ACTIVE CYCLE BREATHING TECHNIQUE​

 

 

ACBT is a technique used for :

• Clearance of excess secretions from the lungs 

• Improving ventilation of the lungs 

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ACBT has three components:

1. Breathing control

2. Thoracic expansion exercise

3. Huffing

               

THE CYCLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Regimen 

 

 

 

 

 

 

 

 

 

 

 

A typical cycle consist at-

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Breathing control ( Until patient is relaxed )

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Thoracic Expansion Exercise (3-5 times)
                 

               
Breathing control (until patient returns to normal respiration)

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Thoracic Expansion Exercise (3-5 times)

       

       

Breathing control

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Huffs ( at appropriate inspiratory volume, depending on the position of the sputum )

               

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Breathing control

 

 

Breathing control :

Is a period of relaxed breathing at patients own rate. It is the tidal volume breathing. Patient should be encouraged to breath in form nose to humidify the air. Breathing should be taught by using diaphragm control stage should continue until the patient is relaxed and ready to progress to next stage.

 

Thoracic expansion exercises (TEE) : These are deep breathing exercises to increase the inspiratory capacity at the end of inspiration, hold for 3-5 seconds before passive expiration. This is repeated for 3-5 breaths.

 

Rationale (TEE): High lung volume are achieved during TEE. The expanding force are created between alveoli. This assist re-expansion of lung tissue. This is called alveolar inter dependence. During inspiration, the alveoli exert forces on the adjacent alveoli which enhance the recruitment of the lung units. Breath hold added during TEE compensate for asynchronous ventilation. Breath hold fills the lung units maximally.

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Huff ( forced expiratory technique )
Huff is forced expiration with open glottis.
Huff + Breathing control = forced expiratory technique is the maneuver used to remove secretions, mobilised by thoracic expansion exercise, collected towards central airway.
The length of the huff and force of contraction of muscle at expiration should be altered to optimise clearance of secretions by maximising airflow.
 

Rationale : huffing is base on EPP (Equal pressure point).The point at which pressure within the bronchi equals Peri-bronchial pressure (out- side airways)  

 

Indications:

1. Post surgery . 

2. Chronic increase sputum production ( chronic bronchitis, cystic fibrosis )

3. Acute increase in sputum production .

4. Poor expansion

5. Sputum retention

6. Respiratory muscle weakness .

7. Asthma, Bronchiectasis, atelectasis

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Precautions:

1. Avoid coughing

2. Prevent hyperventilation

3. Splinting should be done in a post surgical case

4. Cognitive impaired patient should be taught

    
Contraindications:

1. Lung metastasis

2. Pneumothorax (undrained)

3. Hemoptysis

4. Flail chest

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REFERENCES

1. Donna F, Elizabeth D. Principles and practice of Cardiopulmonary Physical Therapy. 3rs ed. 1996.

2. Stuart P. Tidy's Physiotherapy. 13th ed. Philadelphia 2003

3. Yang M, Zhang JE, Huang XX, Li CZ, Hong ZX, Zhang SW. Effect of the self-efficacy-enhancing active cycle of breathing technique on lung cancer patients with lung resection: A quasi-experimental trial. European Journal of Oncology Nursing. 2018 Jun 1;34:1-7.