Active Cycle of Breathing(p.137-141, 155-159)

Aims

• Clearance of bronchial secretions• ↑ lung function

ACBT

BC TEE Huffing

Breathing control

• Resting period between active parts of cycle• Tidal breathing, own rate and depth• Upper chest and shoulders relaxed• Diaphragmatic breathing• Inspiration and expiration barely audible

Thoracic expansion exercises

• Deep breathing emphasizing inspiration• 3-second end-inspiratory hold• Collateral ventilation pathways• Repeat 3 times• Proprioceptive stimulation• “Sniff”• Combined with percussion, shaking or

vibration

Collateral ventilation pathways

Forced expiratory technique“Huffing”

• Combination of one or two huffs with BC (5-10s or 10-20s)

• Huffing from low or high lung volumes • With forced expiratory manouvre = dynamic

compression and airway collapse• This less with huffing• As effective, less effort, not as exhausting• Forced but not violent

ACBT

• Adapted for each patient• In sitting or PD-position• End of Rx = unproductive low lung volume

cough (2 cycles)

ACBT

BC

TEE

BCHUFF

BC

FET

ACBT

BC

TEE

BC

HUFF

BC TEE

BC

HUFF

BCFET

FET

Oscillating positive expiratory pressurep .149-154

• Flutter device• With expiration = PEP and oscillating vibration of

air in airway• Slow breath in, little deeper than normal, hold for

3-5 s.• Expiration through flutter, little faster than

normal, repeat 4-8 times• Deep breath, hold at full inspiration, forced

expiration, can repeat• BC and huff or cough

Flutter device

Bubble PEP

Incentive spirometryp. 163-169

• Increase inspiratory capacity• Slow, deep inspiration with visual feedback• Generate a predetermined flow or achieve

certain volume

• End inspiratory hold• Pattern of breathing = expansion of lower

chest and diaphragmatic breathing

Incentive spirometry

References

• Pryor, J.A. and Prasad, S.A. 2009. Physiotherapy for respiratory and cardiac problems. Adult and paediatrics. Edinburgh: Churchill Livingstone

• Images courtesy of Google search engine