Airway clearance to clear the sputum from your lungs (1) Firstly, ensure that you are getting your 8 glasses of fluid a day. This will help keep your mucus loose.

(2) Secondly, do some exercise every day till you feel breathless, e.g. fast walking. This can be brief (although the more the merrier!), but the aim is to breathe deeply because this helps the little hairs in your airways to move the mucus upwards. (3) Thirdly, a breathing technique can be used as required. (4) Fourthly, if the above don't keep your lungs clear, there are devices such as PEP, the Flutter, Acapella or Cornet that can be used. Details of the breathing technique and Acapella are below.

(3) Breathing technique to clear secretions, modified from the ‘active cycle of breathing’ and ‘autogenic drainage’. Get yourself in a comfortable position, then: (a) Relax your shoulders. Allow your breathing to get steady and relaxed. If possible, focus on breathing comfortably into the bottom of your lungs (diaphragmatic breathing). (b) Take a deep breath so that you feel your lungs filling full of air and getting a good stretch. Hold your breath for a few seconds. Then breathe out comfortably, like a sigh. REPEAT (a) – relaxed breathing. (c) Take a little breath in, then huff out quite sharply, keeping your chin up and throat open. Huff hard enough to shift your secretions but not so hard that you get wheezy or go into a coughing fit. You may need one or two or three huffs. REPEAT (a) – relaxed breathing.

Have a sip of water. The above cycle loosens the secretions in your airways and moves them upwards. You might need to do the cycle several times. WHEN THE SPUTUM IS DEEP IN YOUR LUNGS (i.e. you can’t feel it) TAKE A SMALL BREATH BEFORE THE HUFF. WHEN THE SPUTUM IS HIGH UP (so that you can feel it), TAKE A DEEP BREATH BEFORE THE HUFF. YOU CAN EXPERIMENT WITH THE DEPTH OF THE BREATH BEFORE THE HUFF. Continue the cycle (relaxed breathing, deep breathing and huffing) until your lungs feel clear.

Relaxed breath Huff

Deep breath Relaxed breath

You can check if your lungs are clear by breathing out as far as you can. If you don’t feel crackles, your lungs are probably clear.

(4) Instructions for using the Acapella This device sends vibrations into your airways to help loosen your secretions. When you breathe out into it, your exhaled air is intermittently blocked by a pivoting cone, creating the vibrations. Start with the frequency dial at its lowest resistance • Clockwise increases resistance (frequency) • Anticlockwise decreases resistance. Get yourself in a comfortable position, e.g. with your elbows resting on a table. Allow your breathing to get relaxed and rhythmic. Take a breath in through your nose, slightly deeper than normal. Hold your breath for a second or two.

Breathe out through the Acapella: • actively but not forcefully • keeping a seal on the mouthpiece • over about 3 seconds. If you can’t exhale for 3 seconds, try increasing the resistance. Continue for about 10 breaths. Then do one of your huffs (with either a small breath in, a medium breath in, or a deep breath in, depending on whether your secretions are deep in your lungs or higher up). If your sputum is ready, cough it up; otherwise avoid coughing. Have a sip of water. Allow your breathing to get steady and relaxed again. Continue until your lungs are clear (to check if your lungs are, breathe out as far as you can; if you still have secretions, you will feel them crackling). Experiment with the level of resistance until you get the best results. Avoid coughing unless you have secretions to expectorate. Intersperse the Acapella with your ‘Breathing technique to clear secretions’. Experiment with how much you do of each. You can also try huffing through your Acapella. You can buy the Acapella at: http://www.henleysmed.com/index.html?lang=enuk&target=d460.html&lmd=40455.661273 You could also investigate PEP (Positive Expiratory Pressure), the Flutter and the Cornet.