COUGHING TECHNIQUE

Forced expiration against closed

glottis is known as cough.

1-2 relaxed diaphragmatic breathing

Forced Inspiration
Closure of glottis
Built up of Intrathoracic and Intra abdominal pressure
Sudden opening of glottis
Instruction to say Ha
Cough will be produced

Indications
Upper or large airways secretions. Cough is thought to
be effective in clearing secretions from the larger airways up
to the seventh generation of bronchi. Dynamic airway
compression by high intrathoracic pressures limits cough
effectiveness in small or ove rcompliant airways.
Vigorous coughing (11 times over 10 minutes) has been
shown to be comparable to postural drainage+percussion in
rate and quantity of sputum clearance.
Cough may be impaired by inadequate lung volume,
incomplete glottic closure, respiratory muscle
weakness/general fatigue, pain.

Precautions

Subcutaneous emphysema/ untreated pneumothorax

Raised ICP
Recent eye surgery
Paroxyms of coughing may lead to fatigue,
bronchospasm, airway closure, hypoxia.

HUFFING
TECHNIQUE
FORCED EXPIRATION WITH OPEN GLOTTIS

1-2 relaxed diaphragmatic breathing

Deep Inspiration
Forced expiration with open glottis
At the end of expiration
Patient Instructed to Pronunciate Ha
Huff will be produced

 Both cough and huff causes compression and narrowing of airways

from a point dependent on lung volume
Compression point = Pressure point = Airway pressure = Pleural
pressure

High lung volume Cough/Huff

and main bronchi

Pressure point located on trachea

Mid lung volume Cough/Huff

segmental bronchi

Pressure point over lobar and

Low lung volume Cough/Huff

bronchial tree and alveoli.

Pressure point moves down towards

Series of cough will be exhausting but series of huffing will be less

exhausting and provides same effect of coughing

Forced Expiratory Technique (FET)

Pryor and Webber, 1979

 FET used increase the efficiency of clearance of

secretions with out causing increased
bronchospasm.
Principles:
FET uses the principles Relaxed Diaphragmatic
Breathing (RDB) between series of huffs.

TECHNIQUE
Patient is positioned in relaxed sitting or half lying position.
One or two huffs from mid lung volume to low lung volume
Followed by a period of Relaxed Diaphragmatic Breathing (RDB)
Once secretions reached proximal airways
High lung volume Huff/Cough will be used to clear the secretions
by the contraction of Abdominal and Chest wall musculature
That is followed by a period of RDB
For Children huff is practiced by blowing down a tube.

ACTIVE CYCLE OF BREATHING

TECHNIQUE
The active cycle of breathing techniques (ACBT)
is used to mobilize and clear excess bronchial
secretions. It has been shown to be effective in the
clearance of bronchial secretions and improves
lung function.

 ACBT improves lung function with out

increasing hypoxaemia and airflow
obstruction.
The ACBT is a flexible method of treatment
which can be adapted for use in any patient,
young or old, medical or surgical, where there
is a problem of excess bronchial secretions. It
can be used with or without an assistant.

 It is a cycle of breathing control, thoracic

expansion exercises and the forced expiration
technique (FET).
In order to emphasize the use of thoracic
expansion exercises and the periods of
breathing control, in addition to the FET, the
whole regimen was renamed the active cycle
of breathing techniques(ACBT).

 Thoracic expansion exercises recruit the collateral ventilatory system assisting, the
movement of air distal to mucus plugs in the peripheral airways.
Increasing tidal volume also utilizes the interdependence or mutual force of
adjacent alveoli to reexpand collapsed alveoli.
Sometimes an additional increase in lung volume can be achieved by using a 'sniff
manoeuvre at the end of a deep inspiration. This manoeuvre may not be appropriate
in patients who is hyperinflated.
The ACBT combines airway clearance with the promotion of ventilation. Extensive
evidence supports its effectiveness in sitting or gravity assisted positions.

 A minimum of ten minutes in each productive position is recommended.

The ACBT may be performed with or without an assistant providing
vibration, percussion and shaking. Self percussion/compression may be
included by the patient.

Technique of application of ACBT