Active Cycle of Breathing Techniques (ACTB)

ACBT is a technique which uses breathing exercises to remove phlegm from your lungs. ACBT can be performed in sitting, lying or side-lying positions. Initially you should start in a sitting position until you are comfortable and confident to try different ones.

ACBT uses an alternating depth of breathing to move phlegm from the small airways at the bottom of your lungs to the larger airways near the top where they can be cleared more easily with huffing/coughing.

General rules

  • Try to maintain a good breathing pattern with relaxed shoulders and neck.
  • Try to breathe in through your nose and out through your mouth. Breathing should be slow, like “sighing out”. This can help minimise any wheezing.
  • Try to remember the principles of Diaphragmatic breathing.

Deep Breathing Exercise

  • Take 3-4 deep breaths in allowing the lower rib cage to expand.
  • Try to ensure your neck and shoulders remain relaxed.
  • At the end of the breath in, hold the air in your lungs for 3 seconds (This is an inspiratory hold).
  • Let the air out gently.

Forced Expiratory Technique

  • 1 or 2 “huffs” combined with diaphragmatic breathing.
  • Take half a breath in and blow the air out quickly through an open mouth.
  • Follow this with diaphragmatic breathing.
  • Repeat.
  • As the phlegm moves into the larger airways take a deep breath in and blow it out again through an open mouth, “huff” which should help clear the phlegm out of the back of your throat.
  • A typical cycle of ACBT consist of:
    • Diaphragmatic breathing
    • 4 deep breaths (+/- 3 second inspiratory hold)
    • Diaphragmatic breathing4 deep breaths (+/- 3 second inspiratory hold)
    • Diaphragmatic breathing
    • Forced expiratory technique
breathing technique