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Autogenic Drainage
Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614,
Nottingham NG7 1BR Information for patients

www.nuh.nhs.uk Cystic Fibrosis Physiotherapy

If you require a full list of references for this leaflet please email
patientinformation@nuh.nhs.uk or phone 0115 924 9924
ext. 67184.
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The Trust endeavours to ensure that the information given here formats. For more information please contact:
is accurate and impartial.
Cystic Fibrosis Physiotherapy
City Campus
Hucknall Road, Nottingham
Tel: 0115 69 1169 ext 75019 / 75022

Fiona Haynes, Cystic Fibrosis Physiotherapy Department June 2016. All rights
reserved. Nottingham University Hospitals NHS Trust. Review June 2018. Ref: 1614/
v2/0616/AS.
Public information
What is autogenic drainage? Notes
Autogenic Drainage, or AD, is a breathing technique that uses
controlled breathing and minimal coughing to clear secretions
from your chest.

It involves hearing and feeling your secretions as you breathe

out and controlling the desire to cough until secretions are high
up and easily reached with minimal effort.

Before you start

If prescribed, take DNase at least 1 hour before physio.

Make sure you have taken bronchodilators, if prescribed,

(e.g. salbutamol or bricanyl) at least 10 minutes before physio.

A test breath
Begin with some gentle relaxed breaths known as breathing
control.
Start by sitting in a comfortable upright position. Take a very
slow deep breath in through your nose to your absolute
maximum possible.
Pause at the end of the full breath in with your mouth slightly
open and count for 3-4 seconds.
Breathe out through your mouth. This should be active (you
can feel your tummy muscles tighten) but should not be
forced.
You should listen and feel for secretions crackling as you
breathe out.
Are the crackles at the beginning or end of your breath out?
Beginning = high up in the large airways of your chest
Middle = in the middle sized airways
End = in the small airways

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Notes Unstick secretions
Breathe as much air out of your chest as you can then take a
small breath in using your tummy, feeling your breath at the
bottom of your chest. Breathe out completely to the end of the
breath. You may hear secretions start to crackle. Resist the
desire to cough. Repeat for at least 3 breaths.

Collect secretions
As the crackle of secretions start to get louder change to
medium sized breaths in. Feel the breaths more in the middle of
your chest. Do not breathe out completely. Repeat for at least
3 breaths.

Evacuate secretions
When the crackles are louder still, take long, slow, full breaths
into your absolute maximum, but only breathe out halfway.

Follow with gentle but active huffs this may be enough to

clear secretions and a cough if needed.
Try to stop yourself from coughing until the last phase of AD
when the secretions are higher up and more ready to be
coughed up.
Try to relax with breathing control if you feel the desire to
cough or between cycles.
AD breaths are very gently so you should not start to feel
tight or wheezy.
AD should be done until your sputum is cleared, or you need
a rest.
As you become more familiar with AD you can use it in any
position. Lying on your back with your knees bent is often very
good.

It is possible to use AD in conjunction with the Flutter or

Acapella. Please discuss this with your physiotherapist.

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After physio Your treatment plan
If prescribed, take nebulised antibiotics now.

Make sure you have taken all other prescribed inhalers after
physio.

Points to remember
It may feel uncomfortable doing AD breathing during the
unstick phase. You may need to take a few slightly larger
breaths at intervals during this phase. It gets easier with
practice.

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