Breathing and Coughing Techniques

Breathing and Coughing Techniques

Indications for Techniques

• Indication: For any patient who cannot develop a forceful cough on their own.
• Techniques include:
  • Diaphragmatic breathing
  • Directed cough
  • Forced Expiratory Technique (Huff Cough)
  • Active Cycle of Breathing (ACB)
  • Autogenic Drainage (AD)
  • Splinting
  • Quad Cough (manual cough)

Diaphragmatic Breathing

• Purpose: Helps to increase the contractile force of the abdominal muscles.
• Mechanism:
  • On inspiration, distend the abdomen to lower the diaphragm, enabling lung expansion.
  • On expiration, flatten the abdomen and withdraw the diaphragm to improve the strength of exhalation.
• Reference: Diaphragmatic Breathing Part 1 is illustrated in a YouTube video.

Directed Cough Technique

• Positioning: Patient should be in a sitting position or semi-Fowlers.
• Steps:
  1. Take a deep breath and hold it.
  2. Utilize abdominal muscles to force air against a closed glottis.
  3. Cough with a single exhalation.
  4. Take several relaxed breaths before the next cough.

Forced Expiratory Technique (Huff Cough)

• Steps:
  1. Perform 1-2 forced expirations at middle to low lung volumes.
  2. Expel air rapidly through an open glottis.
• Purpose:
  • The open glottis minimizes increases in pleural pressure and decreases likelihood of bronchiolar collapse.
• Phonation Requirement: The patient should phonate the sounds “huff” or “who” during expiration.
• Indications: Useful for patients prone to airway collapse such as those with emphysema, cystic fibrosis (CF), and bronchiectasis.
• Referential Material: COPDTV - Huff Cough Instruction available on YouTube.

Active Cycle of Breathing (ACB)

• Objective: To cycle through breathing control, thoracic expansion, and Forced Expiratory Technique (FET).
• Components:
  1. Breathing Control:
  • Gentle diaphragmatic breathing at normal tidal volumes.
  • Relax the upper chest and shoulders to help prevent bronchospasm.
  1. Thoracic Expansion:
  • Take deep breaths with a 4-second breath hold, followed by relaxed exhalation, to loosen secretions.
  1. FET Application: Perform 1-2 FETs after cycles of breathing control and thoracic expansion.
• Sequence of Steps:
  • Breathing control (3-4 times)
  • Thoracic expansion (followed by 3-4 repetitions)
  • Breathing control again (1-2 times) followed by FET.
• Referential Material: Active Cycle of Breathing Technique illustrated in a YouTube video.

Autogenic Drainage (AD)

• Positioning: Patient should be seated.
• Technique Phases:
  • Phase 1: Unsticking
  • Full inspiratory capacity maneuver performed through the nose with a 2-3 second breath hold.
  • Followed by breathing at low lung volumes until secretions are felt or heard.
  • Typically, 10-20 breaths are taken.
  • Phase 2: Collection
  • Breathe at low to middle lung volumes until secretions are heard or felt.
  • Instruct the patient to breathe through the secretions and to push the secretions up the airways.
  • Approximately 10-20 breaths.
  • Phase 3: Evacuating
  • Series of larger breaths taken near vital capacity.
  • Take several huff coughs to assist in mucus clearance.
• Visual Aid: A figure (spirogram) illustrating lung volumes during the three phases of autogenic drainage is available for reference.

Splinting Technique

• Indication: Used for patients who have undergone abdominal or thoracic surgery.
• Technique: Place a hand or a pillow over the incision site and apply gentle pressure while coughing to provide support.

Quad Cough (Manual Cough)

• Indication: Useful for patients with spinal cord injuries or any condition where abdominal muscles are weak.
• Steps:
  1. Place palms on the patient’s abdomen below the diaphragm.
  2. Instruct the patient to take 3 deep breaths.
  3. On the exhalation of the third breath, push forcefully inward and upward as the patient coughs.
• Resource: A YouTube video on the topic titled "RESPIRATORY CARE: Quad cough" is available for additional guidance.

Cough Assist Device (MI-E)

• Definition: Mechanical Insufflator-Exsufflator used to assist patients in coughing.
• Functionality: Applies positive and negative pressure to the patient's airway to facilitate the cough reflex.
• Application Methods: Can be applied via mask or directly to an artificial airway.
• Specifications:
  • Can reach pressures up to 60 cmH₂O.
  • Allows for flow rates of up to 10 L/sec.
• Visual Material: A watchable YouTube video provides further information on the device.