 | | | | High frequency chest wall oscillation provides a hands-off approach to loosening secretions in the lungs. |
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High Frequency Chest Wall Oscillation
High Frequency Chest Wall Oscillation, or HFCWO, works by wearing an air filled vest that is connected to a compressor pump that provides a vibration force to all segments of the lungs. The frequency and pressure of the force can be adjusted to the patient’s tolerance. Different sized vests allow it to grow with the patient. A treatment should last 20-30 minutes, and should be combined with huffing and coughing to enhance the movement of secretions.
Huffing
Huffing is a forced expiratory technique that allows mucus to move up through the airways. A patient breathes out forcefully, pushing mucus from deep in the lungs into larger airways, where it can then be coughed out. Unlike coughing, huffing doesn’t collapse airways, but rather provides a gentle squeezing to move the mucus up. Picture a tube of toothpaste. If you squeeze just below the opening, you’ll get a tiny bit of toothpaste out. But if you start down low and gently squeeze while working your way up to the top, you’ll get much more toothpaste out. Similarly, huffing allows you to get more mucus up because you are gently working it up from the bottom of your lungs. To Huff
Inhale using your diaphragm (i.e. belly breathing).
Hold your breath for 3 seconds.
Tilt your head up slightly.
Blow out forcefully and slowly through a wide open mouth (as if fogging up a mirror, NOT like blowing kisses). You should not hear any wheezing.
Blow out for about 4 seconds. Active Cycle of Breathing
Active cycle of breathing techniques, or ACBT, consist of three different breathing patterns to clear secretions—breathing control, thoracic expansion, and forced expiratory technique. Each one can be performed independently or in combination with other forms of airway clearance. Active cycle of breathing techniques, or ACBT, consist of three different breathing patterns to clear secretions—breathing control, thoracic expansion, and forced expiratory technique. Each one can be performed independently or in combination with other forms of airway clearance. Breathing Control
In “belly breathing,” or diaphragmatic breathing, you use the lower chest to breathe while keeping the upper chest and shoulders relaxed. Breathing control allows for rest while performing ACBT, and prevents any increase in airway obstruction. The length of this phase varies depending on the severity of the patient’s symptoms. Thoracic Expansion Exercise
This phase consists of deep breathing exercises, emphasizing inhalation. Patients fill their lungs, and then hold their breath for 2-3 seconds before breathing out. This allows the air to get behind the mucus to help move it up. Patients should take 3-4 deep breaths in this phase. Forced Expiratory Technique
Combining huffing and breathing control, patients breathe in deeply, hold for 2-3 seconds, then breathe out slowly and forcefully, as if fogging up a mirror. Patients should not hear wheezing as they blow out. Repeat 2-3 times followed by a cough, if needed, to clear secretions. Follow the huffing with breathing control. The sequence of ACBT is very flexible, allowing you to cycle through the three phases to move secretions up so you can clear them. Alternate between breathing control and thoracic expansion exercise until you feel the need to cough, and always return to breathing control after huffing to prevent the airways from tightening. ACBT can be combined with postural drainage positions and with HFCWO. Autogenic Drainage
This technique is done by inhaling different volumes of air to move secretions from the outer segments of the airways to the larger ones. It takes a lot of breathing control to do this well. Breathing at low-lung volumes is called the collecting phase because it loosens mucus from the airway walls. Breathing at mid-lung volumes is also called the collecting phase since it moves mucus into the larger airways. The final phase, which involves breathing at larger lung volumes to cough and clear the secretions, is called the evacuating phase. Games
Games and toys can help strengthen the lungs and develop breathing control, while making therapy fun. Wind instruments are a great way to practice breathing control and to give your lungs a good work-out. Cotton ball races—blowing cotton balls across a table with a straw—is a good game that a child can play with siblings, friends or parents. Blowing bubbles, pinwheels, kazoos and harmonicas also make treatment fun to keep children interested.
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