Depending on your condition, your physiotherapy treatment may include:
- Pulmonary clearance exercises (ACBT, FET, PEP)
- Respiratory training exercises (deep breathing exercises and diaphragmatic breathing/breathing control)
- Percussion and Autogenic Drainage
- Prescription of an assistive device to help clear the chest (PEP device)
- Prescription of an assistive device to strengthen the inspiratory and expiratory muscles
- Pulmonary Rehabilitation Classes
Active Cycle of Breathing
What is Active cycle of breathing technique (ACBT)?
Active cycle breathing technique is an exercise that helps remove excess secretions (sputum) from the lungs.
It uses alternating depths of breathing to push sputum from the small airways at the bases of your lungs to larger airways at the top so they can be cleared more easily through huffing and coughing techniques, also known as forced expiratory techniques (FET).
Body position is important before you begin your technique, as this will open up your chest which will facilitate better airflow.
Who would benefit from active cycle of breathing technique?
- A person post surgery
- People with chronic lung disease
- People with an acute chest condition
Deep Breathing Exercises
What are deep breathing exercises?
Deep breathing exercises, often referred to as thoracic expansion exercises aim at getting the biggest breath of air possible into the lungs to help move any secretions that may be present at the bottom of the lungs, and increase lung volumes.
Deep breathing exercises form a stage of the active cycle of breathing exercise, and tend to be carried out in a sitting position. It is advised you place your hands on your lower rib cage so you can feel the air entering the bases of your lungs, keeping your shoulders still – you are aiming for as much movement of your ribs upwards and outwards as possible.
Who would benefit from deep breathing exercises?
Deep breathing exercises are beneficial in all respiratory patients, not only to mobilise secretions but to generally enhance lung function and prevent atelectasis (areas in the lungs where gas exchange is unable to occur). Respiratory conditions that are likely to benefit from thoracic expansion exercises include:
- Cystic Fibrosis (CF)
- Post surgery
- Pneumonia
- Obstructive respiratory conditions – Chronic Obstructive Pulmonary Disease (COPD), emphysema, severe asthma, chronic bronchitis
- Bronchiectasis
Diaphragmatic Breathing
The diaphragm is a dome shaped respiratory muscle found near the bottom of your rib cage, right below your lungs. It also plays a role in postural control and balance.
When you breathe in, the belly should rise during diaphragm breathing, instead of the chest rising.
When you breathe out, the belly should fall. This is ensuring your diaphragm muscle is being utilised.
Diaphragm breathing can help you ‘catch’ your breath when you become breathless and help you slow down and control your breathing in times of stress.
Who would benefit from diaphragmatic breathing?
Anyone who suffers from shortness of breath on exertion, including people with:
- Asthma
- COPD
- Emphysema
- Pulmonary fibrosis
Percussion
What is percussion?
Percussion is a manual technique used to help clear the chest of secretions. The physiotherapist will apply a rhythmical ‘clapping’ motion on the chest wall with a cupped hand to loosen the secretions from the sides of the airways. The technique can be applied over a towel to ensure it does not feel uncomfortable.
It is usually used in combination with active cycle breathing techniques, coupled with positioning in those who are unable to actively participate in active controlled breathing exercises, or with assistive devices such as an oscillating positive expiratory pressure (PEP) device.
Who would benefit from percussion?
Percussion is beneficial as a manual physiotherapy technique to help removal of secretions in a number of conditions, these include:
- Cystic fibrosis
- Emphysema
- Chronic bronchitis
- Pneumonia
- Adult Respiratory distress syndrome (ARDS)
- Bronchiectasis
- Chronic obstructive pulmonary disease (COPD)
PEP Devices
What are PEP Devices?
PEP stands for positive expiratory pressure – you can breathe in normally through the device, but breathing out is hard as it is against resistance. The breath out is longer than the breath in, which helps the air to get behind the sputum, allowing it to move away from the airway walls, and keeps the airways opened for longer.
With an oscillating PEP device (eg. Flutter, Acapella, AerobikA, turboforte), resistance is used to make it more difficult to breathe out, and vibrations are created to help move sputum from the surface of the airways. Typically, you will also perform ACBT/FET to further assist in sputum clearance.
Who would benefit from postural drainage?
Any condition in which sputum retention is an issue would benefit from a PEP device, including:
- Cystic fibrosis
- Emphysema
- Chronic bronchitis
- Pneumonia
- Bronchiectasis
- Chronic obstructive pulmonary disease (COPD)
- Asthma
Inspiratory Muscle Training (IMT)
Inspiratory Muscle Training (IMT) in particular has been shown to improve respiratory muscle function and help to reduce dyspnoea on exertion.
IMT is normally aimed at people who have respiratory conditions such as asthma, bronchitis, emphysema and COPD.
Pulmonary Rehabilitation
Research shows that undergoing a Pulmonary Rehabilitation program not only improves your wellbeing, but also your breathing. It helps to increase your exercise tolerance and general muscle conditioning so that the normal activities of daily living don’t feel so difficult.
At Respiratory Physi02, your program is personalised and class numbers are small so that we are able to offer you the attention you need during the session. We generally begin with 1:1 visits to familiarise you with the class, as we do use a range of Pilates equipment which can be new to some people.
We also provide techniques to help with recovery breathing, positions to assist with shortness of breath, puffer administration technique and balance exercises.
