Breathing Techniques – For Long-Haul COVID-19 and Secondary Infection
Source: Photo by Robina Weermeijer on Unsplash

Breathing Techniques – For Long-Haul COVID-19 and Secondary Infection

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With the 3rd wave of COVID-19’s surging many of us will unfortunately have had COVID and are perhaps still feeling short of breath or have developed a secondary lung infection which produces increased phlegm in your lungs. This can lead to more shortness of breath and prolonged infection. 

Today we’ll highlight three techniques that help to alleviate the symptoms. Physiotherapists can teach you all of these techniques, we recommend that you consult your physio to make sure that your practice is effective and you are able to properly clear your lungs.



The Active Cycle of Breathing Techniques (ACBT) is the first way to help clear your lungs of sputum we’ll look at. It is a set of breathing exercises that loosens and moves the sputum through your airways. 

ACBT involves breathing control, deep breathing exercises and huffing; performed in a cycle until your chest feels clear. 

You should aim to continue with this cycle for about 10 minutes at a time, 3 to 5 times a day, until your lungs are free of phlegm. The three steps detailed below should be performed sequentially.

1. Breathing control: Slowly breathe in through your nose and out through pursed lips letting go of any tension in your body as you breathe out. Repeat this 5 times.

2. Deep Breathing Exercise (DBE): Place one hand on your chest and the other hand over your stomach just below your ribs. Breath in slowly (as above; through your nose). As you breath in push your stomach out, hold for 3 counts and then exhale slowly (as above; through pursed lips). Repeat this 5 times.

3. Huffing: Take a deep breath in and then “huff” the air out through open mouth (as hard and fast as you can) as if you’re trying to mist up a mirror. You should try two types of huffing; first a Short-long, then a Big-short.

3.1. Short-long huff (medium breath in with long huff out), this moves phlegm from deep inside the lungs
3.2. Big-short huff (deep breath in with short quick huff out) when you feel the phlegm ready to come out.

Repeat this 3 times. You will know you are huffing correctly when you feel or hear the phlegm “rumble” or “rattle”.

NB: Coughing, try NOT to cough during the cycle, only do a good cough at the end of each cycle when the phlegm is easy to clear and try spit the phlegm out into a tissue rather than swallow it.

What position should you do ACBT in?

ACBT can either be done in sitting or postural drainage positions (see below), as advised by your physio.

Source: Post Covid-19 physiotherapy advice and exercise programme, London North West University Healthcare, Physiotherapy Department (NHS Trust). -

2) Postural Drainage

When attempting to clear your lungs, it can feel like some of the phlegm is stuck deep inside your lungs. Postural Drainage can help mobilise the phlegm, and help you get the most out of your attempts to clear your lungs.

Postural Drainage is a form of Airway Clearance Therapy that involves placing the patient’s body in various positions in order to drain phlegm or sputum from the lung segments, into the central airways, using gravity.

There are nine positions you should try to clear each section of your lungs, see the image below and the source link for details and instructions;

Upper Lobes

  • Posterior Segment
  • Apical Segment
  • Anterior Segment

Right Middle and Left Lingual

  • Right Lateral and Medial Segments
  • Left Superior and Inferior Lingual Segments

Lower Lobes

  • Posterior Basal Segment
  • Lateral Basal Segment
  • Anterior Basal Segment
  • Superior Segment

From there, the secretions can be removed via coughing, suctioning or ACBT. Postural drainage should be done before a meal, or at least 1 hour after eating.

Source: Postural Drainage Positions and Chest Physiotherapy (CPT) Study Guide by Respiratory Therapy Zone | Therapeutic Procedures. -

3) Bubble Positive Expiratory Pressure (PEP)

PEP a technique involving blowing bubbles through a straw or plastic tube, into water. It creates back pressure keeping the airways open and allowing phlegm to move through the airways. 

PEP is fairly simple, the air can then get behind the phlegm helping to move it more easily upwards through the open airways.

You will need a 2 Litre container (like a milk or fruit juice carton – thoroughly washed), a long straw or rubber tube. Fill the carton with cold water (about half way) – for kids, you can add a little food colouring or soap to the water to make it a bit more fun.


  1. Take a deep breath in (without the straw in your mouth) and then blow out through the straw for as long as you can, emptying your lungs.
  2. Repeat this 5 times, this would be 1 cycle.
  3. Do a huff and cough to clear the phlegm, preferably spitting it out into a tissue instead of swallowing it. (See ACBT above)
  4. Recover with Breathing Control. (See ACBT above)
  5. Repeat the PEP cycle 3 times, 3 times per day.

NB: Make sure you blow out through the straw and do not suck in the contents of the bottle.

After each session, empty water and wash the equipment in hot soapy water, rinse thoroughly and leave to dry; to avoid spreading germs or infections

Source: Bubble PEP (Bubble positive expiratory pressure) " West Suffolk NHS Foundation Trust. -

We’re still OPEN (during the 3rd wave)

While the 3rd wave continues to cause havoc, we’d like to reaffirm our commitment to safe practice and adherence to the strictest of COVID-19 health protocols.

  1. Disinfect all treatment surfaces and equipment before and after use.
  2. Thoroughly wash and dry all linen and towels.
  3. Change all paper towels on our plinths between each patient.
  4. Our staff and physiotherapists wash and disinfect their hands between each patient and regularly throughout the day.
  5. Hand sanitiser is provided.

Please stay safe and we look forward to seeing you!


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