Respiratory Physio Hub: more information

The most widely used technique in the UK is called active cycle of breathing techniques (ACBT). It involves repeating a cycle made up of a number of different steps. These include a period of normal breathing, followed by deep breaths to loosen the mucus and force it up, then coughing the mucus out. The cycle is then repeated for 20 to 30 minutes.

Do not attempt ACBT if you have not first been taught the steps by a suitably trained physiotherapist, as performing the techniques incorrectly could damage your lungs. If you’re otherwise in good health, you’ll probably only need to perform ACBT once or twice a day. If you develop a lung infection, you may need to perform ACBT on a more frequent basis.

Changing your position can also make it easier to remove mucus from your lungs. This is known as postural drainage. Each technique can involve several complex steps, but most techniques involve leaning or lying down while the physiotherapist or a carer uses their hands to vibrate certain sections of your lungs as you go through a series of “huffing” and coughing.

Stand and lean back on a wall or sit with a chair back to support muscles and concentrate on breathing out fully and slowly.

Exercising and building up strength in your legs will also help fitness and make breathing easier.

Try this:

• lie on your side, well supported, with a hand on your tummy
• try and let your abdomen push out your hand
• do this by breathing in and out slowly and silently through your nose
• practice little and often, every hour for 1-2 minutes

Oscillatory positive expiratory pressure (OPEP) devices are designed to help loosen secretions. When you breathe out through the device, you feel pulses of resistance against your breath or oscillations which hold open your airways and help shake the mucous loose. These devices are useful if you are too breathless to do the active cycle of breathing (ACBT). There are 2 main devices;

• Aerobika
• Acapella
• Other devices are available

All have settings  so you can increase the back pressure in the airway.
More pressure is not always most beneficial, so use the settings suggested by your physiotherapist. Both of these devices  have separate parts which need cleaning regularly according to the manufacturers instructions.

This is our advice on how to use:

• Take a long slow breath in, make a seal with your lips around the mouthpiece of the device and breathe out slowly
• You should feel a ‘wobble’ in your chest as you breathe out
• Repeat 5-6 times as more may cause hyperventilation and intersperse with gentle, relaxed breathing. This cycle can be repeated for 5-10 minutes or until no further secretions are felt
• The devices can be used in sitting or lying on your side
• Use a ‘huff’ to try and see if secretions have moved, avoid coughing until secretions are ready to be cleared  from your lungs. Excess coughing may cause you to leak urine due to a weak pelvic floor muscles
• After you have finished clearing your chest , throw away tissues in a bin and wash your hands to minimise spreading infection
• Clear your chest on a regular basis to avoid secretions building up and you getting more frequent infections

Occasionally, medicine inhaled through a device called a nebuliser may be recommended to help make it easier for you to clear your lungs. Nebulisers are devices consisting of a face mask or mouthpiece, a chamber to convert the medicine into a fine mist, and a compressor to pump the medicine into your lungs.

A number of different medicines can be administered using a nebuliser, including salt water solutions. These medicines help reduce the thickness of your phlegm so it’s easier to cough it out. Nebulisers can also be used to administer antibiotics, if necessary.

While the medicines used with a nebuliser can be provided on prescription, the nebuliser device itself is not always available on the NHS. In some areas, a local respiratory service may provide the device without charge but, if this is not an option, you may have to pay for a device. Prices can range from £50 to £150 depending on how complex the device is.

Our noses and sinuses are an important part of our respiratory system. The nose is the body’s air conditioning system and supports the immune system by releasing antiviral substances. There are 3 sets of sinuses in the nasal passages. If they are blocked with mucus, they can affect how loud your voice is. Mucus can trickle down the back of your throat particularly at night which can lead to chest infections.
We are going to show you how to look after your nose and sinuses so you can breathe comfortably through your nose. This will help you control your breathlessness and feeling of anxiety as well as reducing the number of sinus and chest infections.

• Pinch your nose
• Hold your breath slightly
• Tip your head back slowly 3 times
• You can help move the secretions in the sinuses by causing vibrations such as humming loudly and tapping over your cheek bones
• Blow your nose gently to clear the mucus regularly
• Avoid sniffing secretions back into your nasal passages

Used to rinse out the nose with a lukewarm saline solution. This solution goes up one nostril and drains out the other, it does not go into the sinuses. This works slowly over several weeks, maybe up to 6 weeks before any improvement.

One with a valve (more comfortable) or squeezy bottle.

• Make up a pint (600mls) lukewarm saline solution- buy ready made sachets or make your own solution, using table salt
• Boil the water then let it cool to skin temperature before use, measure out 1 pint(600mls) and add 1 level teaspoon of table salt (NOT sea salt)
• Check it tastes like tears and is not too hot or too cold
• Option to add half a teaspoon of bicarbonate
• Clear your nose by blowing it gently first
• Over a sink check the solution flows out of the nozzle
• Tip your head to one side , over the sink, with your mouth open
• Put the nozzle of the bottle in the upper nostril and press the button, the solution will flow out of the other nostril into the sink
• If your nose is very blocked it may take several days before the solution flows freely
• If using a squeezy bottle , make sure you do not force the solution up your nose and keep your head tipped forward
• Use half the solution for 1 nostril and half for the other nostril
• Once you have finished all the solution, blow your nose gently
• Make a fresh batch each time you do a nasal rinse
• Complete this technique twice per day
• If using nasal sprays , carry out nasal rinsing first