ACBT

Question 1

ACBT

Answer 1

Active cycle of breathing technique
3 stages repeated as a cycle
1. Breathing control
2. Thoracic expansion exercises (TEEs)
3. Forced expiratory technique (FET)
Flexible approach and can be adapted without assistance
Can be taught as a self-management strategy for regular airway clearance for long term conditions e.g. bronchiectasis

Question 2

Breathing control

Answer 2

Tidal breathing
Encourage - relaxation of upper chest, diaphragmatic breathing; control their breathing
Proprioceptive facilitation
Continue until patient is ready to progress
1. One hand on stomach and one hand on chest, breath in through nose
2. Feel stomach expand against tour hand and your chest should barely move
3. Breathe out through your mouth and you’ll feel your stomach sink back down

Question 3

Thoracic expansion exercises (TEEs)

Answer 3

Deep breathing exercises - 3 to 5 breaths normally
Encouraging lateral chest expansion - hold on ribs for proprioceptive feedback
Can add a 3 second hold and a ‘sniff’
Hold - decrease collapsed lung tissue and may be good for those with lung pathology as air will first fill unobstructed area and then give time for ventilation of collateral pathways
Increased collateral ventilation
Monitor - patients can become lightheaded

Question 4

Forced expiratory technique (FET)

Answer 4

Forcefully expelling air through an open throat and mouth
Huff - trying to fog up a mirror
Move sputum from small to larger airways
Medium to high volume
Not to many as it can cause broncospasm
May initiate a cough
Normal breath in and long huff out - medium, moved from more peripheral airways.
Deep breath in and short sharp huff out - high, moved from more central airways

Question 5

Adapt the treatment to the patient

Answer 5

Breathing control - can reduce work of breathing
Thoracic expansion exercises - hold and sniff can help improve lung volume
Forced expiratory technique - high and low volumes to aid sputum clearance, can also be taught prophylactically
Add in more or less of each component to meet the needs of the patient

Question 6

Precautions

Answer 6

Consider whether the patient can follow instructions
Bronchospasm - care with FET, may have or need bronchodilators prior to maximise effects
Consider the numbers of TEE and effect on blood pressure