Active Cycle of Breathing Technique

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Description

Active cycle of breathing (ACBT) is an active breathing technique performed by the patient to help clear their sputum.
ACBT consists of three phases:

Phase One: Breathing Control - normal breathing to relax the airways, usually 6 breaths. Instructions to patient: Rest one hand on your stomach and keep your shoulders relaxed to drop down. Feel your stomach rise as you breathe in and fall when you breathe out.

Phase Two: Deep Breathing - Deep breaths to utilize collateral channels and get air behind sputum to mobilise it towards larger airways and towards the mouth. Instructions to patient: Relax your shoulders, place both hands on either side of ribs. Breathe in deeply feeling as your ribs expand, breathe out gently as far as you can until your lungs feel empty. Usually repeated 4 times.

Phase Three: Cough/Huff - To expel sputum. Instructions to patient: Take a medium sized breath in. Squeeze the breath out fairly hard and fast keeping mouth and throat open. Imagine trying to steam up a mirror or blow a tissue held out in front of you. Attempt to clear sputum 2-3 times then return to breathing control (Phase one) to relax airways.

Although ACBT is classed as a cycle the technique can be altered depending on patient preferences and what works for them.

Breathing control can be added between phase two and three if the patient is becoming breathless or phase one and two can be completed a few times before trying a cough/huff if the patient finds it difficult to expectorate.

Manual techniques and positioning can also be combined with ACBT to help the patient expectorate easier. Manual techniques are used during deep breathing with the patient sitting or lying on the affected side and can consist of percussion, vibration or shaking either on lateral ribs or anterior upper ribs depending on where the sputum is situated.

Indication

- Poor expansion

- Sputum Retnetion

- SOBAR/SOBOE

- CF

- Bronchiectasis

- Atelectasis

- Respiratory muscle weakness

- Mechanical Ventilation

- Asthma

Clinical Presentation

It is important to constantly assess for dizzyness or increased shortness of breath throughout ACBT. If patient feels dizzy during deep breathing decrease the number of deep breaths taken during each cycle and return to normal breathing to reduce dizzyness.

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