How to clear mucus from your lungs and airways: Autogenic Drainage

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Young woman breathes in deeply, one hand on her chest
Autogenic drainage is a breathing technique used to clear mucus from the lungs.

Autogenic drainage (AD) is a breathing technique used to loosen and transport mucus from the bronchi, making it easier to cough up. It can be used by people with chronically blocked airways – such as those with cystic fibrosis, chronic bronchitis, COPD or primary ciliary dyskinesia (PCD) – as part of their respiratory therapy. It can also be useful after pneumonia.

Physiotherapist Gemma Stanford explains the benefits of the technique and explains how to perform autogenic drainage.

How does autogenic drainage work?

With autogenic drainage you optimise airflow within your airways by adapting your breathing. This helps to move mucus from the smaller airways further down in the lungs to the larger airways, where it is easier to clear. The AD style of breathing is slow and gentle – like sighing.

How to start

Make sure you clear your nose and upper airways before starting your breathing exercises, a gentle blow of your nose will help optimise your clearance.

AD is usually started by completing a “test” or “diagnostic” breath which helps to identify where mucus is sitting within the lungs: e.g. in the large airways nearer to the throat ready to be huffed or coughed out, or lower down in the smaller airways (where more breathing exercises will be needed to move the mucus into the larger airways to clear it).

How to perform the test breath

  1. To do a test breath, breathe in slowly and quietly through your nose (if you are able) for a full deep breath. When you feel your lungs are full keep trying to breathe in for a count of three seconds, then breathe out fully through a wide, open mouth.
  2. Your breath out should be as strong a flow as possible without creating any noises such as wheezing as you exhale. Wheezing is a sign you are pushing too hard and your airways are reacting and tightening to the effort. As you breathe out listen for any crackling or rattling sputum as this will show you that you are moving mucus.
  3. The rattling or crackling sounds will help you to focus your AD breathing to where your mucus is located – crackling at the start of your breath out means mucus is near your throat and is almost ready to be coughed up, whereas crackles at the end of your breath out mean your mucus is further down in your lungs.
  4. If you do not hear any crackles or rattles it may mean your mucus is not yet loose enough to make any sounds. Your physiotherapist can optimise your technique to help you to identify where your mucus is each time you start AD.

How to perform autogenic drainage

Graphical representation of autogenic drainage
Breathing cycle of autogenic drainage
  1. To continue AD, breathe in slowly through your nose for a medium sized breath, pause for three seconds and then breathe out as far as you can with a smooth flow of air through a wide, open mouth (ensuring not to push too fast and create a wheezing sound).
  2. Breathe in again for a medium-sized breath and exhale after a pause, aiming to keep the crackles or rattles audible within your breath out. Your crackles should get louder with each breath you do.
  3. Slowly start to breathe in a little more and out a little less with each following breath, ensuring you keep the crackles within your breath. If you stop being able to hear your mucus crackling, you may need to breathe out further or in a little more to be able to hear your crackles.
  4. When you are breathing all the way in while keeping a medium-sized breath and your crackles are loud your mucus will be ready to using a huff as described in ACBT or a controlled cough.

For each cycle of AD that you complete you will not always need to breathe all the way out to start, as your mucus will begin to move up your airways and you may find you will hear the crackles or rattles sooner on your breath out. You can then just breathe out to where you hear or feel your crackles and start breathing in a little more from that point, keeping your breath medium-sized and your airflow gentle.

About the Author

Input for this article was given by Dr Gemma Stanford, Clinical Specialist Physiotherapist at the Royal Brompton Hospital, London, UK.

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Note: The information in this blog post is not a treatment recommendation. The needs of patients vary greatly from person to person. The treatment approaches presented should be viewed only as examples. PARI recommends that patients always consult with their physician or physiotherapist first.

An article written by the PARI BLOG editorial team.

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