Autogenic Drainage guide

What does Autogenic Drainage mean?

Autogenic Drainage (AD) means ‘self-drainage’. It is a technique that can help to clear secretions from your lungs preventing chest infections.

How will the 'self drainage' technique help?

It clears secretions using airflow to move from the smaller airways first and then into the larger airways.

There are three phases to the breathing exercises (see diagram below):

1. Unsticking the mucus in the smaller airways by breathing at low lung volumes
2. Collecting the mucus from the middle airways by breathing at low to mid lung volume
3. Removing the mucus from the central larger airways by breathing at mid to high lung volumes.

How to perform the 'self drainage technique

Correct breathing technique is essential for success with autogenic drainage.

Breathing In (inspiration):

• blow your nose prior to starting technique
• breathe in the nose slowly, keeping the upper airways open (Open glottis technique). Your tummy or lower chest should rise
• hold your breath for three seconds to allow air to get into the small airways and behind any sputum.

Breathing Out (expiration):

• make an O and breathe out your mouth or nose as long as it does not restrict the flow of air
• tighten your abdominal muscles as you breathe out to assist the air flow
• the breath out should be fast without causing a wheeze or sigh
• there shoudl be a constant steady airflow
• listen at what point during the breath out your chest crackles with the sputum
• practice by breathing as if you are trying to steam or mist up a mirror
• try not to cough!

Assessment Breath:

• to assess where your mucus is, take a breath in and then breathe out
• if you hear crackles at the beginning of the breath, then the mucus is in the larger airways and you should start with high lung volume breathing
• If you hear fine crackles towards the end of the breath, then the mucus is in the smaller airways and you should start with low lung volume breathing.

The Autogenic Drainage Cycle

You can do this sitting or sat up in bed. Relax your shoulders and arms and then slightly extend your neck.

To begin you need to clear the upper airways (nose and throat) by huffing or blowing your nose.

Low lung volume breathing (unsticking) - small airways

• take a small breath in slowly through your nose, keeping your upper airways open
• hold your breath for a few seconds
• breathe out through your mouth. Keep breathing out as long as you can, allow your tummy (abdominal) muscles to tense. This will take you down to low lung volume
• now take a partial breath in slowly (resist the urge to take a big breath in)
• repeat this until you feel the secretions moving up in your airways.

Middle lung volume breathing (collecting) - middle/large airways

• having breathed all the way out, take a slightly bigger breath in to get you up to a middle lung volume
• hold your breath where it is comfortable then breathe partially out (not all the way out)
• keep breathing this way until you can hear/feel the sputum moving or for a set number of breaths.

High lung volumes (evacuating) - large airways

• having breathed out comfortably, now take a bigger breath in to get up to a high lung volume
• breathe in slowly through your nose, keeping your upper airways open
• hold your breath for a few seconds
• only breathe part of the way out
• take a big breath in slowly and repeat the breath out
• keep breathing this way until you feel/ hear the sputum is ready to be cleared
• do one or two huffs or an effective cough to clear the sputum
• try not to cough until the mucus is in the larger airways, you have now completed one cycle
• use breathing control for one to two minutes. Repeat the cycle until the mucus is cleared
• the key to autogenic drainage is to always breathe at the level you can hear your sputum crackle. This is the sound of the sputum being carried. To keep it audible you will need to adapt your breathing accordingly and your breaths will progressively move to higher lung volumes, thus moving the sputum up the airways.

Diaphragmatic / Abdominal Breathing

This is a more efficient way of breathing and can help you to relax you airways and allow you to feel in control. It is important to practice this between more active exercises such as autogenic drainage.

It is a gentler more relaxed version of the tummy breathing you have been asked to do for the autogenic drainage. Your therapist will advise you/provide more information if required.

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If you have any comments, compliments or concerns you can speak with a member of staff or contact our Patient Advice and Liaison Service (PALS) and Complaints Team.

Telephone: 0151 471 2377 Freephone: 0800 328 2941 Email: palsandcomplaints@merseycare.nhs.uk