1. ACTIVE CYCLE OF BREATHING
TECHNIQUE
Submitted By:- Nahid
Roll No:- 17BPT024
BPT 4th year
Submitted To:- Dr. Jamal Ali Moiz
2. Introduction
The active cycle of breathing technique (also known as ACBT) is an
airway clearance method that uses a cycle of techniques to loosen
airway secretions the lungs in three phases.
• The first phase is breathing control helps to relax the airways.
• The second phase is thoracic expansion exercises helps to get air
behind mucus and clears mucus.
• The third phase is huffing or forced expiratory technique helps
force the mucus out of the lungs.
3. Effect
The active cycle of breathing technique has effects:-
• Loosen and clear secretions from the lungs
• Improve ventilation in the lungs
• Improve the effectiveness of a cough
4.
5. Breathing Control
• Breathing control is breathing gently, using as little effort as possible.
• Breathing control is used to relax the airways and relieve the
symptoms of wheezing and tightness which normally occur after
coughing or breathlessness.
• Closing eyes during breathing promotes relaxation.
• It is very important to do Breathing Control in between the more
active exercises of ACBT as it allows the airways to relax.
6. Instructions to the patient
• Breathe in and out through your nose if you can. If you cannot, breathe
through your mouth instead.
• If you breathe out through your mouth you can use breathing control
with ‘pursed lips breathing.’
• Try to let go of any tension in your body with each breath out.
• Breathe at a rate which feels comfortable; the rate will slow as you
relax.
• Gradually try to make the breaths slower.
7. Thoracic Expansion Exercises
Thoracic expansion exercises are deep breathing exercises that focus on
inspiration and help to loosen secretions on the lungs.
The period of thoracic expansion, which increases lung volume and
promotes collateral ventilation allows air to get behind secretions and
assist in their mobilization.
Instructions to patient:
• Try to keep your chest and shoulders relaxed.
• Take a long, slow and deep breath in, through your nose if you can.
• At the end of the breath in, hold the air in your lungs for 2-3 seconds
before breathing out (this is known as an inspiratory hold)
8. • Breathe out gently and relaxed, like a sigh. Don’t force the air out.
• Repeat 3 – 5 times. If the patient feels light-headed then it is important
that they revert back to the breathing control phase of the cycle.
• To facilitate a maximal inspiration, proprioceptive feedback, with the
therapist, or patient, placing their hands on the thoracic cage, can be
beneficial. This has been associated with increased chest wall
movement and improved ventilation.
• Breathe hold at the end of inspiration encourages collateral ventilation
to redistribute air into collapsed segment and assist in re-expansion of
lung.
9. Forced Expiratory Technique
It helps to move secretions, mobilised by thoracic expansion exercises,
towards the mouth. A huff is exhaling through an open mouth and throat
instead of coughing. Huffing helps moves sputum from the small
airways to the larger airways, from where they are removed by
coughing as coughing alone can not remove sputum from small airways.
Types of Huffs
The Small-long huff/medium volume huff
• This will move sputum from smaller airways in chest. Take a small to
medium breath in and then huff (squeeze) the air out until your lung
feell quite empty.
10. The Big-short huff or Large volume huff
• This moves sputum from larger airways in chest, so use this huff when
it feels ready to come out, but not before. Take a deep breath in and
then huff the air out quickly. This should clear your sputum without
coughing.
• Return to breathing control.
To facilitate opening of glottis, patient can be
taught to huff through a piece of cardboard
spirometry can be used at least 4 cm inside the
patient’s mouth.
11. When to cough?
• If sputum is not cleared by huffing then coughing can be used.
• Listen for crackles when you huff, If you can hear these, you may now
need to cough and clear secretions; try to spit them out into a tissue or
a sputum bowl. Try to avoid excessive coughing as this may reduce
how effective the technique is and make it excessively tiring.
13. Contraindications
• Patients not spontaneously breathing
• Unconscious patient
• Patients who are unable to follow instructions
• Agitated or confused
14. Position
• ACBT can be performed in sitting or in a postural drainage position
• When in sitting, maintain a good breathing pattern with relaxed
shoulders and neck, back supported as this promotes the function of
diaphragm and decrease stress on musculoskeletal. Whatever position
you use make sure you are comfortable, well supported and relaxed
15. Duration and Frequency
• Duration for ACBT should be for about 10 minutes and ideally until
the chest feels clear of sputum.
• ACBT is generally performed once or twice a week. But in case of
exacerbation or more sputum production more sessions can be
performed as per the need of patient.
16. Reference
• The Active Cycle of Breathing Techniques.Association of Chartered
Physiotherapists in Respiratory Care
• Lewis LK, Williams MT, Olds TS.The active cycle of breathing technique:
A systematic review and meta-analysis. Respiratory Medicine, 2012
• Elsayed SH, Basset WK, Fathy KA. Impact of active cycle of breathing
technique on functional capacity in patient with bronchiectasis International
Journal of Therapies and Rehabilitation Research. 2015
• Larner E, Galey P. Active cycle of breathing technique
• McKoy NA, Saldanha IJ, Odelola OA, Robinson KA.Active cycle of
breathing technique for cystic fibrosis
• The active cycle of breathing technique: a systematic review and meta-
analysis Lucy K Lewis et al. Respir Med. 2012
