ACBT

Question 1

Which of the following correctly identifies all three collateral ventilation pathways involved in LTEE?

A
Intrabronchiolar channels of Martin, bronchiole-alveolar canals of Lambert, interalveolar pores of Kohn

B
Interalveolar pores of Kohn, alveolar ducts of Martin, bronchiole-alveolar canals of Lambert

C
Channels of Lambert, pores of Kohn, alveolar sacs of Martin

D
Bronchiole-alveolar canals of Martin, interalveolar pores of Kohn, intrabronchiolar channels of Lambert

Answer 1

A

Question 2

Aim of lower thoracic expansion exercises and what ACBT phase is it?

Answer 2

Active secretion mobilisation, 2nd phase

Question 3

What does the Equal Pressure Point (EPP) represent in the context of FET?

A
The point at which tidal volume equals residual volume during a forced expiration

B
The point at which airway pressure facilitates movement of excess bronchial secretions towards the mouth

C
The pressure threshold at which the glottis must remain open during huffing

D
The lung volume at which inspiratory and expiratory pressures equalise during breathing control

Answer 3

B

Question 4

Which statement most accurately describes the correct sequence and purpose of ACBT phases?

A
LTEE → BC → FET, where BC prevents bronchospasm between mobilisation and clearance

B
FET → BC → LTEE, beginning with clearance to maximise residual volume for deep breathing

C
BC → LTEE → FET, beginning with relaxation, then mobilising secretions, then clearing them

D
BC → FET → LTEE, using huffing to loosen secretions before deep breathing redistributes them

Answer 4

C

Question 5

A patient with COPD requires airway clearance. Which statement regarding huff technique is most clinically significant?

A
Huffing is contraindicated in COPD due to the risk of increased dynamic airway compression compared to coughing

B
Huffing should always be performed to low lung volumes to maximise secretion clearance across all airway levels

C
The glottis must be closed during huffing to generate sufficient intrathoracic pressure for secretion movement

D
Prolonged use of huffing in patients with increased closing volume, such as those with COPD, may cause small airway collapse

Answer 5

D

Question 6

How many deep breaths are recommended per cycle during LTEE, and what breathing phase is emphasised?

A
3–5 deep breaths per cycle with emphasis on inspiration, potentially including a 3-second inspiratory hold

B
5–8 deep breaths per cycle with emphasis on expiration to maximise secretion clearance

C
2–3 deep breaths per cycle with equal emphasis on inspiration and expiration

D
3–5 deep breaths per cycle with emphasis on expiration to reduce air trapping

Answer 6

A

Question 7

Which description correctly characterises a low volume huff and its target secretion location?

A
Short and sharp manoeuvre commencing at mid lung volume, targeting mid-to-high airway secretions

B
Long and forceful expiration commencing slightly above FRC targeting distally located secretions

C
Rapid forced expiration from total lung capacity to residual volume to mobilise peripheral secretions

D
Passive expiration from FRC to residual volume used to clear centrally located secretions

Answer 7

B

Question 8

Which statement about Breathing Control (BC) within ACBT is incorrect?

A
BC is always the starting phase of ACBT

B
BC is incorporated to promote relaxation and prevent hyperventilation

C
BC involves breathing at volumes significantly above tidal volume to maximise FRC

D
Placing a hand on the abdomen may help the patient focus on relaxation during BC

Answer 8

C

Question 9

For which patient group would sniffs during LTEE be considered most inappropriate?

A
Post-surgical patients with significantly decreased lung volumes

B
Patients with severe sputum retention requiring aggressive secretion mobilisation

C
Patients with restrictive lung disease requiring maximal inspiratory muscle recruitment

D
Patients with hyperinflation due to the risk of worsening air trapping

Answer 9

D

Question 10

A patient has secretions at the mid-to-higher airways. Which huff technique should be used, and why?

A
Mid volume huff — short and sharp, commencing at mid lung volume above FRC, to a volume below FRC

B
Low volume huff — long and forceful from slightly above FRC, to ensure peripheral secretions are cleared first

C
High volume huff — from total lung capacity to ensure maximum dynamic airway compression throughout

D
Mid volume huff — slow and passive to avoid triggering small airway collapse in central airways

Answer 10

A

Question 11

Which statement most accurately contrasts the adverse effects of coughing versus huffing?

A
Coughing causes greater airway widening and reduced bronchospasm compared to huffing

B
Coughing produces greater airway compression and narrowing, increasing risk of bronchospasm, exhaustion and pain compared to huffing

C
Huffing increases intra-abdominal pressure more than coughing, making it unsuitable post-surgically

D
Both coughing and huffing carry equal risk of small airway collapse when used for prolonged periods in all patient populations

Answer 11

B

Question 12

What is the primary physiological mechanism by which LTEE facilitates secretion mobilisation via the collateral ventilation system?

A
Increasing positive end-expiratory pressure to force secretions from distal to proximal airways

B
Reducing FRC to create a pressure gradient that drives secretions towards the carina

C
Reducing resistance to airflow through collateral channels, allowing air to pass behind retained secretions

D
Activating accessory inspiratory muscles to generate sufficient negative intrathoracic pressure for secretion movement

Answer 12

C

Question 13

Regarding patient positioning during ACBT, which statement best reflects the key physiological goals?

A
All patients should be placed in high sitting to maximise diaphragmatic excursion regardless of clinical status

B
Supine positioning is preferred for all patients as it minimises unnecessary muscular activity during ACBT

C
Patient position is standardised across ACBT to ensure consistent inspiratory muscle recruitment and V/Q matching

D
Position is individualised, aiming to optimise inspiratory muscle efficiency, match V/Q, reduce unnecessary muscular activity, and maximise FRC within each patient’s clinical context

Answer 13

D

Question 14

Role of forced expiratory technique (FET) and what phase of ACBT

Answer 14

Active secretion clearance, 3rd phase