Instructions for breathing therapy

Air Stacking

Aim

Air stacking is a breathing technique with the aim of inflating the lungs independently. This allows the chest to remain elastic and ensures good ventilation. As a secondary issue, secretions can also be mobilised.

Procedure

Air is inhaled through the nose, stacking breath on top of breath, until the lung is filled to capacity. Then the breath is held briefly (2 – 3 seconds) to allow the air to spread through the lungs. After this “inspiratory hold”, the air is slowly exhaled again. As an alternative, the Acapella breathing device can be used for breathing out.

If patients have a resuscitation bag, this aid can be used to complement inhalation (after each breath or as a one-off after air stacking).

Instructional video Air stacking

Acapella

Aim

This breathing therapy device is used with increased development of secretions or with extremely thick secretions that are hard to mobilise independently. Regular and sustained exhalation through the Acapella creates vibrations. These vibrations liquefy the secretions, which then become easier to mobilise. By breathing out against resistance, the bronchioles remain open for longer, which makes it easier to move the secretions out of the airways.

Procedure

Exhale regularly and for as long as possible at least ten times, ensuring that vibrations are created. Take a short break and repeat. (Suggestion: perform three sets of ten repetitions each time). Both devices (blue and green) must be set to level 4 (this ensures an optimal vibration frequency for mobilising secretions).

Instructional video Acapella

Powerlung

Aim

Muscle strength training for inspiratory and expiratory muscles.

Procedure

• Put on the nose clip and hold the mouthpiece between your lips like a snorkel.
• Using maximum intensity, inhale strongly through your mouth against the resistance and then exhale strongly through your mouth against the resistance. Complete at most ten repetitions in a row, slowly increase the number of sets (to at most seven sets). Repeat this 4 to 5 times a week.
• This training is supposed to be tiring

PowerLung respiratory trainer

POWERbreathe respiratory trainer with nose clip

POWERbreathe

Aim

Respiratory muscle training is used to strengthen the muscles required for inhaling. This results in a greater inhalation volume and thus improved lung function. It also leads to a stronger cough, which improves the mobilisation of secretions.

Procedure

• Put on the nose clip and hold the mouthpiece between your lips, forming an airtight seal.
• Using maximum intensity, breathe in through your mouth against the resistance, exhale slowly, complete at most ten repetitions in a row, slowly increase the number of sets (to at most seven sets).
• Please be aware that this training is supposed to be tiring!
• Increase the resistance regularly (as soon as your perceived exertion decreases).
• The aim is to train at the highest possible intensity. The Borg rating of perceived exertion should be at least 15 (Borg scale: 6 – 20). Repeat this 4 to 5 times a week.

Therapeutic lung stretching with a resuscitation bag

Aim

Therapeutic lung stretching with a resuscitation bag is used to achieve maximum lung capacity. This can result in a stronger cough and thus to better mobilisation of secretions. This also maintains the mobility of the chest.

Procedure

The patient breathes in and, during the inhalation phase, a resuscitation bag is used in time with the breathing rhythm to add extra air to the lung. To do so, the resuscitation bag is squeezed with one hand. When the pressure is released, the resuscitation bag deflates and then fills with air again independently. After a few repetitions, the patient can try to cough up secretions, possibly with the aid of another person providing manual coughing support.

To increase the effect, lung stretching with a resuscitation bag can be combined with air stacking. Here, several inhalations are supported by the resuscitation bag without any exhaling in-between. Therapeutic lung stretching with a resuscitation bag should be carried out about once a day with 5 to 10 consecutive repetitions.

Instructional video Resuscitation bag

Use of resuscitation bag with mask

Resuscitation bag with mouthpiece and mask

Use of resuscitation bag with mouthpiece and nose clip

Abdominal binder

Aim

Breathing support (e.g. coughing aid, vital capacity) for all patients without voluntary motor activity of the abdominal muscles.

Indication

• Patients with a reduced cough
  • Cough with abdominal binder significantly higher than without
• Patients with restricted lung function values
• Patients with restricted holding of note
  • Holding of note with abdominal binder significantly longer than without
  • A louder voice is possible after clinical experience with an abdominal binder

Mode of action

• Improved breathing technique by increasing intra-abdominal pressure
• Diaphragm is pressed upwards
• Increased initial tension of the diaphragm
• Improved starting position for inspiration

Instructions

• Put on the abdominal binder while lying on the back
• Pull the abdominal binder extremely tight, otherwise it will have no effect
• Position the abdominal binder between the iliac crest and the costal arch
• Check the skin, possibly wear a thin vest underneath the binder (make sure there are no creases)