Active Cycle of Breathing Technique (ACBT)

ACBT is an airway clearance technique, it is used to clear airway secretions. ACBT used in several respiratory diseases and post operative conditions

1. Active Cycle of Breathing Techniques (ACBT) t.Sunil kumar

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: Loosen and clear secretions from the lungs. Improve ventilation in the lungs. Improve the effectiveness of a 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 young as 3 or 4 years of age.

5. The active cycle of breathing (ACB) technique involves three phases repeated in cycles: breathing control, Thoracic expansion , and the forced expiratory technique (FET ).

6. Equipment Required for ACB Technique 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 mouth and 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 areas during one session may be tolerated by 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 optimal treatment is given.

9. Treatment With the Active Cycle of Breathing Technique 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 A s 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 and abdomen contract. Sound is like a sigh. but forced. Rate of expiratory flow varies with the following: The individual The disease The degree of airflow obstruction Crackles heard if excess secretions are 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 longer and 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 shorter and 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 long as 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

15. Advantages and Disadvantages of ACB Technique Incorporation of the ACB technique into a treatment of PD and percussion allows the 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 technique at 8 to 10 years of age. The technique may be adapted for patients with gastroesophageal reflux, bronchospasm, and an acute exacerbation of their pulmonary disease.

16. 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 will also be re quired for the patient in whom percussion or shaking during the thoracic expansion phase increases the effectiveness of the treatment .

17. 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

18. 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 .

19. Atelectasis. Respiratory muscle weakness. Mechanical ventilation. Asthma. Increased breathing rate/effort Palpable secretions

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

21. 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 control to reduce dizziness. Inadequate pain control where needed Bronchospasm Acute, unstable head, neck or spinal surgery

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