Pulmonary rehab,Coughing, Huffing, Forced Expiratory technique, Active Cycle Breathing Techniques, Suction.

 To remove the secretions - Effective Coughing, Huffing, Forced expiration technique, Suction
Effective Coughing:-
Definition: The coughing is the forced expiration technique against a closed glottis. 
Aim: To clear the secretions from the trachea and bronchi. 
Technique: The patient is asked to take deep breathe then tighten the abdominal muscle and cough. The air is breathed is high lung volume and deep breathe. 
Effects and uses: The coughing clears the secretions from the central airways. 
Huffing: 
Definition: This is the forced expiration with the glottis open. 
Aim: To move the secretions from the lobar and segmental bronchi. 
Technique: The patient is asked to breathe in and tighten the abdominal muscle and huff through the mouth. The air is breathed in mid lung volume to breathe is medium sized. 
Effects and uses: The secretions are moved from the peripheral airway. 
Forced expiratory technique: 
Aim: 
  • To mobilize the secretions from the peripheral airway to the proximal airways. 
  • To decrease bronchospasm. 
Technique:
  • The patient is asked to perform 1 or 2 huffs, relaxed breathing and once or twice coughing. 
  • The huffing is done from the mid lung volume to the low lung volume so that the secretions are moved from the peripheral airway. 
  • The coughing is performed at the high lung volume and clears the secretions for the central airway. 
  • The relaxed breathing is to decrease or prevent the bronchospasm. 
  • The patient is asked to take medium size of air breathe in followed by a forced expiration through the mouth open. The patient is asked to huff once or twice and then breathing control. 
  • The technique must be repeated till the secretions are reached the proximal airways then followed by a cough of high intensity to remove secretions. This technique can also be combined with the active cycle of breathing technique to be most effective. 

Active Cycle Breathing techniques:
Aim: to clear bronchial secretions
Position of the patient:
  • Less secretions: Sitting
  • More secretions: Alternate side lying combined with postural drainage. 
Total treatment time: 15 to 30 minutes. 
Technique: The active cycle breathing technique is combined with the thoracic expansion exercise, breathing control, forced expiratory technique with huffing or coughing. 
The patient is asked to perform the controlled breathing then three or four thoracic expansion exercises then forced expiratory technique. The technique are performed initially with mid to low lung volume and once the secretions have reached the proximal airway then coughing or huffing with high lung volume is done to remove the bronchial secretions. 
Self treatment regime: The patient is trained and encouraged to perform the technique on his own, so that the patient can practice in the time of emergency and as a home programme too. 

Suction: 
Aim: To suck the accumulated secretions from the main bronchi, trachea or pharynx. 
Technique: A catheter is passed through the pharynx or nasopharynx or can be done through endotracheal tube or tracheostomy tube. 
This catheter on the other end is attached to the suction pump and the secretions are sucked out. 

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