Autogenic drainage (AD) is a self-directed breathing technique that helps patients clear bronchial secretions by moving through three phases: 'unsticking', 'collecting', and 'evacuating'. It requires no equipment, but necessitates good proprioceptive and auditory feedback, making it suitable for adolescents and adults rather than young children. While beneficial for various patients, AD requires practice, self-discipline, and is not ideal during acute pulmonary exacerbations.

1. AUTOGENIC
DRAINAGE
T. SUNIL KUMAR

2. INTRODUCTION
• AUTOGENIC DRAINAGE (AD) IS A BREATHING TECHNIQUE
THAT USES EXPIRATORY AIRFLOW TO MOBILIZE
BRONCHIAL SECRETIONS.
• IT IS A SELF-DRAINAGE METHOD THAT IS PERFORMED
INDEPENDENTLY BY THE PATIENT IN THE SITTING
POSITION.

3. AD CONSISTS OF THREE PHASES:
(1) THE "UNSTICKING" PHASE. WHICH LOOSENS
SECRETIONS IN THE PERIPHERAL AIRWAYS,
(2) THE "COLLECTING" PHASE, WHICH MOVES THE
SECRETIONS TO THE LARGER, MORE CENTRAL
AIRWAYS,
(3) THE "EVACUATING" PHASE, WHICH RESULTS IN THE
REMOVAL OF THE SECRETIONS.

4. • THIS TECHNIQUE OF AIRWAY CLEARANCE REQUIRES
MUCH PATIENCE AND CONCENTRATION TO LEARN AND IS
THEREFORE NOT SUITABLE FOR YOUNG CHILDREN.
• IT IS IDEAL, HOWEVER, FOR THE ADOLESCENT OR ADULT
WHO PREFERS AN INDEPENDENT METHOD.

5. EQUIPMENT REQUIRED FOR AD
• NO EQUIPMENT IS NEEDED FOR A PATIENT TO PERFORM
THE TECHNIQUE OF AD. THE PATIENT MUST POSSESS
GOOD PROPRIOCEPTIVE, TACTILE, AND AUDITORY
PERCEPTION OF THE MUCUS MOVING; THIS FEEDBACK
MAKES IT POSSIBLE TO ADJUST THE TECHNIQUE OF AD.
• TO TEACH THIS METHOD TO A PATIENT, A CAREGIVER
REQUIRES KEEN TACTILE AND AUDITORY SENSES TO
COACH A PATIENT TO MOVE BETWEEN THE PHASES BY
LISTENING TO AND FEELING THE LOCATION AND THE
QUALITY OF THE SECRETIONS.

6. PREPARATION FOR AD
• THE PATIENT SHOULD BE SEATED UPRIGHT IN A CHAIR
WITH A BACK FOR SUPPORT. THE SURROUNDINGS
SHOULD BE DEVOID OF DISTRACTIONS, ALLOWING THE
PATIENT TO CONCENTRATE ON THE BREATHING
TECHNIQUE.
• THE UPPER AIRWAYS (NOSE AND THROAT) SHOULD BE
CLEARED OF SECRETIONS BY HUFFING OR BLOWING THE
NOSE.

7. • THE CAREGIVER SHOULD BE SEATED TO THE SIDE AND
SLIGHTLY BEHIND THE PATIENT, CLOSE ENOUGH TO HEAR
THE PATIENT'S BREATHING.
• ONE HAND SHOULD BE PLACED TO FEEL THE WORK OF
THE ABDOMINAL MUSCLES AND THE OTHER HAND
PLACED ON THE UPPER CHEST

8. TREATMENT WITH AUTOGENIC DRAINAGE
• IN ALL PHASES, INHALATION SHOULD BE DONE SLOWLY,
THOUGH THE NOSE IF POSSIBLE, USING THE DIAPHRAGM
OR LOWER CHEST.
• A 2- TO 3-SECOND BREATH HOLD SHOULD FOLLOW,
ALLOWING COLLATERAL VENTILATION TO GET AIR BEHIND
THE SECRETIONS.
• EXHALATION SHOULD OCCUR THROUGH THE MOUTH
WITH THE GLOTTIS OPEN, CAUSING THE SECRETIONS TO
BE HEARD.
• THE VIBRATIONS OF THE MUCUS MAY ALSO BE FELT WITH
THE HAND PLACED ON THE UPPER CHEST.

9. • THE FREQUENCY OF THESE VIBRATIONS REVEALS THEIR
LOCATION. HIGH FREQUENCIES MEAN THAT THE
SECRETIONS ARE LOCATED IN THE SMALL AIRWAYS; LOW
FREQUENCIES MEAN THAT THE SECRETIONS HAVE
MOVED TO THE LARGE AIRWAYS.
• THE UNSTICKING PHASE-THIS PHASE MOBILIZES MUCUS
FROM THE PERIPHERY OF THE LUNGS BY LOWERING THE
MID-TIDAL VOLUME BELOW THE FUNCTIONAL RESIDUAL
CAPACITY LEVEL.
• IN PRACTICE, INSPIRATION IS FOLLOWED BY A DEEP
EXPIRATION INTO THE EXPIRATORY RESERVE VOLUME.
THE PATIENT ATTEMPTS TO EXHALE AS FAR INTO THE
EXPIRATORY RESERVE VOLUME AS POSSIBLE,
CONTRACTING THE ABDOMINAL MUSCLES TO ACHIEVE
THIS.

10. • THIS LOW LUNG VOLUME BREATHING CONTINUES UNTIL
THE MUCUS IS LOOSENED AND STARTS TO MOVE INTO
THE LARGER AIRWAYS.
• THE COLLECTING PHASE: THIS PHASE COLLECTS THE
MUCUS IN THE MIDDLE AIRWAYS BY INCREASING THE
LUNG VOLUME OVER THE UNSTICKING PHASE.
• TIDAL VOLUME BREATHING IS THEN CHANGED
GRADUALLY FROM EXPIRATORY RESERVE VOLUME
TOWARD THE INSPIRATORY RESERVE VOLUME RANGE SO
THAT THE LUNGS ARE EXPANDED MORE WITH EACH
INSPIRATION.
• THE PATIENT INCREASES BOTH INSPIRATION AND
EXPIRATION TO MOVE A GREATER VOLUME OF AIR.

11. • THIS LOW TO MIDDLE LUNG VOLUME BREATHING
CONTINUES UNTIL THE SOUND OF THE MUCUS
DECREASES, SIGNALLING ITS MOVEMENT INTO THE
CENTRAL AIRWAYS TO BE EVACUATED.
• THE EVACUATING PHASE- IN THIS PHASE, THE PATIENT
INCREASES INSPIRATION INTO THE INSPIRATORY
RESERVE VOLUME RANGE.
• THIS MIDDLE-TO-HIGH LUNG VOLUME BREATHING
CONTINUES UNTIL THE SECRETIONS ARE IN THE TRACHEA
AND ARE READY TO BE EXPECTORATED.
• THE COLLECTED MUCUS CAN BE EVACUATED BY A
STRONGER EXPIRATION OR A HIGH VOLUME HUFF. NON
PRODUCTIVE COUGHING SHOULD BE AVOIDED, SINCE IT
MAY RESULT IN COLLAPSE OF AIRWAYS.

12. • COMPRESSION OF THE AIRWAYS SHOULD BE AVOIDED. IF
WHEEZING IS HEARD, THE EXPIRATORY FLOW RATE MUST
BE DECREASED. BEGINNERS MAY HAVE TO USE PURSED
LIPS TO AVOID AIR WAY COMPRESSION.
• INSTRUCTING THE PATIENT TO ROLL THE TONGUE (IF
POSSIBLE) MAY ASSIST IN CONTROLLING THE
EXPIRATORY FLOW RATE.
• THE DURATION OF EACH PHASE OF AD DEPENDS ON THE
LOCATION OF THE SECRETIONS. THE DURATION OF A
SESSION DEPENDS ON THE AMOUNT AND VISCOSITY OF
THE SECRETIONS.
• A PATIENT WHO IS EXPERIENCED IN AUTOGENIC
DRAINAGE WILL CLEAR SECRETIONS IN A SHORTER
AMOUNT OF TIME THAN A BEGINNER. AN AVERAGE
TREATMENT WILL BE 30 TO 45 MINUTES IN LENGTH

14. ADVANTAGES AND DISADVANTAGES OF AD
• AFTER INSTRUCTION IN THE TECHNIQUE OF AD HAS BEEN
COMPLETED, IT MAY BE PERFORMED INDEPENDENTLY BY
PATIENTS OVER 12 YEARS OF AGE AND REQUIRES NO
ADDITIONAL EQUIPMENT.
• SINCE IT DOES NOT REQUIRE THE USE OF POSTURAL
DRAINAGE POSITIONS, IT IS APPROPRIATE FOR PATIENTS
WITH GASTROESOPHAGEAL REFLUX. IT IS ALSO
RECOMMENDED FOR USE IN PATIENTS WITH AIRWAY
HYPERREACTIVITY.

15. • TO LEARN THIS TECHNIQUE, PATIENTS MUST
DEMONSTRATE GOOD SELF-DISCIPLINE AND POSSESS
THE ABILITY TO CONCENTRATE.
• THIS METHOD TAKES MORE PRACTICE THAN OTHERS. A
PATIENT MUST ALSO BE AVAILABLE FOR PERIODIC
REEVALUATION AND REFINEMENT OF THE TECHNIQUE.
• AD IS NOT THE TREATMENT OF CHOICE FOR A PATIENT
WHO IS UNMOTIVATED OR UNCOOPERATIVE, AND THE
STUDY OF FLOW VOLUME CURVES SUGGESTS THAT AD
WOULD NOT BE APPROPRIATE FOR SMALL CHILDREN
EVEN IF THEY ARE COOPERATIVE.

16. • THE PERIOD OF HOSPITALIZATION FOR AN ACUTE
PULMONARY EXACERBATION IS A DIFFICULT TIME FOR A
PATIENT TO LEARN AD.
• IN FACT, PATIENTS WHO ARE SKILLED IN THE TECHNIQUE
CHOOSE A MORE PASSIVE (LESS ENERGY-CONSUMING)
FORM OF AIRWAY CLEARANCE AT SUCH A TIME UNTIL
THEY RETURN TO THEIR BASELINE PULMONARY STATUS.

17. THANK YOU