The Active Cycle of Breathing Technique (ACBT) consists of 3 components - breathing control, thoracic expansion exercises, and huffing - to help clear secretions from the lungs. Breathing control involves relaxed tidal breathing to recover from fatigue. Thoracic expansion exercises emphasize slow, deep breathing through the nose to improve ventilation and airflow through collateral channels in the lungs. Performing 5 breaths with breath holds can help mobilize secretions.

1. ACTIVE CYCLE OF
BREATHING TECHNIQUE
(ACBT)
Dr.Krishna gohil (PT)

2. • Active cycle of breathing consists of a series of manoeuvres
performed by the patient to emphasize independence in
secretion clearance and thoracic expansion.
• ACBT is an airway clearance strategy renamed to clarify
the directed breathing and forced expiratory techniques
first described in the literature in 1979, (pryor et al 1979).

3. • Its used to:
Looses and clear secretions from the lungs that helps to
reduce the risk of chest infection.
Improve ventilation in the lungs.
Improve the effectiveness of a cough.

4. PURPOSE
• The purpose of this technique is to produce dynamic
compression and collapse of the airway downstream of
equal pressure point, creating a pinch point and increased
turbulent airflow.
• The technique can be performed in any breath enhancing
position and no equipment is required. When used to clear
secretions.

5. COMPONENTS
• It has 3 component:
breathing control
thoracic expansion exercise
huffing

6. BREATHING CONTROL
• BC is tidal volume breathing at patients own respiratory
rate and volume.
• The person is encouraged to breath with lower chest, using
diaphragmatic breathing pattern, with relaxation of the
upper chest and shoulders.
• Its allows recovery from fatigue, oxygen desaturation or
signs of bronchospasm and relieves breathlessness.

7. • Patients should be encouraged to breathe in through their nose to
humidify, warm and filter the air and to decrease the turbulence of
inspired flow.
• Breathing control should continue until the person feels ready to
progress to the other stages in the cycle.
• Breathing in a slow and relaxed manner reduces the work of
breathing and consequently the oxygen requirements.
Hyperventilation is also a known trigger for bronchospasm in some
people.

8. THORACIC EXPANSION EXERCISE
• TEEs are deep breathing exercise with an emphasis on slow,
controlled inspiration through the nose.
• Inspiration is active, with larger than normal volume breaths
which are often combined with a 3 sec. end inspiratory breath
hold with the glottis open, prior to passive expiration.
• The patient is instructed to breathe in slowly and deeply with
minimal accessory muscles use.
• This is repeated for up to five breaths.

9. • To facilitate a maximal inspiration, proprioceptive feedback, with the therapist, or
patient, placing their hands on the thoracic cage, can be beneficial.
• This has been associated with increased chest wall movement and improved
ventilation.

10. • Large inspiratory volumes are believed to facilitate collateral ventilation .
• This can be further enhanced by a breath hold.
• Resistance to airflow within the canals of Martin, channels of Lambert and
Pores of Kohn, (between the bronchioles and alveoli), is usually high, with
little movement during tidal volume breaths.
• With increasing inspired volumes, the resistance decreases and air flows
through these channels to enhance expiratory flow behind the secretions

11. • At high lung volumes, achieved during thoracic expansion
exercises, the expanding forces between alveoli are greater
than at tidal volume and may assist with the re-expansion
of lung tissue. This is known as alveolar inter-dependence
• During inspiration, the expanding alveoli exert forces on the
adjacent alveoli which enhance the recruitment of lung
units.

13. • https://bronchiectasis.com.au/resources/videos/the-active-cycle-of-breathing-
technique