ACBT for Sputum Clearance — SCE Palliative Medicine MCQ
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Correct answer: E — Active cycle of breathing technique (ACBT) with huffing
Explanation lettering: D = shown as A · A = shown as B · E = shown as C · C = shown as D · B = shown as E
The correct answer is B. NICE guideline NG115 (2018, updated 2019) advises using the active cycle of breathing technique (ACBT), including forced expiratory technique or “huffing,” for patients with excessive sputum, as it enhances secretion clearance especially in those too weak to expectorate effectively ([nice.org.uk](https://www.nice.org.uk/guidance/ng115/evidence/full-guideline-pdf-6602767453?utm_source=openai)). A systematic review and meta‑analysis confirm that ACBT significantly increases sputum wet weight compared with conventional physiotherapy and oscillatory devices ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/22100537/?utm_source=openai)). Manual percussion alone lacks evidence as sole therapy. High‑frequency chest wall oscillation (option C) has limited supportive evidence in acute exacerbations and is not first‑line in stable chronic care. Repeated deep nasopharyngeal suctioning (D) is invasive and not standard in stable COPD. Head‑down postural drainage (E) can worsen breathlessness in advanced COPD and is not routinely recommended.
Reference: NICE NG115: Chronic obstructive pulmonary disease in over 16s – Physiotherapy recommendations, 2018/2019; plus The active cycle of breathing technique: systematic review and meta‑analysis, 2011 (PubMed PMID:22100537), https://www.nice.org.uk/guidance/ng115/chapter/recommendations