Breathing Exercises and Clearing Your Chest
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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.Page 2
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 3Introduction
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 4Normal 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)
• S it 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.
• ry to keep your breathing rhythmic, regular, calm, gentle and
T
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.
• ake a good, slow, deep breath in through your nose until
T
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• nce your lungs are ‘full’ gently allow the air out of your lungs.
O
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.
• est and practise your relaxed breathing taking gentle, calm
R
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.
• S tart 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.
• epeat if you feel the secretions are not quite ready to cough
R
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 6Summary 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 7The 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 85 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 9How 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 10Page 11
Produced by: The Ipswich Hospital NHS Trust Heath Road, Ipswich, Suffolk IP4 5PD Hospital switchboard: 01473 712233 www.ipswichhospital.nhs.uk
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