The Active Cycle of Breathing Technique (ACBT)
The active cycle of breathing technique is performed to aid clearance of bronchial secretions (Webber & Pryor 1993). It combines thoracic expansion exercises, breathing control and forced expiratory technique in a treatment approach which is flexible to the patient's needs.
A typical active cycle of breathing technique starts with a period of breathing control, the length of which will vary according to the patient's signs of bronchospasm (ACPRC 1996) but may be in the region of one minute or so (Tannenbaum 1995). This is followed by three or four thoracic expansion exercises to mobilize secretions in the smaller bronchi. Forced expiration technique from mid to low lung volume may then move the secretions proximally, and this may stimulate a cough, or alternatively, a huff from high lung volume may remove the secretions. It is vital that breathing control follows immediately after the forced expiratory technique as this helps to reduce induced bronchospasm and minimize patient fatigue (Tannenbaum 1995; Hardy 1994).
It is recommended that the technique be performed in the sitting position if secretions are minimal or it can be combined with postural drainage positions, e.g. alternate side lying (Tannenbaum 1995). It may also be necessary in those patients with significant bronchospasm to follow the thoracic expansion exercises with a period of breathing control prior to performing forced expiration technique (Webber & Pryor 1993).
In cases where mobilization of secretions is slower, two periods of thoracic expansion exercises in the cycle, interspersed with breathing control, may be necessary (Webber & Pryor 1993).
The cycle of techniques is repeated until the huff is unproductive and sounds dry, or earlier than this if the patient becomes fatigued (Webber & Pryor 1993; Hardy 1994). The total treatment time will usually be between 15 and 30 minutes (ACPRC 1996).
Once the patient is conversant with the active cycle of breathing techniques, he can be encouraged to use it as a self-treatment regime (Webber & Pryor 1993), until it becomes habitual and can be used in periods of exacerbation.
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