This study compares two techniques used in respiratory physiotherapy

1. RESPIRATORY PHYSIOTHERAPY IS A SUBTLE
COCKTAIL OF
• A pinch of Patience
• A spoonful of Ability
• A bowl of Kindness and
• An ocean of Passion

3. A COMPARISON OF AUTOGENIC DRAINAGE AND
THE ACTIVE CYCLE OF BREATHING TECHNIQUES
IN PATIENTS WITH CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
Presented by
J.ARUL JOSEPH ARUN M.P.T(cardio),M.H.A,
APPASAMY PHYSIOTHERAPY & REHABILITATION CENTRE
PUTHUR,TIRUCHIRAPALLI

4. INTRODUCTION
• Chronic obstructive Pulmonary Disease(COPD) according to
National Lung Education Program is defined as a group of disease that
includes chronic bronchitis, emphysema and asthmatic bronchitis.
• Common characteristic of these disease include chronic or
progressive dyspnea, cough with sputum production, and recurrent
lower respiratory tract infections.
• COPD is the fifth leading cause of death worldwide and its prevalence
is increasing gradually.
• Crude estimates suggest there are 30 million COPD patients in India.
• Smoking constitutes 90% cause of COPD population. Besides air
pollution, occupational pollutant and deficiency in alpha1 antitrypsin
are also other causes.

5. OBJECTIVES
• This study aims to provide effective physical therapy measure with
objectives of pulmonary rehabilitation in mind.
• The patient is considered to suffer from COPD if he or she has functional
limitation due to cough and excessive sputum production for a period of two
months to three years along with dyspnea

6. THE STUDY
• The study aims to compare Autogenic Drainage and Active Cycle of
Breathing Technique, thereby maintaining good bronchial hygiene
Active Cycle of Breathing Technique
Initially designed by Thompson(1973) from New Zealand as forced Expiration
technique later renamed as active cycle of breathing technique. It consists of
repeated cycle of controlled breathing and thoracic expansion exercise which
ends by breathing control and forced expiration technique(huffing)
Autogenic Drainage
It is an anti dyspneic technique designed by Chevallier(1967) from Belgium.
It consist of three phases, Unstick phase, collection phase and evacuation
phase where the breathing pattern alters in each

7. NEED FOR THE STUDY
• Main objective of physical therapy for COPD patients are clearing of
secretion, dyspnea control and to improve the functional activities.
These can be achieved from various techniques but more focused
towards these objectives are
1.Active cycle of breathing technique
2.Autogenic Drainage
3.Conventional Chest Physiotherapy

8. LITERATURE REVIEW
• Miller et al has concluded that Autogenic Drainage was found to be as
good as ACBT at clearing mucous in patients with cystic fibrosis.
• Giller et.al has concluded that Autogenic drainage is less likely to
produce oxygen desaturation and may be better tolerated by patients with
cystic fibrosis.
• Savci et.al has concluded in their studies that Autogenic Drainage is
as effective as ACBT in clearing secretion and improving lung function
• GE Wilson et al has concluded in their study that the Active Cycle of
Breathing appears to be more effective than traditional methods of
physiotherapy
• Cecins NM et al has concluded in their studies that the ACBT
in the horizontal position is a simple airway clearance regimen suitable for
individuals who produce greater than 20 gm of sputum per day

9. HYPOTHESES
• Based on the literature review available supporting the effect
of Autogenic Drainage and Active cycle of Breathing
Technique. It is necessary that the study is done on unbiased
null hypotheses which could be stated as
“There is no significant difference between Autogenic
Drainage and Active Cycle of Breathing Technique in
maintaining bronchial hygiene in patients with chronic
obstructive pulmonary diseases”

10. MATERIALS
• MATERIALS
The study aims to use two advanced techniques of cardio respiratory
physiotherapy namely ACTIVE CYCLE OF BREATHING TECHNIQUES &
AUTOGENIC DRAINAGE
ACTIVE CYCLE OF BREATHING TECHNIQUE: It has three components in a set
cycle
1.Relaxation and breathing control
2.Thoracic expansion techniques
3.Forced expiration Technique
This cycle is repeated until the huff becomes dry or is non-productive or 20
minutes

11. ACTIVE CYCLE OF BREATHING TECHNIQUE

12. ACTIVE CYCLE OF BREATHING TECHNIQUE

13. MATERIALS
• AUTOGENIC DRAINAGE
• It is also known as anti dyspnea technique and is based on quiet expiration
in a relaxed state
• It has 3 phases
• Unstick phase: in this phase quiet inspiration and breath hold is followed
by deep exhalation in the expiratory reserve volume range
• Collection phase:in this phase breathing takes place at low to mid lung
volume, intensity of breathing is at expiratory reserve and inspiratory
reserve volume range, helps to move secretion to central airways
• Evacuation Phase: in this phase breathing level is at mid to high lung
volume, deep inspiration in the inspiratory reserve volume range is
followed by huffing which thereby helps in removing the secretion

14. Autogenic drainage

15. STUDY DESIGN
• This study is conducted in the format of EXPERIMENTAL PRETEST
POST TEST MULTIVARIATE STUDY DESIGN
• Group I : These patients received Active Cycle of Breathing
Technique apart from conventional physiotherapy
• Group II : these patients received Autogenic Drainage apart from
conventional physiotherapy
• STUDY SETTING: The study was carried out in the department of
Pulmonology and Critical are, Sri Ramakrishna Hospital Coimbatore

16. METHODOLOGY
• DURATION OF STUDY :The study was conducted for a duration of three months
• Sampling: subjects were selected by systematic random sampling
Patients with a clinical diagnosis of COPD were assigned to group I and group II.
Each group had 10 patients each.
• INCLUSION CRITERIA: All patients referred for physiotherapy with diagnosis of
COPD were included in the study
• EXCLUSION CRITERIA:
1.Patient with cardiac disorder
2.Patient with infectious disease
3.Patients with neuromuscular and musculoskeletal disorder for which exercise
modification are required

17. STATISTICAL TOOLS
• The study was conducted in a pretest-postest study design with a
multi variate format. The parameters recorded were
1.Peak Expiratory flow rate
2.Dyspnea Grade
3.Chest expansion
4.Pre and post exercise pulse rate and blood pressure
5.Post exercise rate of perceived exertion
6. Six minute walking distance

18. STATISTICAL TOOLS
To analyse these variables ,two tailed ANOVA F–test between the pre
and post values of same group performed to establish the effect of
F-test

19. STATISTICAL ANALYSIS
Data collected were analyzed and the mean value, standard deviation and two
tailed ANOVA F test were performed
The two tailed ANOVA F test ratios calculated showed Table values of F=4.2839 at
P=0.05. The F ratio calculated were not significant. Based on these results the null
hypotheses has to be accepted
Techniques PEFR BP RPE DI C.EXP 6MWD PR TOTAL
ACBT 0.69 8 1.05 1.2 0.734 311.5 3.2 326.374
AD 0.47 8 1.4 0.7 0.586 326.1 3.2 340.456
TOTAL 1.16 16 2.45 1.9 1.32 637.6 6.4 666.83

20. IMPROVEMENTS IN CHEST PARAMETERS
BETWEEN ACBT & AD

21. RESULTS
The mean value calculated for
• PEFR showed 0.9 in ACBT and 0.47 in autogenic drainage,
• whereas for BP it showed a value of 8 for both the techniques.
• In calculating the value for rate of perceived exertion it shows 1.05 for ACBT
and 0.7 for AD.
• Chest expansion showed a value of 0.734 for ACBT and 0.586 for AD.
• Six minutes walking distance recorded a value of 311.5 n ACBT and 326.1 in
AD.
• Pulse rate showed values of 3.2 in ACBT and autogenic drainage.
In general, the parameters recorded higher levels of improvement in autogenic drainage than ACBT
though it was not significantly evident in the F Ratio

22. RECOMMENDATION
Based on the outcome of the statistical analysis it is suggested that the future studies should
be modified to accommodate the following changes
1. Larger sample size and a long term follow up to analyze the effect.
2. more objective parameters could be utilized in recording the efficacy of these
parameters and their difference analyzed for variation
3. To apply the techniques in lung disease other than COPD and comparing their efficacy.

23. CONCLUSION
In prudence to the above discussion and analysis of the outcome it is suggested that though Autogenic Drainage produces
benefits in treating Chronic Obstructive Pulmonary Disease, it is not significant to produce any added benefit by itself
when compared with Active Cycle of Breathing Technique.
it should be emphasized that six minutes walking distance and dyspnea index showed significant increase in autogenic
drainage and this means that a better improvement in functional status is expected at least as far as Exercise Tolerance is
concerned.
Since the F ratio does not record any significant variation, the study is concluded by accepting the null hypotheses which
is stated as There is no significant difference between Autogenic Drainage and Active Cycle of Breathing Technique in
maintaining Bronchial Hygiene in patients with Chronic Obstructive Pulmonary Disease.

24. REFERENCE
• 1.Shen M, Li Y, Ding X, et al. Effect of active cycle of breathing techniques in patients with chronic obstructive pulmonary disease: a
systematic review of intervention. European Journal of Physical and Rehabilitation Medicine. 2020 Oct;56(5):625-632. DOI:
10.23736/s1973-9087.20.06144-4. PMID: 32397703.
• 2. Mckoy NA, Wilson LM, Saldanha IJ, Odelola OA, Robinson KA. Active cycle of breathing technique for cystic fibrosis. The
Cochrane Database of Systematic Reviews. 2016 Jul;7:CD007862. DOI: 10.1002/14651858.cd007862.pub4. PMID: 27378490;
PMCID: PMC8682958.
• 3 McCormack P, Burnham P, Southern KW. Autogenic drainage for airway clearance in cystic fibrosis. The Cochrane Database of
Systematic Reviews. 2017 Oct;10:CD009595. DOI: 10.1002/14651858.cd009595.pub2. PMID: 28984368; PMCID: PMC6485652.
• 4. Grillo LJF, Housley GM, Gangadharan S, Majid A, Hull JH. Physiotherapy for large airway collapse: an ABC approach. ERJ Open
Research. 2022 Jan;8(1). DOI: 10.1183/23120541.00510-2021. PMID: 35211621; PMCID: PMC8864626.
• 5. Savci S, Ince DI, Arikan H. A comparison of autogenic drainage and the active cycle of breathing techniques in patients with
chronic obstructive pulmonary diseases. J Cardiopulm Rehabil. 2000 Jan-Feb;20(1):37-43. doi: 10.1097/00008483-200001000-
00006. PMID: 10680096.
• 6. Miller S, Hall DO, Clayton CB, Nelson R. Chest physiotherapy in cystic fibrosis: a comparative study of autogenic drainage and the
active cycle of breathing techniques with postural drainage. Thorax. 1995 Feb;50(2):165-9. doi: 10.1136/thx.50.2.165. PMID:
7701456; PMCID: PMC473916.
• 7. Pereira JS, Lemos FA, Di Naso FC, Krüger R, de Oliveira A, Knorst MM, Dias AS. Effect of 6-minute walk test on neuromuscular
properties of patients with chronic obstructive pulmonary disease. Clin Respir J. 2017 Nov;11(6):812-819. doi: 10.1111/crj.12420.
Epub 2015 Dec 28. PMID: 26620735.