University Teaching Trust

Active Cycle Breathing

Technique (ACBT)

Respiratory Medicine
0161 206 5321

© G19042302W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2019.
Document for issue as handout. Unique Identifier: MED 20 (19). Review date: May 2021.
What is ACBT?
This is a technique to help you
clear phlegm from your chest.
Coughing alone can be tiring
and unproductive. Active Cycle
of Breathing uses different
depths of breathing to move
phlegm from the small airways
at the bottom of your lungs
to larger airways near the top
where they can be cleared more
easily with huffing/coughing.
Active Cycle of Breathing can
be performed in sitting, lying
or postural drainage positions.
At first you should start in the
sitting position.
Active Cycle of Breathing should
only be carried out following
demonstration and instruction
by your physiotherapist.
General Rules
l Try to maintain a good
breathing pattern with
relaxed shoulders and neck
l Try to breathe in through
your nose and out through
your mouth. Breathing out
should be slow, like “sighing
out”. This minimises any
wheezing
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The cycle consists of:
Breathing Control
(also called tummy breathing)
Breathing control is a part of the
cycle to allow rest. It is advisable
to practice this exercise when
feeling relaxed and in control in
order to use it effectively.
l Relax in a comfortable
position, with your head,
neck and arms well supported
and shoulders dropped
l Rest one hand on your tummy,
keeping shoulders and upper
chest relaxed and allow your
hand to rise gently as you
breathe in. (If you imagine
air filling your tummy like a
balloon this may help)
l Sigh out gently through the
mouth
l Ensure shoulders remain relaxed
l Over a few seconds, gradually
increase depth of breathing
while staying relaxed
Deep breathing exercises
This is an exercise to help you
make better use of the lower
parts of your lungs and loosen
any phlegm.
l Relax in a comfortable
position, with your head,
neck and arms well
supported and shoulders
dropped
l Breathe out gently
l Try to make sure that your
neck and shoulders stay
relaxed
l Take a long deep breath in,
slowly through your nose if
comfortable, if not, through
your mouth. At the end of
the breath in, hold the air in
for 2-3 seconds
l Let the air out gently
through your mouth
l Repeat 3 - 4 times then rest
G19042302W. Design Services, Salford Royal NHS Foundation Trust,
Forced expiration technique
also known as Huff
Huffing, also known as the
forced expiratory technique
helps to remove phlegm better
than coughing. It is less tiring
than coughing.
l Take a half breath in
l With your mouth open
squeeze the air forcefully
out of your lungs, as though
you are steaming up a mirror
before wiping it clean. Your
tummy muscles should tighten,
but your throat muscles
should stay relaxed. The huff
must be long enough to
move the phlegm up from
smaller, deeper airways into
the larger, higher airways. If
it is too short it won’t be as
effective
l Follow this with breathing
control until you have your
breath back
l Repeat
l As phlegm moves into larger
breathing tubes take a deep
breath in. Another huff or a
cough will then clear them
All Rights Reserved 2017.
2019. Document for issue as handout.
2
Unique
Unique
Identifier:
Identifier:
MEDMED71(16).
20 (19).
Review
Review
date:
date:
January
May 2019.
2021.
 When do I stop?
Keep doing the cycle until you
A full cycle consists of:
have done two cycles without
Breathing clearing any phlegm OR until
Huff x2 Control you are tired.
How often should I do
Breathing
Deep Breathing them?
Control
3-4 Breaths If you spit up phlegm every
day then you will need to
clear your lungs daily. Your
physiotherapist will advise you
Deep Breathing Breathing on how many times a day you
3-4 Breaths Control should be clearing your chest.
Use this method instead of just
coughing when you feel that
The number of times/breaths may vary depending on how you have phlegm to clear from
breathless you are or on the amount of phlegm. your chest.
If you cough up phlegm only
occasionally then you may
use the technique only when
needed for example when you
have a chest infection. If you
have an infection you will need
to do the cycle several times a
day to clear the phlegm.
3 © G19042302W. Design Services, Salford Royal NHS Foundation Trust,
Other things which may
help?
l If you use a bronchodilator/
inhaler medication use it
before you do your exercises
l Drink plenty of clear water
l Always clear your chest in the
morning. A hot drink may
help you if you wake feeling
dry
l Clear your chest before you
eat
l If your phlegm changes
colour take a sample to your
doctor
l If you have any questions
about your chest condition
contact your doctor, nurse or
physiotherapist
Contact number
0161 206 5321
respiratoryphysio@srft.
nhs.uk
All Rights Reserved 2019. Document for issue as handout.
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Unique Identifier: MED 20 (19). Review date: May 2021.
© G19042302W. Design Services
Salford Royal NHS Foundation Trust
All Rights Reserved 2019
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Unique Identifier: MED 20 (19)
Review Date: May 2021

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