Posted 11/26/2006 4:57 PM (GMT -8)
I'm not sure if this is what you're talking about, but it is a breathing technique that you can do in place of the vest:
Autogenic drainage (AD) means self-drainage. It uses expiratory airflow to mobilize secretions. It was first developed in the 1960s to treat asthmatic patients. It is now being used widespread to treat patients with retention of secretions. The technique has certain advantages over conventional postural drainage and percussion. The patient can perform the technique alone in a sitting position.
This is a "concentration intensive" technique useful for people with cystic fibrosis, bronchiectasis, chronic bronchitis or other lung conditions that produce large volumes of retained secretions. Patients who can learn AD are 12 years or older and can learn a new breathing pattern. AD training requires one or two initial one-hour sessions with an instructor. One to three 30-45 minute follow-up teaching sessions may be needed.
Autogenic drainage utilizes expiratory airflow to mobilize mucus from the smaller airways first and central airways last. There are three phases of the breathing exercise:
"Unsticking" the mucus in the smaller airways by breathing at low lung volumes,
"Collecting" the mucus from the middle airways by breathing at low to mid lung volumes, and
"Evacuating" the mucus from the central airways by breathing at mid to high lung volumes.
Choose a breath-stimulating position like sitting or lying down, relaxed with the neck slightly extended.
Clear the upper airways (nose and throat) by huffing or blowing ones nose.
a) Slowly breathe in through the nose, keeping the upper airways open. Use the diaphragm and/or the lower chest if possible.
b) You should always breathe in a normal sized breath, but the level at which you breathe depends on where the mucus is located. Begin by low volume breathing. First take a normal sized breath in, then breathe out for as long as you can. Now you are at low lung volume. So for the next three phases of exercises you gradually expand your breathing up to a high lung volume.
Hold your breath for approximately 3 seconds during which all the upper airways should be kept open. This improves the even filling of all lung parts. The pause allows enough time for the air to get behind the secretions.
a) Preferably breathing out through the mouth. (You may breathe out through the nose, so long as the expiratory airflow velocity is not impeded).
b) Keep the upper airways open, (Glottis, throat and mouth). Do not slow down the expiratory airflow. In low lung volume breathing, breathing out is done in a sighing manner. If you force your breath out, it may cause the airways to compress thus, instead of increasing the speed of the expiratory airflow you will slow down the airflow. A sign of this is when you hear an audible wheeze on breathing out.
c) When breathing out in the proper way, often the mucus can be heard distinctly rattling along the airways. Or if you put your hand over the upper chest, you can also feel the mucus vibrating. High frequencies mean that the mucus is in the small airways, low frequencies mean that the mucus is located in the large airways. This feedback makes it possible and easy to adjust the technique.
d) At low lung volume breathing, you need to squeeze the air out by using your abdominal muscles, until you can breathe out no more. As you progress to the next level of breathing you need only breathe out the same volume of air as you breathed in.
6. a) Repeat the cycle by breathing in. Inhale slowly avoiding the mucus going back. Continue to breathe at the low level breathing until the mucus starts to collect and moves upwards. Indications of this are:
Crackling of the mucus can be heard throughout all of expiration.
You feel the mucus moving up.
You feel a strong urge to cough.
When either or all of the above occurs, the level of breathing is gradually raised. Thus the breathing evolves from a lower to a higher lung volume breathing.
b) Finally the collected mucus reaches the large airways where from it can be evacuated by a stronger expiration or a high lung volume huff.
c) Don't cough until the mucus is in the larger airways and used after huffing if you need to assist in the expectoration of the mucus to the mouth.
d) You have now finished one cycle. Allow a break of one to two minutes where you should relax and perform breathing control before you start on the next cycle. The cycles are repeated throughout the session which may last between twenty to forty-five minutes until you feel that all the mucus has been expectorated. If you still have mucus present at the end of a session, please do more frequent sessions of AD.
When preparing for Autogentic Drainage relax, sit comfortably, and perform slow - controlled diaphragmatic breathing.
The Three Volume Levels of Autogenic Drainage
Level One: "Unsticking" of peripheral secretions is achieved by Alow lung volume breathing@. First, exhale completely, inhale a small breath, hold the breath for 1-3 seconds, then exhale completely again. This step is repeated for 1-3 minutes, or until crackles are heard at the beginning of expiration.
Level Two: "Collecting" the mucus in larger or mid-sized airways is achieved by taking in a slow medium-sized breath for 1-3 seconds, then exhaling to 1/3 to 1/2 of expiratory reserve volume (ERV). Repeat this step for 1-3 minutes, listening once again for crackles. When crackles are heard at the beginning of expiration, you should continue for 2-3 more breaths and then proceed to level III.
Level Three: "Evacuating" the mucus in the central airways is achieved by breathing at normal to high volumes. Take in a slow deep breath, holding the breath for 1-3 minutes, listening again for expiratory crackles.
Each level requires an average of 2-3 minutes, with the full cycle taking 6-9 minutes. When secretions are felt in the larger, central airways (usually in level III), do 2-3 effective "Huff" type coughs. The Huff cough maneuver uses the mid to high lung volumes in level III.
Coughing should be avoided if possible in levels I and II. If coughing is unavoidable, do 2-3 Huff coughs.
When the mucus has been mobilized and evacuated as described, some of the remaining mucus has moved partially up the respiratory tract. This makes the collection and evacuation of the next mucus plug easier and quicker. It is like the mucus is transported a conveyer-belt.
During drainage sessions, positions can be changed to improve regional lung ventilation.
As said before, in AD, it is best to start with the mobilization of the peripheral mucus first from the small airways. Using a low-lung volume breathing, the flow rates in the larger airways are also affected so that the mucus is moved in most of the levels of airways simultaneously. Should the urge to cough be too strong due to mucus in the larger airways. These secretions should be cleared first.
Patients being initiated in AD can have problems breathing at low-lung volumes. You may commence to breathe at your natural tidal volume level and gradually go down to residual volume. Later during the session and also being more experienced, you will soon find out that breathing out more deeply is not so difficult, or you may want to intersperse one breath at normal tidal volume while breathing at low lung volume breathing.
The larger and thinner in consistency the collected mucus plug, the less expiratory force is needed to transport it upwards.
The duration of an AD session depends on the total amount and viscosity of the secretions. Experienced patients drain their lungs quicker than others. Drainage should always be done thoroughly. This way lung function will improve on the short and the long run. You should never do more than 1 hour of inhalation and drainage together per session. Also, AD may be done throughout the day.
Patients who drain well, improve their lung function. This improves their activity level which increases the spontaneous drainage during the day. The airways remain clearer over a longer period of time.
To be able to practice these techniques you need to have the correct breathing pattern. This is necessary both for preventative and curative reasons. The use of accessory techniques such as breathing re-education, thoracic mobility exercises, relaxation training, functional breathing exercises and physical activities, are of the utmost importance to facilitate bronchial drainage in aiding the movement of mucus.
Aerosol therapy greatly improves the drainage when the highest deposition of the particles reaches those parts of the lung where needed especially upstream of obstructions. This is best accomplished by using the Autogenic Drainage Breathing Pattern.