Acbt

ACBT

1. ACTIVE CYCLE OF BREATHING TECHNIQUE Submitted By:- Nahid Roll No:- 17BPT024 BPT 4 th year Submitted To:- Dr. Jamal Ali Moiz

2. Introduction The active cycle of breathing technique (also known as ACBT) is an airway clearance method that uses a cycle of techniques to loosen airway secretions the lungs in three phases. The first phase is breathing control helps to relax the airways. The second phase is thoracic expansion exercises helps to get air behind mucus and clears mucus. The third phase is huffing or forced expiratory technique helps force the mucus out of the lungs.

3. Effect The active cycle of breathing technique has effects:- Loosen and clear secretions from the lungs Improve ventilation in the lungs Improve the effectiveness of a cough 

4. Breathing Control Breathing control is breathing gently, using as little effort as possible. Breathing con trol is used to relax the airways and relieve the symptoms of wheezing and tightness which normally occur after coughing or breathlessness. Closing eyes during breathing promotes relaxation. It is very important to do Breathing Control in between the more active exercises of ACBT as it allows the airways to relax.

5. Instructions to the patient Breathe in and out through your nose if you can. If you cannot, breathe through your mouth instead. If you breathe out through your mouth you can use breathing control with ‘pursed lips breathing.’ Try to let go of any tension in your body with each breath out. Breathe at a rate which feels comfortable; the rate will slow as you relax. Gradually try to make the breaths slower.

6. Thoracic Expansion Exercises T horacic expansion exercises are deep breathing exercises that focus on inspiration and help to loosen secretions on the  lungs .  The period of thoracic expansion, which increases lung volume and promotes collateral ventilation allows air to get behind secretions and assist in their mobilization. Instructions to patient: Try to keep your chest and  shoulders  relaxed. Take a long, slow and deep breath in, through your  nose  if you can. At the end of the breath in, hold the air in your lungs for 2-3 seconds before breathing out (this is known as an inspiratory hold)

7. Breathe out gently and relaxed, like a sigh. Don’t force the air out. Repeat 3 – 5 times. If the patient feels light-headed then it is important that they revert back to the breathing control phase of the cycle. 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. B reathe hold at the end of inspiration encourages collateral ventilation to redistribute air into collapsed segment and assist in re-expansion of lung.

8. Forced Expiratory Technique It helps to move secretions, mobilised by thoracic expansion exercises, towards the mouth. A huff is exhaling through an open mouth and throat instead of coughing. Huffing helps moves sputum from the small airways to the larger airways, from where they are removed by coughing as coughing alone can not remove sputum from small airways. Types of Huffs The Small-long huff/medium volume huff This will move sputum from smaller airways in chest. Take a small to medium breath in and then huff (squeeze) the air out until your lung feell quite empty.

9. The Big-short huff or Large volume huff This moves sputum from larger airways in chest, so use this huff when it feels ready to come out, but not before. Take a deep breath in and then huff the air out quickly. This should clear your sputum without coughing. Return to breathing control. To facilitate opening of glottis, patient can be taught to huff through a piece of cardboard spirometry can be used at least 4 cm inside the patient’s mouth.

10. When to cough? If sputum is not cleared by huffing then coughing can be used. Listen for crackles when you huff, If you can hear these, you may now need to cough and clear secretions; try to spit them out into a tissue or a sputum bowl. Try to avoid excessive coughing as this may reduce how effective the technique is and make it excessively tiring.

11. Indications Atelectasis Respiratory muscle weakness Mechanical ventilation Asthma Increased breathing rate/effort Audible rattling in airways Palpable secretions Post surgical /pain (rib fracture). Chronic increased sputum production e.g in Chronic bronchitis, cystic fibrosis Acute increase sputum production. Poor expansion. Sputum Retention Cystic Fibrosis. Bronchiectasis

12. Contraindications Patients not spontaneously breathing Unconscious patient Patients who are unable to follow instructions Agitated or confused

13. Position ACBT can be performed in sitting or in a postural drainage position When in sitting, maintain a good breathing pattern with relaxed shoulders and neck, back supported as this promotes the function of diaphragm and decrease stress on musculoskeletal. Whatever position you use make sure you are comfortable, well supported and relaxed

14. Duration and Frequency Duration for ACBT should be for about 10 minutes and ideally until the chest feels clear of sputum. ACBT is generally performed once or twice a week. But in case of exacerbation or more sputum production more sessions can be performed as per the need of patient.

15. Reference The Active Cycle of Breathing Techniques.Association of Chartered Physiotherapists in Respiratory Care Lewis LK, Williams MT, Olds TS.The active cycle of breathing technique: A systematic review and meta-analysis. Respiratory Medicine, 2012 Elsayed SH, Basset WK, Fathy KA.  Impact of active cycle of breathing technique on functional capacity in patient with bronchiectasis International Journal of Therapies and Rehabilitation Research. 2015 Larner E, Galey P. Active cycle of breathing technique McKoy NA, Saldanha IJ, Odelola OA, Robinson KA. Active cycle of breathing technique for cystic fibrosis The active cycle of breathing technique: a systematic review and meta-analysis Lucy K Lewis et al. Respir Med. 2012