Controlled Breathing & Airway Clearance Techniques

Objective - Describe the various controlled breathing techniques used in adjunctive respiratory therapies.

---

Controlled Breathing Techniques

The controlled breathing techniques in this lesson include:

• Manually assisted cough
• Forced expiratory maneuver
• Autogenic drainage
• Pursed-lips breathing (PLB)
• Diaphragmatic breathing
• Mechanical insufflator-exsufflator

---

Normal Airway Clearance Requirements

Normal airway clearance requires:

• Patent airway
• Functional mucociliary escalator
• Strong effective cough

Four Phases of Normal Cough

1. Irritation
2. Inspiration
3. Compression
4. Expulsion

---

Purpose of Controlled Breathing Techniques

Controlled breathing techniques are used to:

• Expand the lungs
• Mobilize secretions
• Support airway clearance
• Reduce and/or reverse breathing difficulties

These techniques are used for specific control of breathing and coughing. They have specific applications and usefulness according to the patient's limitations and capabilities.

---

Directed Cough Techniques

Directed cough techniques in this lesson:

• Manually assisted coughing
• Forced expiratory maneuver
• Autogenic drainage

Indications for Directed Cough

Directed cough may be used to:

• Aid removal of retained secretions from central airways
• Address presence of atelectasis
• Provide prophylaxis against postoperative pulmonary complications
• Serve as a routine part of bronchial hygiene in patients with:
  • CF
  • Bronchiectasis
  • Chronic bronchitis
  • Necrotizing pulmonary infection
  • Spinal cord injury
• Function as an integral part of other bronchial hygiene therapies, such as postural drainage therapy, PEP therapy, and incentive spirometry
• Obtain sputum specimens for diagnostic analysis

---

Manually Assisted Cough

Manually assisted cough is performed with physical manipulation of the chest or abdomen by a medical assistant or with a mechanical device.

Heimlich Maneuver Method

• Patient sits at 45 degrees facing away from the assister
• Patient inhales as deeply as possible
• Abdomen is forced in and upward with a closed fist by the medical assister
• The movement simulates a forceful cough

Recumbent Method

• Patient lies supine
• After deep inhalation, the patient's abdomen is pushed inward and upward with overlapping palms
• The movement simulates a forceful cough during exhalation

Mechanical Device

• Cough Assist, or insufflator-exsufflator device, is listed as another option

---

Forced Expiratory Technique (FET)

Forced expiratory technique is also called huff cough.

FET consists of:

• One or two forced expirations
• Middle to low lung volume
• Open glottis
• A period of diaphragmatic breathing and relaxation afterward

FET Procedure

• Patient takes breaths of varying depth
• Exhalation is forceful with a huffing effort to help keep the glottis open
• During exhalation, the patient stays conscious of the effort to push secretions toward the upper airway for expectoration when raised

---

Autogenic Drainage

Autogenic drainage is an airway clearance technique characterized by breathing control.

The patient focuses on:

• Rate
• Depth
• Location of lung volumes during respiration

The patient uses diaphragmatic breathing to mobilize secretions.

The source notes the patient should be in a sitting position for maximum benefit.

Three Phases

Each phase lasts approximately 3 minutes.

Procedure Pattern

• Patient breathes in at variable depths
• Breathing starts with shallow inhalations and progresses to deeper inhalations
• Exhalation size and depth match inhalation size and depth
• Phase 1 unsticks mucus with rapid and shallow breaths
• Phase 2 collects mucus from small to large airways
• Phase 3 moves mucus toward large airways for expulsion

---

Pursed-Lips Breathing (PLB)

During exhalation, lips are pursed to create expiratory resistance and back pressure.

This back pressure:

• Splints the airways open
• Helps prevent airway collapse and air trapping
• Prolongs the expiratory phase of breathing

PLB is primarily used in patients with severe COPD.

The technique helps reduce or alleviate dyspnea and more effectively empties the lungs at the end of each breath.

PLB Procedure

• Patient inhales comfortably through the mouth or nose at a normal pace
• Patient exhales through pursed, whistle-position lips
• Exhalation lasts twice or greater the duration of inhalation
• The source lists this as a 1:4 pattern
• Technique reduces the amount of trapped air in the lungs

PLB Benefits

• Splints airways open to increase ease of exhalation
• Reduces air trapping, also called dynamic hyperinflation
• Prolongs exhalation time to increase CO2 elimination
• Improves rate of exhalation to reduce work of breathing
• Improves ventilation and reduces dyspnea

---

Diaphragmatic Breathing

Diaphragmatic breathing is intended to help reengage and strengthen the diaphragm while breathing.

Goals:

• Strengthen the diaphragm
• Decrease work of breathing (WOB)
• Decrease oxygen demand
• Use less effort and energy to breathe

This technique uses the lower abdominal muscles to assist ventilation and reduce WOB.

Patients with COPD may have a hyperinflated chest and flattened diaphragm. This causes them to engage upper chest accessory muscles.

Diaphragmatic Breathing Procedure

• Performed lying or sitting
• Shoulders relaxed
• One hand on the chest and one hand on the stomach
• Inhale through the nose for 2 seconds
• Focus on moving the stomach outward more than the chest
• Encourage slow exhalation
• Incorporate pursed-lips breathing
• Repeat the exercise as able

---

Mechanical Insufflation-Exsufflation

Mechanical insufflation-exsufflation is listed in the source as one of the controlled breathing techniques.

The source also lists Cough Assist, or an insufflator-exsufflator device, as part of manually assisted cough options.

---

High-Yield Review

Types of Controlled Breathing

• Manually assisted coughing
• Forced expiratory maneuver
• Autogenic drainage
• Pursed-lips breathing (PLB)
• Diaphragmatic breathing
• Mechanical insufflation-exsufflation

Quick Differentiation