ACBT.

active cycle of breathing

technique.
• ACBT was described for clearence of bronchial
secretion in pt with asthma.
• 3 ventilatory phases:
• 1) breathing control (BC)
• 2) thoracic expansion exercises (TEE)
• 3) forced expiratory tech (FET)
 BC (breathing control )

• Is a gentle tidal volume (TV) breathing with

relaxation of the upperchest and shoulder.
• Diaphgramatic breathing pattern is used for it.
(inspiration through nose, expiration through
mouth)
 TEE(thoracic expansion exe)
• Are deep breathing exercise emphasizing
inspiration.
inspiration is active

followed by 3 sec “HOLD”

passive relaxed expiration.

3 sec hold at full inspiration has shown to
Collapse of lung.
• In normal lung, resistance to airflow via
collateral ventilatory system is high and there
is littlemov of gas through these channels.
• with lung volume and in presence of lung
pathology ,resistance decrese allowing air to
flow via collateral channels.
• TEE can be facilitated with proprioceptive
stimulation by placing a hand ,either pt’s or
therapist’s over the part of chest wall where
mov of chest is to be encouraged.
• Sometime additional increse in lung volume
can be achieved by using a “sniff” at the end
of deep inspiration.
• TEE may be combined with chest shaking,
clapping for clearance of secretion.
 FET(forced expiratory tech)
• Is a combination of ½ forced expiration (huff)
and period of BC .
• Huffing to low lung volume should assist the
mov of the more peripherally situated
secretions.
• And when secretion have reached the larger
more proximal upperairway, huff/cough from
high lung volume can be used to clear them.
• Mead and colleagues described the
physiological theory of equal pressure point
(EPP), which is the basic for FET.
• With any forced expiratory manoeuvre ,tthere
is dynamic compression and collapse of the
airway downstream(toward th mouth) of
equal pressure point.
• EEP is the point in the airway where pressure
is equal to pleural pressure.
• At the time forced expiratory manoeuvre (huff/cough),
pleural pressure is +20 cmH2o.
• Elastic recoil is pressure of lung +5 cmH2o.
• Consequently the peripheral pressure is +25 cmH2o.
• There is a downward gradient from +25 cmH2o at the
mouth ,somewhere along the airway ,pressure with in the
airway will equal the pleural pressure.
• Proximal to this ,dynamic compression and collapse of he
airway take place.
• BC after ½ huff, is necessary to prevent any increse in
airflow obstrucion.
 Equipment.

• 1) in manual tech; pt’s or therapist’s hand to

percuss/shake/vibrate the chest wall during TEE.
• 2)mechanical percussors/ virators may be used.
• 3) if PD position are used, equipment for
positioning.
• 4) to teach the huffing maneuver, peak flow
mouthpiece to keep the mouth and glottis open.
• Young childrenmay be taught games of huffing at
cottonballs or tissue to improve technique.
 Preparation.

• Positionof the pt: in PD position or sitting

position.
• Minimum of 10 min in any productive position
may be necessary to clear the secretion.
 Sequence.
• BC (diaphragmatic breathing at TV)
• 3 or 4 TEE (deep inhalation with relaxed exhalation at
vital capacity with or without chest percussion)
• BC
• 3 or 4 TEE.
• BC
• FET( 1/2 huff at mid to low lung volume, abdominal
muscle contaction to produce forced exhalation.
• BC.
•