Breathing Techniques

Both of the following breathing techniques are flexible, efficient, and effective when taught correctly. They foster independence because once taught they can be used without assistance. They are particularly suited to people with chronic lung problems but are adaptable to those with acute disease, autogenic drainage being preferable for fatigued patients. They are described separately but are based on the same principles and physiotherapists are advised to develop their own technique which incorporates both.

Active Cycle of Breathing:

The active cycle of breathing consists of a cycle of huffs from mid to low lung volume interspersed with deep breathing and relaxed abdominal breathing. During huffing or forced expiration, the pleural pressure becomes positive and equals the alveolar pressure at a point along the airway called the equal pressure point, usually in the segmental bronchi. Towards the mouth from this point the transmural pressure gradient is reversed so that pressure outside the airway is higher than inside, thus squeezing the airway by a process known as dynamic compression. This limits airflow, but the squeezing of airways mouth wards of this point mobilizes secretions. At high lung volumes, the equal pressure point is more proximal because pleural pressure increases. It is thought that huffing at low lung volume mobilizes secretions from the more distal airways.

To counteract airway closure, the huffing phase of the cycle is interspersed with deep breathing. Relaxed abdominal breathing is also interspersed to reduce risks of bronchospasm, paroxysms of coughing of desaturation.

Autogenic Drainage:

Autogenic drainage shares a similar rationale to active cycle of breathing, with special emphasis on creating high airflow in different generations of bronchi without allowing airway collapse. Controlled breathing clears secretions from small to large airways by gradually increasing the total amount of gas left in the lungs after a resting expiration. For people with cystic fibrosis or bronchiectasis, the full sequence can take up to thirty to forty five minutes to complete, but it is less burdensome when combined with activities such as nebulizing drugs or watching television. For other patients, length of treatment is shorter and flexible, control of the speed of inhalation and exhalation is the key.

Autogenic drainage is particularly suited to people with chronic hypersecretory disease, but selected components can be used for the acute hospital patient, postoperative patients who are anxious about pain and stitches, people with haemoptysis or asthma or for those at risk of panic attacks. For breathless people, short sessions are required, with modifications as necessary to avoid upsetting the breathing pattern. Adolescents appreciate that autogenic drainage can reduce their hyper inflated chests so long as they do not start inhalation before fully breathing out.

Patients choose their position. Most sit upright, although some prefer supine. For facilitation of abdominal movement, some patients find prone helpful. During teaching, the physiotherapist’s hands can be used to assess secretions and facilitate exhalation. Face muscles, shoulders and arms remain relaxed throughout. The mouth, throat, and glottis are kept open and the neck is maintained in slight extension because any obstruction prevents free laminar flow of air. Upper airway closure and air swallowing are less likely if there is little movement of the larynx.

The nose is blown if necessary, and the throat cleared of secretions to reduce resistance to airflow. The location of secretions is identified by the patient exhaling until the rattle of secretions is heard. The later the rattle on exhalation, the more peripheral are secretions.

Positive Expiratory Pressure:

Positive expiratory pressure is the application of positive pressure at the mouth during expiration. Breathing out against resistance is thought to open up airways, even the distribution of ventilation, force air through collateral channels and boost mucociliary clearance. Positive expiratory pressure also helps counteract airway closure caused by floppy airways or coughing.

Intermittent Positive Pressure Breathing:
Some weak or drowsy patients with sputum retention may respond to intermittent positive pressure breathing. If other interventions have been ineffective, mechanical assistance can promote deep breaths in order to mobilize secretions or to maintain ventilation while other techniques are applied.

These are some of the breathing techniques that are followed in daily life for health and fitness.