Breathing and Coughing Exercises for Hospitalised Patients
Hospitalised patients with respiratory conditions, particularly those who have undergone chest or abdominal surgery, should perform breathing and coughing exercises in order to prevent further issues and complications (Allina Health 2015).
Breathing and coughing exercises are crucial for assisting breathing and clearing excess secretion in the recovery stage. If sputum builds up in the lungs, it may become infected and increase the risk of pneumonia (My Health Alberta 2019; Penn Medicine 2016).
Furthermore, excess sputum impedes the ability of the lungs to oxygenate effectively (Stewart 2019).
A study by the University of Melbourne found that preoperative education and teaching of respiratory exercises halves the rate of post-surgery complications for major abdominal surgery patients (Boden & Denehy 2018)
Which Patients Should Perform Respiratory Exercises?
- Patients with chronic obstructive pulmonary disease (COPD);
- Patients with an interstitial lung disease;
- Patients with cystic fibrosis;
- Patients undergoing lung, chest or abdominal surgery;
- Patients with a muscle-wasting disorder that affects breathing muscles;
- Patients with asthma;
- Patients undergoing surgery for a lung transplant or lung cancer; and
- Any patient who may be immobile for whatever reason.
(MedlinePlus 2018; NIH 2019)What are the Benefits of Respiratory Exercises?
Performing respiratory exercises can help to:
- Strengthen accessory muscles around the lung, as they become weak when a patient is not able to mobilise;
- Strengthen the diaphragm, allowing it to assist with lung expansion and improve air reaching the base of the lung;
- Take the burden off other muscles in the neck, back and chest that are used when the diaphragm is not working to full capacity;
- Clear the airway of excess sputum;
- Improve lung function; and
- Reduce the risk of developing respiratory infections or atelectasis (alveoli collapse).
(American Lung Association 2020; Tokarczyk, Greenberg & Vender 2013 pp. 301-323)
Preparing Patients for Breathing Exercises
The Active Cycle of Breathing Techniques (ACBT) is an exercise comprising three sections:
(Bronchiectasis Toolbox 2018)
This technique is used to clear excess sputum and improve ventilation of the lungs, and can be performed in any breath enhancing position (Bronchiectasis Toolbox 2018).1. Breathing Control
This is a period of relaxed breathing at a rate comfortable for the patient. The patient should breathe in through their nose and out through their nose or mouth until they are ready to progress to the next stage.
(Bronchiectasis Toolbox 2018; Troughton 2015)2. Chest Expansion Exercises
This exercise aims to mobilise sputum in the lungs.
The patient should breathe in deeply and slowly, through the nose if possible, while trying not to rely on accessory muscles. After holding the breath for two to three seconds, they should breathe out gently while keeping their shoulders and chest relaxed. This should be repeated up to five times.
(Bronchiectasis Toolbox 2018; Troughton 2015)3. Huffing
A huff is forceful exhalation of breath with an open throat.
This technique (also known as forced expiration technique) is used to shift sputum from the lower airways to the upper airways so that it can be expelled through the mouth.
The patient should use different lengths of inhalation in order to move the sputum upwards:
A rumbling or rattling noise in the chest indicates that the huffing is moving the sputum successfully.
Only one to two huffs should be performed consecutively before another period of breathing control, as they can cause chest tightness or wheezing.
(Bronchiectasis Toolbox 2018; Troughton 2015; ACPRC 2011)
A typical cycle of ACBT comprises:
(Bronchiectasis Toolbox 2018)
This cycle is generally repeated until huffing is no longer producing sputum, or the patient needs to rest (Bronchiectasis Toolbox 2018).Other Breathing Exercises Coughing Exercise
(My Health Alberta 2019
Pursed Lip Breathing
(American Lung Association 2015)Diaphragm Breathing
(American Lung Association 2015)Considerations
- The patient may begin to feel dizzy. If this occurs, stop the exercise and observe their vital signs.
- If sputum obstructs the airway, perform basic life support and call for help.
- The patient may experience pain during exercises from surgery or their condition.
- Critical care patients may deteriorate while sitting out of bed due to the sensitive nature of their condition, or other complications.
In order to improve lung function and recovery, it is important for the patient to perform breathing and coughing exercises frequently. Patient education is imperative to ensure the exercises are done accurately.Additional Resources
- American Lung Association, Breathing Exercises, https://www.lung.org/lung-health-diseases/wellness/breathing-exercises
- Bronchiectasis Toolbox, The Active Cycle of Breathing Technique (ACBT) video, https://bronchiectasis.com.au/resources/videos/the-active-cycle-of-breathing-technique
- Allina Health 2015, Respiratory Exercises, Allina Health, viewed 27 April 2020, https://www.allinahealth.org/health-conditions-and-treatments/health-library/patient-education/preparing-for-your-hysterectomy/preparations/respir atory-exercises-breathing-exercises
- American Lung Association 2015, Belly Breathing, online video, 18 September, viewed 27 April 2020, https://www.youtube.com/watch?time_continue=87&v=wai-GIYGMeo&feature=emb_title
- American Lung Association 2020, Breathing Exercises, American Lung Association, viewed 27 April 2020, https://www.lung.org/lung-health-diseases/wellness/breathing-exercises
- American Lung Association 2015, Pursed Lip Breathing, online video, 9 September, viewed 27 April 2020, https://www.youtube.com/watch?time_continue=136&v=7kpJ0QlRss4&feature=emb_title
- A ssociation of Chartered Physiotherapists in Respiratory Care 2011, The Active Cycle of Breathing Techniques, Association of Chartered Physiotherapists in Respiratory Care, viewed 27 April 2020, https://www.acprc.org.uk/Data/Publication_Downloads/GL-05ACBT.pdf
- Boden, I & Denehy, L 2018, Training for Recovery Before Major Surgery, Pursuit, 12 March, viewed 27 April 2020, https://pursuit.unimelb.edu.au/articles/training-for-recovery-before-major-surgery
- Bronchiectasis Toolbox 2018, The Active Cycle of Breathing Technique (ACBT), Bronchiectasis Toolbox, viewed 27 April 2020, https://bronchiectasis.com.au/physiotherapy/techniques/the-active-cycle-of-bre athing-technique
- Bronchiectasis Toolbox 2018, Forced Expiration Technique (FET), Bronchiectasis Toolbox, viewed 27 April 2020, https://bronchiectasis.com.au/paediatrics/airway-clearance/forced-expiration-technique
- MedlinePlus 2018, Pulmonary Rehabilitation, MedlinePlus, viewed 27 April 2020, https://medlineplus.gov/pulmonaryrehabilitation.html
- My Health Alberta 2019, Deep Breathing, Coughing, and Moving After Surgery, My Health Alberta, viewed 27 April 2020, https://myhealth.alberta.ca/Alberta/Pages/deep-breathing-coughing-after-surgery.aspx
- National Heart, Lung, and Blood Institute 2019, Pulmonary Rehabilitation, National Heart, Lung, and Blood Institute, viewed 27 April 2020, https://www.nhlbi.nih.gov/health-topics/pulmonary-rehabilitation
- Troughton, J 2015, The Active Cycle of Breathing Techniques, Oxford University Hospitals NHS Trust, viewed 27 April 2020, https://www.ouh.nhs.uk/patient-guide/leaflets/files/11659Pbreathing.pdf
- Penn Medicine 2016, Breathing After Surgery, Penn Medicine, viewed 27 April 2020, https://www.pennmedicine.org/updates/blogs/heart-and-vascular-blog/2016/october/breathing-after-surgery
- Stewart, N 2019, Chest Physiotherapy, Physio Works, viewed 27 April 2020, https://physioworks.com.au/treatments-1/chest-physiotherapy
- Tokarczyk, A J, Greenberg, S B & Vender, J S 2013, ‘Chapter 14 - Oxygen Delivery Systems, Inhalation Therapy, and Respiratory Therapy’, Benumof and Hagberg's Airway Management (Third Edition), viewed 27 April 2020, https://www.sciencedirect.com/topics/nursing-and-health-professions/breathing-exercise
( Answers: c, b, a)
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