Pulmonary

Rehabilitation
D R . WA J E E H A , P T
A S S I S TA N T P R O F E S S O R
 Interventions
To Clear Secretions
Breathing technique
ACTIVE CYCLE OF BREATHING
Active Cycle of Breathing
Active cycle of breathing technique (ACBT) is an airway clearance technique that can be
performed independently by the patient after appropriate instruction.

It involves a combination of breathing control, thoracic expansion exercises, and FET
performed in series and repeated for several cycles.
Active cycle of breathing
Active cycle of breathing (ACB) consists of a
Relaxed abdominal breathing
Interspersed with deep breathing
Cycle of huffs from mid to low lung volume
Technique
Patients take up their position of choice. This is often sitting but some find postural drainage
positions helpful, e.g. alternate side-lying.
relaxed abdominal breathing (breathing control) to facilitate relaxation
three or four deep breaths (thoracic expansion) to reverse airway closure and open
collateral channels
relaxed abdominal breathing, to maintain relaxation
one or two huffs, from low lung volume at first, to mobilize secretions
relaxed abdominal breathing
Cycles continue until the chest is subjectively or objectively clear.
Avoidance of high lung volumes is easier if patients are told to inhale only a 'half-breath'
before the huff, or to huff at the end of expiration only.
Higher lung volumes can be used once secretions are mobilized from distal airways.
Many patients will be able to identify when secretions are shifting.
Variation
Number of huffs
Force of the huff
Rests between cycles, momentary or long
Sequence can vary so long as the principles of alternate stretching and squeezing of the
airways are followed and relaxation is maintained.
ACBT can be performed in cycles that vary in composition according to each patient’s specific
condition, as illustrated in

For example, patients with high volumes of mucus production, but without much airway
hyperreactivity, atelectasis, or plugging, may benefit from simple ACBT (A)

Patient with significant bronchospasm may require longer periods of breathing control (B)

 patients with airway plugging, atelectasis, and some reactive airway disease may benefit more
from additional breathing control and thoracic expansion exercises (C).
Avoid
Unhelpful examples include:
huffing at too high a lung volume at first, by taking a deep breath before the huff
not alternating the stretching components (deep breathing or abdominal breathing) with the squeezing
component (the huff)
taking too sharp a deep breath, thus forcing the secretions back or stirring up bronchospasm
not relaxing between cycles
Coughing before secretions are accessible.

Huffing should be delayed or modified if it causes bronchospasm, fatigue or spasms of coughing.

Some patients prefer to do several cycles of deep and abdominal breathing before the huff.
Many patients find it complicated to learn three components.
https://
www.youtube.com/watch?v=
XvorhwGZGm8
Any Question