<p> Acapella</p><p>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.</p><p>Start with the frequency dial at its lowest resistance  Clockwise increases resistance (frequency)  Anticlockwise decreases resistance.</p><p>Get yourself in a comfortable position, e.g. with your elbows resting on a table. Allow your breathing to get relaxed and rhythmic.</p><p>Take a breath in through your nose, slightly deeper than normal.</p><p>Hold your breath for a second or two.</p><p>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.</p><p>Continue for about 10 breaths.</p><p>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.</p><p>Have a sip of water.</p><p>Allow your breathing to get steady and relaxed again.</p><p>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.</p><p>Avoid coughing unless you have secretions to expectorate.</p><p>Intersperse the Acapella with doing your ‘Breathing technique to clear secretions’. Experiment with how much you do of each. You can also try huffing through your Acapella.</p><p>Alex Hough, Respiratory Physiotherapist. www.alexhough.com. 01323 638615</p>