E-INTERVIEW with Michael Cunningham - Cystic Fibrosis ...

AUTOGENIC DRAINAGE
The importance of continuous and consistent daily
physiotherapy cannot be over emphasised, as stated
by the Annual Report 2005 of the Cystic Fibrosis
Registry of Ireland. However, physiotherapy is often
not prioritised in many CF patients daily routine and
by this I am referring to Airway Clearance. Many
patients will quite gladly go for a walk, or a run if they
are able, yet airway clearance for some can be more
of a challenge. We in St. Vincent's Hospital understand
and appreciate the time constraints on many
of our patients lives e.g.: studies, careers, families
etc, which is why we always try to tailor airway
clearance specifically for each individual patient.
Autogenic Drainage (AD) is an airway clearance
technique that many of our patients find very effective
and efficient. This article will hopefully encourage
more patients to use this simple technique to
clear more secretions, with less stress to the airways.
Here's the science:
AD is a technique based on the physiology of
breathing. It is not the classic "tipping" that occurs in
paediatric and, sometimes, adult centres. Expiratory
flow, that is, the speed at which you breathe out, is
the active force that is used to mobilise the sputum.
(Jean Chevallier, 2002)
As you are sitting there now, you are breathing at
what we call Tidal Volume. You are taking relatively
relaxed breaths in and out (Between the 2 red lines
on the diagram).
When you take a deep breath in, you inhale into your
Inspiratory Reserve (Up to the top blue line)
When you breathe out firmly, you exhale into your
Expiratory Reserve (The green line on the diagram).
Even if you huff/breathe out as much air as you possibly
can, you will still have some air left in your
lungs - this is what keeps your lungs inflated and
prevents them from collapsing. This is called your
Residual Volume (between the green and blue
lines).
One of the most important aspects of any breathing
technique, including AD and ACBT (Active Cycle of
Breathing Technique) is the Breath Hold. Imagine
16
By Aoibheann Leeney and Hope Fisher
you are going swimming - you take a deep breath
and you hold that breath as you go under the water.
To do this, a flap of tissue at the top of your throat
(glottis) closes over your windpipe to prevent any
water that might get into your mouth while submerged
going down your windpipe into your lungs.
Now, the important thing while doing AD is NOT to
do this!! As you take a deep breath in, hold your
mouth and throat open - you should feel a little extra
air going into your lungs without you actually actively
trying to inhale it. This is happening as extra airways
are being recruited (opened up), and air is getting
in behind plugs of sputum that might be closing
off some smaller airways. As you breathe out, you
shouldn't hear a big sigh, instead you should hear a
firm, continuous breath out. (Think about when you
hold your breathe under water and come up gasping
for air - don't do that!!). The breath in, the breathhold
and the breath out should be smooth and
almost flow as one (poetic as it might sound!)
So, now you have read about the basics, here's how
its done: (See Diagram)
o Take a few deep breaths to prepare, slowly breathing
in and out
o On the last deep breath, hold for 2-3 seconds,
then breathe out gently but firmly, as far as you can,
with enough force so that you can hear your secretions
crackling.
o Take a small breath in (low lung volume), hold for
2-3 seconds, then breathe out, again so that you can
hear your secretions.
o Repeat this as many times as is necessary for you
to either:
1. Feel your secretions start to collect or
2. Hear you breath become more coarse, thus
changing from a crackle to a rattle or
3. Both
o At this stage, you can now move up to a medium
size breath in (medium lung volume). Do this gently,
so that you do not move the secretions you have
worked so hard to move up from the small airways,
back down with the force of your larger in-breath.
Hold the breath for 2-3 seconds, then breathe out
firmly. It is important to note here that you do not