Airway clearance when you have a lung condition

Hello, I’m Sara and I’m a respiratory physiotherapist.

I’m going to show you how to clear phlegm from your lungs using the Active Cycle of Breathing Technique. You can do this technique in a comfortable and safe place without needing any equipment.

In the active cycle of breathing, there are three main stages: relaxed breathing control, deep breathing, and huffing.

When you’re ready, get into a comfortable position with your arms and shoulders relaxed. We're going to practice today in a sitting position.

Start to breathe in slowly and gently through your nose. Then breathe out slow and gently through pursed lips, letting go of any tension in your body with each breath. Your breath out should take longer than your breath in.

If you’re not able to breathe in through your nose, you can breathe in through your mouth instead.

You might find it helpful to place one hand on your chest and the other on your stomach. When you breathe in, you’ll feel your stomach move out with your hand. And when you breathe out, you’ll feel your stomach gently fall with your hand. The hand on your chest should hardly move.

Do this for one to two minutes to control your breathing and relax your airways.

The next step is deep breathing. This helps to loosen phlegm in your lungs.

Take a long, slow deep breath in through your nose until your lungs feel comfortably full, keeping your arms and shoulders still and relaxed. If you can, try to pause at the top of the breath for two to three seconds. Then breathe out slowly and gently through your mouth.

Aim to repeat these breaths three to five times. Your respiratory physiotherapist will help you work out how many deep breaths to do.

If you start to feel breathless, wheezy or tired, stop and rest.

Once you've completed the deep breathing, go back to relaxed breathing control to give yourself time to recover.

The final stage is called huffing.

Huffing is a big breath out through an open mouth. It helps to bring phlegm up the tubes that carry air in an out of your lungs so you can clear it. It’s gentler on your airways than a forceful cough.

There are two types of huff, a long huff and a short huff.

The long huff works best when your phlegm is lower down in your chest. To do a long huff, take a small to medium breath in through your nose, then slowly and firmly squeeze air out of your lungs through a wide-open mouth, like you’re misting up a mirror.

You might notice some crackling sounds as you’re huffing. This is normal. It means phlegm is moving up your airways. You might need to do the long huff a few times before it sounds clear, and you have no crackles for the full breath out.

The short huff works best when phlegm is higher up in your airways and you’re ready to bring it up. To do a short huff, take a big, deep breath in through your nose. Then breathe out quickly and forcefully through an open mouth and throat. Do this once or twice.

After each huff, try to rest with a few minutes of relaxed breathing control. It can be tempting to repeat the huff straight away, but it’s important to give your airways time to recover so they’re relaxed and ready for the next huff.

Sometimes the huff will bring the phlegm high enough to clear into a tissue without a cough. But if you feel the phlegm at the back of your throat and you think it will be easy to clear, you can just do a gentle cough into a tissue. Throw the tissue in the bin and wash your hands with warm water and soap after clearing your airways.

Continue this cycle until your huff sounds clear, but if you start to feel breathless, wheezy, or tired, stop and rest with relaxed breathing control.

Your physiotherapist will help guide you in how many times a day you should perform these exercises. The aim is to complete as many cycles as you need to fully clear your chest.

Watch our other video to find out how to clear your airways using a handheld device, if you have been prescribed one by your respiratory physiotherapist.

Hello, I’m Sara and I’m a respiratory physiotherapist.

I’m going to show you how to clear phlegm from your lungs using a handheld airway clearance device.

This is an oscillating positive expiratory pressure device or OPEP device, called Aerobika. There are a few different types. Your respiratory physiotherapist will help you find the right one.

Make sure the resistance dial on your Aerobika is set to the number prescribed by your respiratory physiotherapist.

When you’re ready, get into a comfortable position with your arms and shoulders relaxed. We're going to practice today in a sitting position.

Start to breathe in slowly and gently through your nose. Then breathe out slow and gently through pursed lips, letting go of any tension in your body with each breath. Your breath out should take longer than your breath in.

If you’re not able to breathe in through your nose, you can breathe in through your mouth instead.

You might find it helpful to place one hand on your chest and the other on your stomach. When you breathe in, you’ll feel your stomach move out with your hand. And when you breathe out, you’ll feel your stomach gently fall with your hand. The hand on your chest should hardly move.

Do this for one to two minutes to relax your airways.

The next step is using your device. This helps to loosen the phlegm in your lungs.

Put your lips around the mouthpiece to make a tight seal. This device has a hole on the opposite side of the mouthpiece, so make sure your hand isn’t blocking it.

Take a slow and slightly bigger than normal breath in through the device until your lungs feel comfortably full. Try to keep your arms and shoulders still and relaxed. If you can, pause at the top of the breath for two to three seconds.

Then breathe out slowly through the device. You should hear a vibration.

Try to keep your cheeks still as you breathe out, making sure they’re not puffing or vibrating. You can use your hands to help control any movement to begin with. Take your time and if you can, try not to cough.

You should repeat these breaths between five and ten times, but your respiratory physiotherapist can help you work out how many breaths to do.

If you start to feel breathless, wheezy or tired, stop and rest with relaxed breathing control.

The final stage is called huffing. Huffing is a big breath out through an open mouth. It helps to bring phlegm up the tubes that carry air in and out of your lungs so you can clear it. It’s gentler on your airways than a forceful cough.

There are two types of huff, a long huff and a short huff.

The long huff works best when your phlegm is lower down in your chest.

To do a long huff, remove the device from your mouth and take a small to medium breath in through your nose. Then slowly and firmly squeeze air out of your lungs through a wide-open mouth and throat, like you’re misting up a mirror.

You might notice some crackling sounds as you’re huffing. This is normal. It means phlegm is moving up your airways. You might need to do the long huff a few times before it sounds clear and you have no crackles for the full breath out.

The short huff works best when phlegm is higher up in your airways and you’re ready to bring it up.

To do a short huff, take a big, deep breath in through your nose. Then breathe out quickly and forcefully through an open mouth. Do this once or twice.

After each huff, try to rest by doing a few minutes of relaxed breathing control. It can be tempting to repeat the huff straight away, but it’s important to give your airways time to recover, so they’re open and ready for the next huff.

Sometimes the huff will bring the phlegm high enough to clear into a tissue without a cough. But if you can feel the phlegm at the back of your throat and you think it will be easy to clear, you can just do a gentle cough into a tissue. Throw the tissue in the bin and wash your hands with warm water and soap after clearing your airways.

Continue this cycle until your huff sounds clear, but if you feel breathless, wheezy, or tired, it’s okay to stop and try again later.

Your physiotherapist will help you work out how many times a day you should perform these exercises. The aim is to complete as many cycles as you need to fully clear your chest.

Speak to your physiotherapist for advice if you’re struggling to use your device. They can check you’re using it correctly and help you adjust the breathing exercises if needed.

Watch our video on the Active Cycle of Breathing Technique to find out how to clear your airways without using the device.