of the
Equal Pressure Point(EPP), which is the basis for
forced expiratory technique(FET).
• EPP is a point in the
airways where the air
way pressure is equal
to the pleural pressure.
The forced expiratory
maneuver produces
compression of airway
peripherally to EPP.
• A huff from high lung volume causes
compression within the trachea and bronchi,
which moves secretion from these larger
airways.
• A huff continue to low lung volume shift the EPP
more peripherally, which mobilizes more
peripheral secretions.

PREPARATION OF PATIENT
ACBT may be performed in sitting position but
has been shown to be more effective in gravity
assisted position i.e. in postural drainage
position.
 PREPARATION OF THERAPIST
• Equipment required is therapist hand to percuss or shake
during thoracic expansion phase.
• Mechanical percussors or vibrators may be used.
• Small children may also be taught to flap their arms to their
lateral chest as they performed the huff, a technique referred
to as “Chicken Breathe”.
TREATMENT TIME:
A minimum of 10min in any productive
position may be necessary to clear the airway of a
patient with a moderate amount of secretions.
 ADVANTAGE
• It improves the lung function without
increasing hypoxemia or airflow obstruction.
• It is useful for patient with gastroesophageal
reflux, bronchospasm and acute exacerbation
of their pulmonary disease.
• The decrease in oxygen saturation that has
been demonstrated with PD and Percussion
has been prevented by the use of ACBT.
 DISADVANTAGE
• Assistance may be required for children or
critically ill patient.
• Proper precaution are necessary for the
patient with hyperactive airway or after
surgery.

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