Active Cycle of Breathing (p.137-141, 155-159)

Aims Clearance of bronchial secretions ↑ lung function ACBT BC Huffing TEE

Breathing control Resting period between active parts of cycle Tidal breathing, own rate and depth Upper chest and shoulders relaxed Diaphragmatic breathing Inspiration and expiration barely audible

Thoracic expansion exercises Deep breathing emphasizing inspiration 3-second end-inspiratory hold Collateral ventilation pathways Repeat 3 times Proprioceptive stimulation “Sniff” Combined with percussion, shaking or vibration

Collateral ventilation pathways

Forced expiratory technique “Huffing” Combination of one or two huffs with BC (5-10s or 10-20s) Huffing from low or high lung volumes With forced expiratory manouvre = dynamic compression and airway collapse This less with huffing As effective, less effort, not as exhausting Forced but not violent

ACBT Adapted for each patient In sitting or PD-position End of Rx = unproductive low lung volume cough (2 cycles)

ACBT BC TEE BC FET HUFF BC

ACBT BC TEE BC FET BC HUFF BC TEE HUFF BC FET

Oscillating positive expiratory pressure p .149-154 Flutter device With expiration = PEP and oscillating vibration of air in airway Slow breath in, little deeper than normal, hold for 3-5 s. Expiration through flutter, little faster than normal, repeat 4-8 times Deep breath, hold at full inspiration, forced expiration, can repeat BC and huff or cough

Flutter device

Bubble PEP

Incentive spirometry p. 163-169 Increase inspiratory capacity Slow, deep inspiration with visual feedback Generate a predetermined flow or achieve certain volume End inspiratory hold Pattern of breathing = expansion of lower chest and diaphragmatic breathing

Incentive spirometry

References Pryor, J.A. and Prasad, S.A. 2009. Physiotherapy for respiratory and cardiac problems. Adult and paediatrics. Edinburgh: Churchill Livingstone Images courtesy of Google search engine