Information for patients Breathing Exercises and Clearing Your Chest Physiotherapy Department Tel: 01473 702073 DMI ref: 1898-08.indd(RP) Issue 1: October 2008 The Ipswich Hospital NHS Trust, 2008. All rights reserved. Not to be reproduced in whole, or in part, without the permission of the copyright owner.
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Contents Introduction... Page 4 How your lungs work... Page 4 How to clear your chest... Page 5 Summary of the active cycle of breathing... Page 7 Handy tips... Page 7 Positions to help you to clear your chest... Page 7 How to drain... Page 9 How often should you clear your chest... Page 10 Order you should position yourself in... Page 10 Page 3
Introduction When you have a chest condition or infection you may find that you cough and produce mucous or phlegm (sputum) from your lungs. This may become difficult to clear, especially if you are unwell, and could result in your breathing becoming more difficult, with the need to use more energy and effort to keep your chest clear. The aim of this booklet is to explain why it is important to clear your chest and to provide you with more effective and efficient techniques and exercises to help ensure you can clear your chest. How your lungs work The bronchial tree larynx (voice box) trachea (windpipe) right lung left lung Your lungs produce sputum as a normal defence mechanism to help clear dust particles and unwanted pollutants from your lungs and to help fight infections. Sometimes, following repeated infections or due to lung damage, your lungs produce more sputum than normal. Page 4
Normal sputum clearance mechanisms rely on little hair-like structures called cilia to move the sputum along and out of your airways. These can be damaged by smoking and may not work very well if you have a build-up of sputum, making it more difficult to keep your airways clear. If sputum remains in your lungs it provides an ideal environment for infections to develop. It is important that you try to clear your chest in order to reduce your risk of developing chest infections and to reduce the risk of existing infections getting worse. It will also help to speed your recovery from an infection. How to clear your chest There are two main treatment methods used to clear your chest. One uses a basic principle of breathing exercises whilst the other combines these breathing exercises with body positioning to help you to clear your chest more effectively. The combination of these exercises is called the active cycle of breathing. Basic breathing exercises 1 Relaxed breathing (breathing control) Sit in a comfortable position. Leaning forwards, resting your arms on your legs or a table, or relaxed in a comfortable armchair is ideal. Concentrate on lowering and relaxing your shoulders and upper chest. Try to keep your breathing rhythmic, regular, calm, gentle and relaxed. 2 Deep breaths Deep breaths are used to help increase the expansion of your lungs and encourage as much air as possible to enter, helping to open them and encourage mucous out of your lungs more easily. Take a good, slow, deep breath in through your nose until you feel you are unable to fill your lungs with any more air. (Imagine you are trying to expand the lower part of your waist as if you are trying to stretch a waistband.) Page 5
Once your lungs are full gently allow the air out of your lungs. Do not force the breath out. Repeat this until you have taken three or four deep breaths but no more or you may feel light-headed. Rest and practise your relaxed breathing taking gentle, calm and quiet breaths. Repeat the deep breaths once more. 3 Huffing Huffing is a technique which can help to clear your chest more easily. It helps to keep the airways open, unlike coughing which can make your chest feel more tight and wheezy. Start by taking a deep breath in and then force the air out of your lungs using your stomach muscles, as if you are trying to create steam on a pair of glasses to clean them. This is a huff. Try two long huffs and then two short huffs quickly and forcefully. This helps to move secretions from the small airways to the larger airways. Relax, rest and breathe quietly. Repeat if you feel the secretions are not quite ready to cough up. Otherwise, try a cough immediately. Avoid repeatedly coughing as this will make your airways close and feel tight. Also avoid coughing too strenuously. If you are unable to clear any secretions and feel that there is sputum in your lungs, repeat the breathing cycle of exercises 1, 2 and 3. If you are still unable to clear anything, stop the exercises and try later on in the day. If your chest feels dry do not persevere as there is no need. Page 6
Summary of the active cycle of breathing 1 Breathing control comfortable position. 2 3 4 deep breaths. 3 Repeat steps 1 and 2. 4 Two long huffs and then two short huffs. 5 Cough to clear. 6 Return to step 1 and start again. Handy tips If you are clearing sputum / mucous from your chest it is a good idea to do these exercises regularly. Morning and evening is a good routine to keep your chest clear but if you have more secretions in the day or are unwell you may need to increase the frequency. If you use nebulisers or inhalers try to do the exercises after you have taken your reliever medication as this will help to open your airways and make the clearance of any secretions easier. Continue with the exercises until you are confident your chest feels clear. Stop if you are getting too tired to carry on and return to the exercises later. Stop if your chest begins to feel tight. Keep drinking lots of fluid, unless you are on a fluid restriction, to help keep secretions moist and easier to clear. Positions to help you to clear your chest Postural drainage. The principle is to use gravity to help you clear specific areas of your lungs. This is important as mucous can sometimes accumulate in areas of your lungs which are difficult to clear well with general coughing. Postural drainage helps you to clear your chest more effectively and therefore helps to reduce your chances of developing chest infections. The positions illustrated overleaf, combined with the above breathing techniques, will enable you to clear your chest more effectively. Page 7
The positions normally used are shown below. Positions 1 to 4 can be used lying on either your left or right side. 1 The tipped position using a wedge helps to clear your right lung at the bottom (base). or: Pillows can also be used to form the tipped position if you do not have a wedge. or: If you are unable to tolerate a tip, side lying may be beneficial. 2 Half side lying position with one pillow behind your back to gain the tilt. 3 Lying on your back with one or two pillows beneath your head. 4 Sitting up. Page 8
5 High side lying helps to clear the upper and middle part of the lung and is useful if you are short of breath. 6 Forward lean sitting (such as sitting at a table and leaning forward) helps to clear your upper lobes. How to drain The use of a postural drainage frame, although expensive, is the easiest and most comfortable option. We can give you information about frames and wedges if you think you would like to buy one. A spare single bed (not a divan) may be tipped by raising the foot end by 30 cm (12 ). This is often best achieved by using wooden blocks. A foam wedge or 3 4 pillows can be put on top of your own bed, but for some people with back or hip problems this is not as comfortable. This is not recommended if your balance is poor. Page 9
How often should you clear your chest? You should clear your chest as regularly as you feel you need to. If your chest is dry, you may not need to do daily treatment. Some people may need to adopt specific positions in the morning and in the evening. Remember to leave at least one hour after eating before you do the exercises. Do not use them: if you feel sick if you have a bad headache if you are more breathless than usual and are unable to lie flat. Do not tip yourself but keep doing the exercises whilst sitting, if you can if you have just eaten. Once you are in a position you should do your breathing exercises until you feel there is no more mucous to clear. Once you have reached this point, move into the next position you have been shown. Order you should position yourself in 1 2 3 4 5 6 7 For further information or advice please contact your physiotherapist at the Chest Physiotherapy Department on 01473 702073. Page 10
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