Physio guide for how to cough up phlegm, breathe easier and reduce the risk of chest infection. This step by step guide to coughing phlegm out of your lungs combines the physiotherapy techniques of deep breathing, huffing and coughing to clear the lungs most effectively. Physiotherapist and chest patient demonstration from https://www.pelvicexercises.com.au

Effective Coughing involves:

1. Correct coughing posture sitting upright with the back well supported
2. Deep breathing exercises to encourage increased ventilation and movement of lung secretions (phlegm) to the central bronchi (airways). These exercises involve expanding the base of the rib cage with slow deep breaths and allowing the air to passively leave the body without force.
3. The Huff (forced expiratory technique) to draw phlegm from the outer lungs to the central airways making it easier to cough up phlegm. This technique involves taking in a medium size breath and then breathing out forcefully through an open mouth and glottis. The huff creates negative pressure in the lungs that draws phlegm towards the large central airways from the smaller outer airways.
4. Coughing after the huff technique with your mouth covered in the direction away from others helps prevent the spread of virus and bacteria. The cough will often become more productive during the hour or so following the huff exercise.

How Many Times to do this Coughing Routine?

The technique demonstrated can be performed 1-2 times in a row no more than once hourly. Doing this whole breathing, huffing and coughing routine twice a day, ideally morning and night help can help you clear your chest and cough more effectively. During exacerbation for example with bronchitis, virus or pneumonia (resolution) this technique can used more often throughout the day if required. Limit using the technique to every couple of hours to avoid feeling breathless.

The Coughing and Breathing Cycle (ACBT) involves:
*Correct upright posture
*3-5 deep breathing exercises
*Relaxed breathing
*3-5 deep breathing exercises
*Relaxed breathing
*1-2 huffs
*Cough

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Reference: van der Schans CP (1997) Forced expiratory manoeuvres to increase transport of bronchial mucus: a mechanistic approach. Monaldi Arch Chest Dis.52(4):367-70.
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