Active Cycle of Breathing (ACBT)

The Active Cycle of Breathing is a critical tool for secretion mobilization. It can also be modified in several ways to address patient-specific needs. But the basic cycle is more than enough for most patients. The goal is to loosen secretions and get air underneath them so they can be mobilized (or coughed) out.

I teach this to my patients pretty often across multiple settings, but there are a few things specific to COVID-19 that we need to remember:

These patients have an active viral infection that is easily spread
The ACBT is an aerosol-generating procedure, which can aerosolize COVID-19
Others in the room may be at risk so the patient should only be performing this in a closed room
Performance of the ACBT with a COVID-19 patient put YOU at risk, especially if you do not have the proper PPE
HAND HYGIENE IS CRUCIAL
As COVID-19 is a restrictive disease state, you may not need airway clearance techniques. But that doesn’t mean you won’t need many other interventions.

I thought this post would be a little more entertaining if you guys had a video so here goes…

I’ve provided you with a downloadable printout to hand to your patients when you are instructing this. I have also not included any reps or times on this hand out so that you can change it for your specific patient tolerance. I’ve found that my home care patients could typically tolerate 5-10 reps of each activity around the cycle, but my SNF patients max out around 5. That original cycle recommends 20-30 seconds at each activity, but my patients simply can’t do that most of the time. The overall recommended duration of performance is 10 minutes.