A huff sometimes called the forced expiration technique [FET] is a manoeuvre used to move secretions in addition to a cough. FET can be used as a stand-alone technique but should always be included in any airway clearance routine.
If taught appropriately, the FET is probably the most effective airways clearance technique. Taught by a health care professional for effectiveness, it is safe to try by yourself.
The technique is generally taught in sitting. It is used as part of the active cycle breathing program.
The patient is instructed to take a medium breath in through the nose. Then breathe out with mild to moderate force and extended expiratory flow, with the glottis and mouth open. The length of the huff and force of contraction of the muscles of expiration may be altered. This is to optimise clearance of mucous secretions.
To facilitate the opening of the glottis, the patient can be taught to perform a huff with a piece of cardboard spirometry tubing (or any tubing of a similar diameter). But simply being coached into ‘steaming up a window’ is often sufficient.
What evidence is there?
Huffing has been found to be more effective in the upright position (Badr et al 2002). The limited available evidence does not seem to support using the FET as a solitary treatment. Clinical experience tends to show that this is one technique which patients often fail to do as effectively as they should.
Why not just cough?
- Coughing is more tiring
- Coughing repeatedly can irritate the upper respiratory airway
- Eventually coughing hurts the chest and rib area
- Huffing leads to less coughs
How to give it a simple try?
- Take a breath in through the nose
- Open the mouth and keep open
- Breathe out with some force (not a lot of force)
- The breath out is similar to fogging up a mirror
- The breath can be normal or large depending upon the level you find most effective.
- You can do this a few times to promote movement of sputum or until a cough is stimulated
If used as part of a plan to improve chest clearance techniques, a huff is a useful and fairly easy technique to master.
If you would like to learn from a healthcare professional, then give us a call on 0131 478 4646 and see one of our respiratory physiotherapy team in one of our four Edinburgh physiotherapy clinics.
