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

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

3. 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

4. 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

5. Collateral ventilation pathways

6. 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

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

8. ACBT BC
TEE BC
FET
HUFF BC

9. ACBT BC
TEE BC
FET BC
HUFF BC
TEE
HUFF BC
FET

10. 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

11. Flutter device

12. Bubble PEP

13. 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

14. Incentive spirometry

15. References
Pryor, J.A. and Prasad, S.A Physiotherapy for respiratory and cardiac problems. Adult and paediatrics. Edinburgh: Churchill Livingstone
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