Author Archives: Jackie Aim

Autogenic Drainage

This is a breathing technique used to clear differing levels of the lung and help you to breathe better.
Autogenic drainage can be difficult to explain in words. It is important that you are first shown how to do this by your physiotherapist as sections may be individually tailored to your needs.

Feel that Active Cycle of Breathing Technique is not effective.
Feel that Active Cycle of Breathing Technique is making you wheezy.
You cough a lot.
Regularly produce a lot of sputum.

Autogenic Drainage from Cat Young on Vimeo.

View text transcript

We are now going to demonstrate Autogenic Drainage which is another treatment which can be used to treat your chest.

What we are going to do this time is start off with a test breath. Your test breath will be a nice big deep breath in as far as you can and hold for three then huff out.

Keep doing that huff until you hear the secretions or feel the rumbling in your chest. When you feel the rumbling in your chest, take a normal breath in and huff out until you feel the urge to cough and clear the phlegm.

This technique is moving the phlegm up the chest so it is easier to clear it out of your chest.

I am going to put my hands on your chest while you are doing your breaths in to make sure you don’t take too deep a breath in the top part of your chest.

Deep breath in, hold for three and then do your huff out until you hear the phlegm moving. Normal breath in and huff out. Take several breaths until you feel the urge to cough.

Repeat again. Test breath first. Deep breath, hold for three then huff. Continue until your chest feels more comfortable and you have coughed up your secretions.

This form of breathing exercise uses breathing right out, as far as possible, to loosen mucus from the small airways at the edges of your lungs. The mucous can then be moved to the larger more central airways making it easier to cough up.

Other Airways Clearance Techniques

Other Airway Clearance Technique and devices can be tried to help you to clear your sputum.

To get the best from these you should speak to a respiratory physiotherapist.

Autogenic Drainage (AD).
Positive Expiratory Pressure (PEP).
Oscillatory Positive Expiratory Pressure.

You can find out more about each of these techniques on the following pages.

Frequently asked questions

Q. I'm too breathless

A. Try to increase time spent on breathing control, don’t do the breath hold, consider using a position that supports your arms.

Q. How often should I do the active cycle of breathing?

A.It is important to clear your lungs every day, so you will be able to do more activities you enjoy and that you need to do.

Q. I am coughing all the time. What can I do?

A. Firstly check with your GP. A referral to a respiratory physiotherapist for breathing control can be very useful and can reduce your coughing.

Active Cycle of Breathing Technique (ACBT)

The main Airway Clearance Technique used in COPD is the Active Cycle of Breathing Technique (ACBT).

ACBT is easy to learn.
It can be adapted to your needs.
You don’t need any equipment or assistance so can be done anywhere at any time.
It is usually the first Airway Clearance Technique of choice for people with COPD.
If you have difficulty with Active Cycle of Breathing Technique ask to see a respiratory physiotherapist who can help.

Active Cycle of Breathing from Cat Young on Vimeo

View text transcript

This is a short video to show a short demonstration of the active cycle of breathing to help clear secretions of the chest.

What we are going to do first of all is, I will talk you through the technique and then we will run through it together.

First of all we need three deep breaths. So it’s going to be a nice big deep breath in. Hold for three and then just sigh gently out. We will do three breaths, then we will go to breathing control which is your slow normal breathing and then back to three deep breaths again. We will then go on to the huff which is when we are trying to move the secretions and make them rumble. A huff is a medium sized breath in as you breathe out as if you are steaming up a mirror or a glass when you clean it. (Like a forced sigh) Yours will sound grumbly. You are going to keep on doing that until you feel the urge to cough. Then you are going to cough to clear any secretions which are there.

Three slow deep breaths in and out when you are ready. Some normal relaxed breaths. When you feel ready do another three slow deep breaths. A couple of relaxed breaths and when you are ready go on to your huff. Repeat the huff two or three times until you have the urge to cough.

Once you have cleared your chest have a few normal relaxed breaths and start the cycle over again with deep breaths and huffs.

Three slow deep breaths, followed by normal breaths. Three deep breaths followed by the huff breaths until you feel the urge to cough.

Key terms

Breathing Control

Gentle relaxed breathing, using the lower part of your chest, with relaxation of your upper chest and shoulders. You shouldn’t feel that you are working at breathing and you should allow your tummy to rise or move out as you breathe in and fall as you breathe out.

Deep Breathing

Can also be known as ‘thoracic expansion exercises’. These concentrate on expanding your chest as far as possible to allow maximum air into your lungs, by deep breathing and breath holding. This allows air to move behind trapped sputum and loosen it so that it may be coughed out.

Take a slow, steady, relaxed breath in, as far as you can, through your nose if you can. A slow breath will allow your lungs to fill evenly, opening up the small air sacs.

Breathing through your nose slows your breath to allow more equal filling of your lungs. It also warms, moistens and filters the air which will help to avoid coughing and wheezing.

Now hold your breath for a slow count of up to 3. Holding your breath will allow the air to circulate right down into the air sacs and get behind the sputum so that it can be driven out of your lungs. Followed by a quiet, gentle, relaxed breath out.

Huffing

Can also be referred to as ‘forced expiratory technique’. It concentrates on pushing air out of your lungs. The idea is to encourage the sputum up through your airways until it can be cleared with a cough. Too short a huff may not be effective, too long can lead to bouts of coughing, so practice is essential.

Take a slightly deeper than normal breath in and then with your mouth open (as if biting into a large apple or imagine you are steaming up a mirror), squeeze the air out forcibly. You should feel your stomach muscles contract. If your huff sounds wheezy you have squeezed too hard.
Keep huffing out to the end of your breath.

You can use breathing control between huffs to avoid wheezing.

If you can hear or feel that the sputum is ready and sitting high enough in your throat, cough or huff again to spit it out into a seal-able container or into disposable tissues. Remember to wash your hands after this.

Before doing your Airway Clearance Techniques

Bottle of water Reliever inhaler Lady coughing Man sitting upright in a chair, adopting good posture Pelvic floor area

Drink and tissues. Be prepared with a drink, and something to cough into such as a tissue or pot, before you start.
Inhalation therapy. If you take bronchodilator inhalers or nebulisers such as Salbutamol, use these prior to performing your Airway Clearance Technique. This will open up your airways and make it easier to move the sputum up and out of your lungs. If you use a saline nebuliser you should use this prior to your airway clearance. This will help to loosen the sputum making your airway clearance easier.
Clear your upper airway. Cough up any sputum at the back of your throat and blow your nose. This will make the breathing exercises easier.
Adopt a good posture. This will allow the muscles that help you with your breathing to work as well as they can. You are also less likely to develop joint pain if your posture is good. Good posture can also limit the downward pressure onto your pelvic floor muscles which can help avoid stress urinary incontinence.
Think about tightening up your pelvic floor as you are doing your airway clearance. This will help with problems such as stress incontinence. For more information please see our section on: stress urinary incontinence.

Airway clearance and physical activity

Group of older people doing an aerobics class

Physical activity can be one of the best ways to help clear sputum out of your lungs. Physical activity that makes you breathe more deeply and quickly which will loosen the sputum and move it through your lungs, towards your mouth.

It is important to be active and use an Airway Clearance Technique.

Physical activity is a general term used to describe movement of the body that uses energy. It can be as simple as going about your day to day routine.

For more information please see our section on: Physical activity and exercise.

Reflection

Think about the type of activity that makes you breathless. This can make you cough and clear your sputum.

walking up a hill
carrying heavy bags
bending to pick up leaves in the garden
housework
washing the car

Hydration & humidification

To get the most out of your Airway Clearance Technique you must drink fluids (not alcohol) and stay well hydrated.
When you are dehydrated your natural lung clearance methods don’t work as well.

Hydration – How much you should drink per day?

This will vary depending on your size, how active you are, how warm you keep your house, and other medical conditions you may have. A good rough guide is about 8 glasses or between 1 and 2 litres daily. A good tip is – if your mouth feels dry, your airways are dry.
Drinking water is great, but other fluids can be just as good.
Limit drinks containing caffeine (tea, coffee, cola, energy drinks). Although it is a myth that they increase dehydration, they won’t give you as much benefit as a non-caffeinated drink. They can also make you pass urine more often meaning more trips to the toilet. Try decaffeinated versions.
If you do drink alcohol be aware that your lungs will feel the hangover too! This is because of dehydration and your cilia will not work as well over night.
If you are in any doubt about whether you should be increasing the amount you drink, speak to your Nurse or Doctor. Some medical conditions may mean you have to restrict your fluid intake.

Humidification – to moisten the air you breathe

The best way to keep your airways moist is to stay well hydrated.
Try steam inhalations to moisten your airways – menthol or eucalyptus oils can be added to hot water. (Take care when using hot water for steam inhalation)
Only a few people with COPD will need a nebuliser. If you do have a nebuliser, using it can help.

Managing your cough better

Coughing alone will only clear the sputum that is sitting in your trachea/windpipe.

By using an Airway Clearance Technique you will give the whole of your lungs a proper clear out – right down to the tiny air sacs (alveoli).
You will not need to cough as much when you use the breathing exercises in your Airway Clearance Technique to move the sputum right up to the back of your throat.
This will let you plan your day to avoid lots of coughing at times when you would rather be doing other things. For example at the cinema, socialising or sleeping!
Less coughing means feeling less breathless, less pain and having more energy.

By managing your cough better:

You can make socialising more enjoyable.
Feel less tired and sore.
Get a better nights sleep.
Reduce stress urinary incontinence. Repeated coughing or sneezing can often cause women to have problems with leaking or incontinence. For more help and advice about this see section about stress urinary incontinence.

Q. Is it all right to swallow sputum?

It is safe to either cough and spit or cough and swallow you can use either or both
If you cough and still hear and feel a rattle – your chest is not cleared. Try again.

Why use an Airway Clearance Technique?

Picture of lungs

It is not normal to be aware of your sputum. If sputum is troubling you, practising an airway clearance technique can help you to manage this. You will need a physiotherapist to show you these techniques.

Clearing your chest everyday should become as normal in your routine as brushing your teeth. If you have a lot of sputum then you should try to clear it first thing in the morning and last thing at night so you get as much of the mucous up as possible. You will improve the amount of oxygen getting in to your lungs and you will be less troubled by your chest during the day and night. The aim of clearing your chest everyday will mean you will have fewer chest infections which are less severe and cause less damage to your lungs.

Ask your GP about possible medication to loosen the sputum.

Airway clearance techniques will help you to:

Reduce the amount of sputum in your lungs, and prevent airways becoming blocked.
Reduce the chance of a chest infection.
Make clearing your chest easier and less tiring.
Spot a change in your sputum earlier, and treat a chest infection promptly (for more information see our section on: Signs of infection or exacerbation and what to do).
Manage your cough better.
Remove mucous plugs.

What are Airway Clearance Techniques?

Airway Clearance Techniques are different types of breathing exercises that help you to get sputum out of your lungs.

This is a term that may be used to cover lots of different ways that you may be taught to clear sputum out of your lungs.
May also be referred to as ‘Chest Clearance’, ‘Breathing Exercises’ or ‘Breathing Techniques’, ‘physio’ or ‘physiotherapy’.
There are several different types of airway clearance techniques.
You may find that one works better than another, or is more convenient for you.
It is important that you are shown how to do these techniques by a respiratory physiotherapist.
Your physiotherapist will recommend how often you should do these techniques and will adjust them to meet your needs.

Sputum – benefits and downside

Our bodies have many defence mechanisms to protect us from infection, sputum is one of these. Sputum filters out harmful particles that we can breathe in and reduces our risk of developing infections.

The benefits of sputum	The downside of sputum
We all have sputum in our lungs. Sputum helps to protect our airways from infection. More about this can be found in the section on ‘What is COPD’. A change in our sputum can give us an ‘early warning’ sign. More about this can be found in the section on ‘Managing an exacerbation’.	Some people have more sputum than is usual. Sometimes it can be difficult to shift. Sometimes it can be distressing. Sometimes it clogs up the airways making breathing feel more difficult. Lots of coughing can be tiring and sore. Coughing can be embarrassing.

Please note there is no audio for this animation.