ACBT (Active Cycle of Breathing Techniques)

This is relaxed normal breathing using the lower chest. This helps to relax the airways for the next stage of deep breathing called Thoracic expansion exercises

• Breathe in and out gently through your nose if you can. If you cannot, use your mouth instead with pursed lips.
• It is important to do Breathing Control in between the more active exercises of ACBT as it allows your airways to relax.

These are 3-4 deep, full breaths (ideally in through your nose) where your lungs are slowly filled to full expansion. If it is comfortable to do so, a short 3-4 second hold at the end of full expansion (before you breathe out) can give time for the air to move throughout your lungs.

These deeper breaths will help loosen and move the sputum because at the end of each breath in, the air filters through to the small airways, which can then get behind the sputum. When you breathe out, the exhaled air can ‘push’ the sputum upwards towards the larger airways (towards the mouth)

• Take the longest, slowest, deepest breath in possible, through your nose if you can. Try to keep your chest and shoulders relaxed.
• Breathe out gently and relaxed, like a sigh. You should do around 3-5 deep breaths.

After loosening the secretions in the small airways, the Forced expiration Technique (Huff) will help move it further and eventually clear it from your lungs.

A huff is exhaling through an open mouth and throat instead of coughing. It helps move sputum up your airways so that you can clear it in a controlled way, it is less aggressive than a cough.

• Start with a breath in, then to ‘huff,’ squeeze air quickly from your lungs, out through your open mouth and throat, as if you were trying to mist up a mirror or your glasses.

• Use your tummy muscles to help you squeeze the air out, but do not force it so much that you cause wheezing or tightness in your chest. Huffing should always be followed by breathing control.
• The size of the breath in before the huff and the length of the huff out will move sputum from different parts of the lungs, your physiotherapist will guide you on this (small-long huff or big -short huff).
• Your Forced expiratory technique needs to be checked regularly by your physiotherapist as it is easy to get into bad habits and perform this incorrectly which can waste a lot of energy. A huff that is too strong may create a wheeze or whistling noise, which might make it harder for sputum to move.