Chest Clearance Techniques guide

Active cycle of breathing technique (ACBT)

The active cycle of breathing technique consists of three separate exercises:

• Breathing control
• Deep breathing exercises
• Huffs.

These are combined into the cycle shown below:

Only cough if secretions are there to clear. Complete three cycles of ACBT per session. Repeat regularly when secretions are present.

Breathing in COPD

People with COPD tend to breathe using the upper part of their chest, with shoulders hunched forward often fixing their arms on their knees. This is inefficient and uses a lot of energy. In this position, the oxygen you breathe is not being used effectively.

What is breathing control?

Diaphragmatic / Abdominal Breathing

This is a more efficient way of breathing and can help you relax and feel in control. When you take a deep breath in, the diaphragm flattens which squashes the abdominal contents causing your abdomen to gently expand. Unfortunately, having COPD for many years may make breathing in this relaxed way difficult.

Test your breathing

Place one hand on your upper chest and one hand on your stomach, just below your ribs. You will probably feel your top hand move more than your bottom hand as you take a breath in. This is an ineffective way of breathing, common in patients with chest problems.

How to practice diaphragmatic breathing (breathing control)

Get in a comfortable, well supported position, for example sitting in an armchair, sitting up in bed. Relax your head, neck, shoulders and upper chest. Place one hand on your stomach just below your ribs.
Breathe in slowly through your nose and then sigh the air out, either through your nose or mouth (whichever is most comfortable).

This should be normal sized breath not a deep breath. You should feel your stomach rise as you breathe in and fall as you breathe out. It is very difficult to change your breathing pattern, however, if you practice daily it will become more natural.

Once you have mastered this at rest, you can use this exercise independently to recover from doing any activity for example walking and climbing stairs. We will encourage you to use breathing control to recover your breath during the exercise sessions.

Secretion retention

People with COPD can keep hold of mucous (phlegm) within their lungs. Mucous pooling within the lungs encourages infection and prevents the exchange of gas. It is beneficial to clear secretions that may be present in your chest.

Deep breathing exercises

This improves even circulation of air to the whole of the lungs and starts to unstick the secretions. Take slow breath in through your nose until your lungs are full up with air. When you breathe out remember to extend it blowing the air out.

Huff

Take a slow half breath in through your nose. Feel your lower chest expand. Open your mouth wide to make a big o with your lips and blow the air out through an open mouth.

Postural drainage

Changing your position can make it easier to remove mucus from your lungs. This is known as postural drainage, which is a sputum clearance method using gravity to aid the removal of sputum from the deeper parts of your lungs. It is most effective for people who produce a moderate to large amount of sputum (half a pot per day).

You should not do postural drainage as part of your physiotherapy regime if you have or develop any of the following:

• Gastro-oesophageal reflux
• Acid reflux (stomach acid)
• Nausea
• Significant increase in breathlessness
• Fresh blood in sputum
• Recent rib, spine or muscle injury, or bronchospasm (wheeze).

Do not do postural drainage for at least an hour after eating a large meal. Aim to do at a convenient time for you, balancing with when you are at your most productive of sputum.

Complete each position for three to five minutes. Practice ACBT (Active Cycle of Breathing Technique) while in the position.

Try percussion while in the position. The illustration below shows the correct hand position for chest percussion.

Hydration

If you become dehydrated you may have difficulty in clearing any mucus on your chest. The mucus can become very thick and sticky. Therefore, ensure you take in enough fluid, approximately eight glasses of fluid per day. Try to avoid too much caffeine (tea/coffee) as this can make you more dehydrated.

Humidification

If sputum is particularly thick then hot water baths and steam inhalations may help expectoration. If you find that your sputum is thick and sticky on a regular basis then discuss this with your GP. There are medications available to help loosen your sputum.

The Acapella

A device, shaped like a small torch, that uses a combination of vibration and air pressure to help remove mucus. More information can be found in our Acapella guide.

The Flutter

A handheld advice, shaped like an asthma inhaler, which delivers vibration to the airway of your lungs, making it easier to cough out mucus.

Our patients matter

Mersey Care NHS Foundation Trust listens and responds to patients and their carers to help improve the services we deliver.

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

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