acbt

1. ACTIVE CYCLE
OF BREATHING
TECHNIQUES
(ACBT)
Dr. Sonia Bhatia
(P.T)

2. INTRODUCTION
• THE ACTIVE CYCLE OF BREATHING TECHNIQUES (ACBT) IS
AN ACTIVE BREATHING TECHNIQUE PERFORMED BY THE
PATIENT AND CAN BE USED TO MOBILISE AND CLEAR
EXCESS PULMONARY SECRETIONS AND TO GENERALLY
IMPROVE LUNG FUNCTION.
• EACH COMPONENT CAN BE USED INDIVIDUALLY OR AS
PART OF THE ACBT CYCLE DEPENDING ON THE PATIENT'S
PROBLEM.
• ONCE ACBT HAS BEEN TAUGHT, THE PATIENT CAN BE
ENCOURAGED TO USE IT INDEPENDENTLY.

3. • ACBT IS USED TO:
1. LOOSENAND CLEAR SECRETIONS FROM THE LUNGS.
2. IMPROVE VENTILATION IN THE LUNGS.
3. IMPROVE THE EFFECTIVENESS OFA COUGH

4. • THIS METHOD ENCOURAGES ACTIVE PARTICIPATION OF
THE PATIENT AND HAS BEEN SHOWN TO BE AS EFFECTIVE
WHEN PERFORMED BY THE PATIENT ALONE AS WITH THE
AID OF A CAREGIVER.
• POSTURAL DRAINAGE POSITIONS MAY BE USED IN
CONJUNCTION WITH ACB TECHNIQUE.
• THIS METHOD OF AIRWAY CLEARANCE MAY BE USED WITH
SOME CHILDREN AS YOUNGAS 3 OR 4 YEARS OFAGE.

5. • THE ACTIVE CYCLE OF BREATHING (ACB) TECHNIQUE
INVOLVES THREE PHASES REPEATED IN CYCLES:
1. BREATHING CONTROL,
2. THORACIC EXPANSION, AND
3. THE FORCED EXPIRATORY TECHNIQUE (FET).

6. EQUIPMENT REQUIRED FORACBTECHNIQUE
• THE ONLY EQUIPMENT REQUIRED FOR THIS MANUAL
TECHNIQUE IS THE PATIENT'S OR CAREGIVER'S HANDS TO
PERCUSS OR SHAKE/VIBRATE THE CHEST WALL DURING
THE THORACIC EXPANSION PHASE.
• MECHANICAL PERCUSSORS OR VIBRATORS MAY BE USED
DURING THE THORACIC EXPANSION PHASE, EITHER FOR
SELF-PERCUSSION BY THE PATIENT OR FOR USE BY THE
CAREGIVER.
• IF PD POSITIONS ARE USED, EQUIPMENT FOR
POSITIONING WILL BE REQUIRED.

7. • TO TEACH THE HUFFING MANEUVER, IT MAY BE HELPFUL
TO USE A PEAK FLOW METER MOUTHPIECE TO KEEP THE
MOUTHAND GLOTTIS OPEN.
• YOUNG CHILDREN MAY BE TAUGHT GAMES OF HUFFING
AT COTTON BALLS OR TISSUE TO IMPROVE THE
TECHNIQUE.
• TO HELP THEM FOCUS ON THE EXPIRATORY MANEUVER,
SMALL CHILDREN MAY ALSO BE TAUGHT TO FLAP THEIR
ARMS TO THEIR LATERAL CHEST AS THEY PERFORM THE
HUFF, A TECHNIQUE REFERRED TO AS THE "CHICKEN
BREATH"

8. PREPARATION FOR ACB TECHNIQUE
• TREATMENT OF TWO OR THREE PRODUCTIVE
DURING ONE SESSION MAY BE TOLERATED BY
AREAS
MOST
PATIENTS.
• THE PATIENT IS POSITIONED OR POSITIONS HERSELF IN A
PD POSITION TO STIMULATE DRAINAGE OF A PRODUCTIVE
AREA OF THE LUNGS. THE ENTIRE TREATMENT MAY ALSO
BE DONE IN THE SITTING POSITION.
• A MINIMUM OF 10 MINUTES IN ANY PRODUCTIVE POSITION
MAY BE NECESSARY TO CLEAR A PATIENT WITH A
MODERATE AMOUNT OF SECRETIONS. PATIENTS AFTER
SURGERY OR WITH MINIMAL SECRETIONS MAY NOT
REQUIRE AS MUCH TIME, AND VERY ILL PATIENTS MAY
FATIGUE BEFORE OPTIMALTREATMENT IS GIVEN.

9. TREATMENT WITHTHEACTIVE CYCLEOF
BREATHINGTECHNIQUE
• BREATHING CONTROL-THE PATIENT IS INSTRUCTED TO
BREATHE IN A RELAXED MANNER USING NORMAL TIDAL
VOLUME.
• THE UPPER CHEST AND SHOULDERS SHOULD REMAIN
RELAXED AND THE LOWER CHEST AND ABDOMEN SHOULD
BE ACTIVE. THE PHASE OF BREATHING CONTROL SHOULD
LAST AS LONG AS THE PATIENT REQUIRES TO RELAX AND
TO PREPARE FOR THE NEXT PHASES, USUALLY 5 TO 10
SECONDS.

10. • THORACIC EXPANSION-THE EMPHASIS DURING THIS
PHASE IS ON INSPIRATION. THE PATIENT IS INSTRUCTED
TO TAKE IN A DEEP BREATH TO INSPIRATORY RESERVE;
EXPIRATION IS PASSIVE AND RELAXED.
• THE CAREGIVER OR THE PATIENT MAY PLACE A HAND
OVER THE AREA OF THE THORAX BEING TREATED TO
FURTHER ENCOURAGE INCREASED CHEST WALL
MOVEMENT.
• CHEST PERCUSSION, SHAKING, OR VIBRATION MAY BE
PERFORMED IN COMBINATION WITH THORACIC
EXPANSION AS THE PATIENT EXHALES.

11. • FOR SURGICAL PATIENTS OR THOSE WITH LUNG
COLLAPSE, A BREATH HOLD OR A SNIFF AT THE END OF
INSPIRATION ENCOURAGES COLLATERAL VENTILATION TO
ASSIST WITH RE-EXPANSION OF THE LUNG.
• FET: THIS PHASE CONSISTS OF HUFFING INTERSPERSED
WITH BREATHING CONTROL. A HUFF IS A RAPID, FORCED
EXHALATION BUT NOT WITH MAXIMAL EFFORT.
• THIS MANEUVER CAN BE COMPARED WITH FOGGING A
PAIR OF EYEGLASSES WITH WARM BREATH SO THEY MAY
BE CLEANED.
• UNLIKE A COUGH IN WHICH THE GLOTTIS IS CLOSED, A
HUFF REQUIRES THE GLOTTIS TO REMAIN OPEN. IN AN
EFFECTIVE HUFF, THE MUSCLES OF THE ABDOMEN
SHOULD CONTRACT TO PROVIDE GREATER EXPIRATORY
FORCE.

12. INEFFECTIVE HUFFING
• MOUTH HALF OR ALMOST CLOSED
• EXPIRATION ALWAYS STARTING
FROM HIGH LUNG VOLUME
• ABDOMINAL MUSCLES NOT USED
• SOUND MORE LIKE HISSING OR
BLOWING
• MOUTH SHAPED AS FOR "E"
SOUND
• INCORRECT QUALITY OF
EXPIRATION
• TOO VIGOROUS OR LONG.
PRODUCING PAROXYSMAL
COUGHING
• TOO GENTLE
• TOO SHORT
• "CATCHING" OR "GRUNTING" AT
THE BACK OF THE THROAT
EFFECTIVE HUFFING
• MOUTH OPEN, O-SHAPED TO KEEP
GLOTTIS OPEN
• FORCED EXPIRATION
• FROM MID TO LOW LUNG VOLUME
MOVES PERIPHERAL SECRETIONS
• FROM HIGH TO MID LUNG VOLUME
MOVES PROXIMAL SECRETIONS
• MUSCLES OF THE CHEST WALL
ANDABDOMEN CONTRACT.
• SOUND IS LIKE A SIGH. BUT
FORCED.
• RATE OF EXPIRATORY FLOW
VARIES WITH THE FOLLOWING:
• THE INDIVIDUAL
• THE DISEASE
• THE DEGREE OFAIRFLOW
OBSTRUCTION
• CRACKLES HEARD IF EXCESS
SECRETIONSARE PRESENT

13. • TWO DIFFERENT LEVELS OF HUFFING ARE
CHARACTERIZED IN THE FET. TO MOBILIZE SECRETIONS
FROM PERIPHERAL AIRWAYS, A HUFF AFTER A MEDIUM-
SIZE BREATH IN WILL BE EFFECTIVE. THIS HUFF WILL BE
LONGERAND QUIETER.
• TO CLEAR SECRETIONS THAT HAVE REACHED THE
LARGER, PROXIMAL AIRWAYS, A HUFF AFTER A DEEP
BREATH IN WILL BE EFFECTIVE. THIS HUFF WILL BE
SHORTERAND LOUDER.
• THE PATIENT MUST PAUSE FOR BREATHING CONTROL
AFTER ONE OR TWO HUFFS. THIS WILL PREVENT ANY
INCREASE IN AIRFLOW OBSTRUCTION. THE ACB
TECHNIQUE MAY BE ADAPTED TO THE INDIVIDUAL
PATIENT'S NEEDS.

14. • IF SECRETIONS ARE TENACIOUS, TWO CYCLES OF THE
THORACIC EXPANSION PHASE MAY BE NECESSARY TO
LOOSEN SECRETIONS BEFORE THE FET CAN FOLLOW.
• IN A PATIENT WITH BRONCHOSPASM OR UNSTABLE
AIRWAYS, THE PERIOD OF BREATHING CONTROL MAY BE
AS LONGAS 10 TO 20 SECONDS.
• AFTER SURGERY, THE PATIENT MAY BE SHOWN HOW TO
SUPPORT THE INCISION WITH THEIR HANDS DURING THE
FET TO ACHIEVE SUFFICIENT EXPIRATORY FORCE.
• WHEN A HUFF FROM A MEDIUM-SIZED INSPIRATION
THROUGH COMPLETE EXPIRATION IS NONPRODUCTIVE
AND DRY SOUNDING FOR TWO CYCLES IN A ROW, THE
TREATMENT MAY BE CONCLUDED

16. ADVANTAGESAND DISADVANTAGES OFACB
TECHNIQUE
• PATIENT TO PARTICIPATE ACTIVELY IN A SECRETION
MOBILIZATION TREATMENT AND OFFERS THE
PROSPECT OF INDEPENDENTLY MANAGING AIRWAY
CLEARANCE.
• THE ACB MAY BE INTRODUCED AT 3 OR 4 YEARS OF AGE,
WITH A CHILD BECOMING INDEPENDENT IN THE
TECHNIQUEAT 8TO 10YEARS OFAGE.
• THE TECHNIQUE MAY BE ADAPTED FOR PATIENTS WITH
GASTROESOPHAGEAL REFLUX, BRONCHOSPASM, AND
AN ACUTE EXACERBATION OF THEIR PULMONARY
DISEASE.
• INCORPORATION OF THE ACB TECHNIQUE INTO A
TREATMENT OF PD AND PERCUSSION ALLOWS THE

17. • A DECREASE IN OXYGEN SATURATION CAUSED BY CHEST
PERCUSSION MAY BE AVOIDED BY USING THE ACB
TECHNIQUE.
• WHEN THE TECHNIQUE IS PERFORMED INDEPENDENTLY,
THE COST OF USING ACB TECHNIQUE FOR THE LONG
TERM IS MINIMAL.
• HOWEVER, IN YOUNG CHILDREN AND IN EXTREMELY ILL
ADULTS, A CAREGIVER WILL BE NECESSARY TO ASSIST
THE PATIENT WITH THIS TECHNIQUE.
• AN ASSISTANT WILLALSO BE REQUIRED FOR THE PATIENT
IN WHOM
THORACIC
PERCUSSION OR SHAKING DURING THE
EXPANSION PHASE INCREASES THE
EFFECTIVENESS OF THE TREATMENT.

18. • CARE MUST BE TAKEN TO ADAPT THE ACB TECHNIQUE
FOR PATIENTS WITH HYPERREACTIVE AIRWAYS OR AFTER
SURGERY.
• THIS INDIVIDUAL APPROACH WILL BE HELPFUL WITH ALL
PATIENT USING THE TECHNIQUE TO OPTIMIZE
EFFECTIVENESS

19. INDICATIONS
• POST SURGICAL /PAIN (RIB FRACTURE/ICC).
• CHRONIC INCREASED SPUTUM PRODUCTION E.G
IN CHRONIC BRONCHITIS, CYSTIC FIBROSIS.
• ACUTE INCREASE SPUTUM PRODUCTION.
• POOR EXPANSION.
• SPUTUM RETENTION.
• CYSTIC FIBROSIS.
• BRONCHIECTASIS.

20. • ATELECTASIS.
• RESPIRATORY MUSCLE WEAKNESS.
• MECHANICAL VENTILATION.
• ASTHMA.
• INCREASED BREATHING RATE/EFFORT
• PALPABLE SECRETIONS

21. CONTRAINDICATIONS
• PATIENTS NOT SPONTANEOUSLY BREATHING
• UNCONSCIOUS PATIENT
• PATIENTS WHOARE UNABLE TO FOLLOW INSTRUCTIONS
• AGITATED OR CONFUSED

22. PRECAUTION
• IT IS IMPORTANT TO CONSTANTLY ASSESS FOR DIZZINESS
OR INCREASED SHORTNESS OF BREATH THROUGHOUT
ACBT.
• IF A PATIENT FEELS DIZZY DURING DEEP BREATHING,
DECREASE THE NUMBER OF DEEP BREATHS TAKEN
DURING EACH CYCLE AND RETURN TO BREATHING
CONTROLTO REDUCE DIZZINESS.
• INADEQUATE PAIN CONTROL WHERE NEEDED
• BRONCHOSPASM
• ACUTE, UNSTABLE HEAD, NECK OR SPINAL SURGERY

23. THANKYOU