Active Cycle of Breathing Technique for Dyspnea in a Patient with Suspected Pulmonary Tuberculosis and HIV: A Case Report
DOI:
https://doi.org/10.53713/htechj.v4i5.623Keywords:
Pulmonary Tuberculosis, HIV, Active Cycle Breathing Techniques (ACBT), dyspnea, pulmonary tuberculosis, respiratory functionAbstract
Pulmonary tuberculosis complicated by human immunodeficiency virus infection may contribute to respiratory impairment, increased work of breathing, secretion retention, and dyspnea. Active Cycle of Breathing Technique (ACBT) is a non-pharmacological respiratory intervention designed to improve breathing control, lung expansion, and airway clearance. This case report evaluated short-term respiratory responses to ACBT in a patient with suspected pulmonary tuberculosis, HIV, dyspnea, and an ineffective breathing pattern. The patient presented with shortness of breath, rapid, shallow breathing, use of accessory muscles, a respiratory rate of 28 breaths/min, and peripheral oxygen saturation of 97% while receiving oxygen via a non-rebreather mask at 10 L/min. ACBT was implemented as part of nursing care, in combination with semi-Fowler's position and standard respiratory management. The intervention was performed for approximately 10–15 minutes over three consecutive days, with respiratory rate and oxygen saturation assessed before and after each session. Respiratory rate generally decreased following ACBT, with the greatest reductions observed on the third day, from 28 to 25 breaths/min and from 26 to 24 breaths/min. Oxygen saturation remained stable or increased, reaching 99% after selected sessions. The patient also demonstrated improved breathing control and reduced respiratory effort. Repeated ACBT sessions were associated with short-term improvements in respiratory rate and with maintenance or modest improvements in oxygen saturation. ACBT may represent a feasible adjunctive nursing intervention for respiratory symptom management, although larger controlled studies are required to confirm its independent and sustained effects.
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Burge, A. T., Gadowski, A. M., Jones, A., Romero, L., Smallwood, N. E., Ekström, M., Reinke, L. F., Saggu, R., Wijsenbeek, M., & Holland, A. E. (2024). Breathing techniques to reduce symptoms in people with serious respiratory illness: A systematic review. European Respiratory Review, 33(174), 240012. https://doi.org/10.1183/16000617.0012-2024
Chen, X., Li, C., Zeng, L., Rong, T., Lin, P., Wang, Q., Guo, Z., Long, H., & Zhong, J. (2023). Comparative efficacy of different combinations of Acapella, active cycle of breathing technique, and external diaphragmatic pacing in perioperative patients with lung cancer: A randomised controlled trial. BMC Cancer, 23(1), 282. https://doi.org/10.1186/s12885-023-10750-4
Franks, L. J., Walsh, J. R., Hall, K., Adsett, J. A., & Morris, N. R. (2024). Patient perspectives of airway clearance techniques in bronchiectasis. Physiotherapy Theory and Practice, 40(3), 505–515. https://doi.org/10.1080/09593985.2022.2126741
Gao, B., Wang, S., & Jiang, S. (2024). The occurrence mechanism, assessment, and non-pharmacological treatment of dyspnea. Medical Review, 4(5), 395–412. https://doi.org/10.1515/mr-2024-0006
Herrero-Cortina, B., Lee, A. L., Oliveira, A., O’Neill, B., Jácome, C., Dal Corso, S., Poncin, W., Muñoz, G., Inal-Ince, D., Alcaraz-Serrano, V., Reychler, G., Bellofiore, A., Posthumus, A., Tonia, T., Chalmers, J. D., & Spinou, A. (2023). European Respiratory Society statement on airway clearance techniques in adults with bronchiectasis. European Respiratory Journal, 62(1), 2202053. https://doi.org/10.1183/13993003.02053-2022
Hess, D. R. (2024). Pulse oximetry: 2023 year in review. Respiratory Care, 69(8), 1033–1041. https://doi.org/10.4187/respcare.12023
Holland, A. E., Spathis, A., Marsaa, K., Bausewein, C., Ahmadi, Z., Burge, A. T., Pascoe, A., Gadowski, A. M., Collis, P., Jelen, T., Reilly, C. C., Reinke, L. F., Romero, L., Russell, A.-M., Saggu, R., Solheim, J., Vagheggini, G., Vandendungen, C., Wijsenbeek, M., ... Ekström, M. (2024). European Respiratory Society clinical practice guideline on symptom management for adults with serious respiratory illness. European Respiratory Journal, 63(6), 2400335. https://doi.org/10.1183/13993003.00335-2024
Ivanova, O., Hoffmann, V. S., Lange, C., Hoelscher, M., & Rachow, A. (2023). Post-tuberculosis lung impairment: Systematic review and meta-analysis of spirometry data from 14,621 people. European Respiratory Review, 32(168), 220221. https://doi.org/10.1183/16000617.0221-2022
Jones, A. Y. M., Pickering, R., Gough, S., & Mandrusiak, A. (2025). Practical guide: The active cycle of breathing technique (ACBT). Journal of Physiotherapy, 71(3), 211–215. https://doi.org/10.1016/j.jphys.2025.06.007
Langkjaer, C. S., Bundgaard, K., Bunkenborg, G., Nielsen, P. B., Iversen, K. K., Bestle, M. H., & Bove, D. G. (2023). How nurses use National Early Warning Score and Individual Early Warning Score to support their patient risk assessment practice: A fieldwork study. Journal of Advanced Nursing, 79(2), 789–797. https://doi.org/10.1111/jan.15547
Litvinjenko, S., Magwood, O., Wu, S., & Wei, X. (2023). Burden of tuberculosis among vulnerable populations worldwide: An overview of systematic reviews. The Lancet Infectious Diseases, 23(12), 1395–1407. https://doi.org/10.1016/S1473-3099(23)00372-9
Liu, J., Ding, C., Shi, Y., Wang, Y., Zhang, X., Huang, L., Fang, Q., Shuai, C., Gao, Y., & Wu, J. (2024). Advances in mechanism of HIV-1 immune reconstitution failure: Understanding lymphocyte subpopulations and interventions for immunological nonresponders. The Journal of Immunology, 212(11), 1609–1620. https://doi.org/10.4049/jimmunol.2300777
Lu, H.-B., Liu, X., Wang, Y.-Q., Cao, H.-P., Ma, R.-C., Yin, Y.-Y., Song, C.-Y., Yang, T.-T., & Xie, J. (2022). Active cycle of breathing technique: A respiratory modality to improve perioperative outcomes in patients with lung cancer. Clinical Journal of Oncology Nursing, 26(2), 176–182. https://doi.org/10.1188/22.CJON.176-182
Mave, V., Paradkar, M., Conradie, F., Gupta, A., Avihingsanon, A., Meintjes, G., Turkova, A., Dooley, K. E., & Chaisson, R. E. (2025). Tuberculosis disease among people with HIV: Therapeutic advances. The Lancet HIV, 12(5), e367–e381. https://doi.org/10.1016/S2352-3018(25)00040-2
Mbanje, C., Kuhn, I., Musakwa, N., Calvi, M., Boccia, D., Muhwa, J. C., Mvusi, L., Jaramillo, E., Evans, D., & Meghji, J. (2024). A scoping review of interventions to address TB associated respiratory disability. eClinicalMedicine, 73, 102646. https://doi.org/10.1016/j.eclinm.2024.102646
Meghji, J., Auld, S. C., Bisson, G. P., Khosa, C., Masekela, R., Navuluri, N., & Rachow, A. (2025). Post-tuberculosis lung disease: Towards prevention, diagnosis, and care. The Lancet Respiratory Medicine, 13(5), 460–472. https://doi.org/10.1016/S2213-2600(24)00429-6
Michard, F., & Saugel, B. (2025). New sensors for the early detection of clinical deterioration on general wards and beyond: A clinician’s perspective. Journal of Clinical Monitoring and Computing, 39, 435–442. https://doi.org/10.1007/s10877-024-01235-1
Ockenga, J., Fuhse, K., Chatterjee, S., Malykh, R., Rippin, H., Pirlich, M., Yedilbayev, A., Wickramasinghe, K., & Barazzoni, R. (2023). Tuberculosis and malnutrition: The European perspective. Clinical Nutrition, 42(4), 486–492. https://doi.org/10.1016/j.clnu.2023.01.016
Phillips, J., Hing, W., Pope, R., Canov, A., Harley, N., & Lee, A. L. (2023). Active cycle of breathing technique versus oscillating PEP therapy versus walking with huffing during an acute exacerbation of bronchiectasis: A randomised, controlled trial protocol. BMC Pulmonary Medicine, 23(1), 36. https://doi.org/10.1186/s12890-023-02324-8
Phillips, J., Pope, R., Hing, W., Canov, A., Harley, N., & Lee, A. L. (2026). Active cycle of breathing technique versus oscillating positive expiratory pressure therapy versus exercise with huffing during an exacerbation of bronchiectasis: A randomised, controlled trial. Respirology, 31(8), 787–797. https://doi.org/10.1002/resp.70265
Reis, N., Gaspar, L., Paiva, A., Sousa, P., & Machado, N. (2023). Effectiveness of non-pharmacological interventions in the field of ventilation: An umbrella review. International Journal of Environmental Research and Public Health, 20(7), 5239. https://doi.org/10.3390/ijerph20075239
Sigg, A.-A., Zivkovic, V., Bartussek, J., Schuepbach, R. A., Ince, C., & Hilty, M. P. (2024). The physiological basis for individualized oxygenation targets in critically ill patients with circulatory shock. Intensive Care Medicine Experimental, 12, 72. https://doi.org/10.1186/s40635-024-00651-6
Solomon, G. M., Barker, A. F., McSpiritt, E., Marikovics, S., & Quittner, A. L. (2023). Pilot evaluation of a management toolkit for airway clearance therapy in bronchiectasis (IMPACT BE). ATS Scholar, 4(1), 76–86. https://doi.org/10.34197/ats-scholar.2022-0061IN
Sossen, B., Kubjane, M., & Meintjes, G. (2025). Tuberculosis and HIV coinfection: Progress and challenges towards reducing incidence and mortality. International Journal of Infectious Diseases, 155, 107876. https://doi.org/10.1016/j.ijid.2025.107876
Taha, M. J. J., & Abuawwad, M. T. (2025). Integrating case reports into systematic reviews: Methodological strategies and challenges. Systematic Reviews, 14, 208. https://doi.org/10.1186/s13643-025-02955-4
Thille, A. W., Balen, F., Carteaux, G., Chouihed, T., Frat, J.-P., Girault, C., L'Her, E., Marjanovic, N., Nay, M.-A., Ray, P., Reffienna, M., Retenauer, L., Roch, A., Thiery, G., & Truchot, J. (2024). Oxygen therapy and non-invasive respiratory supports in acute hypoxemic respiratory failure: A narrative review. Annals of Intensive Care, 14, 158. https://doi.org/10.1186/s13613-024-01389-w
Trajman, A., Campbell, J. R., Kunor, T., Ruslami, R., Amanullah, F., Behr, M. A., & Menzies, D. (2025). Tuberculosis. The Lancet, 405(10481), 850–866. https://doi.org/10.1016/S0140-6736(24)02479-6
Tredinnick-Rowe, J., & Symonds, R. (2023). Rapid systematic review of respiratory rate as a vital sign of clinical deterioration in COVID-19. Expert Review of Respiratory Medicine, 16(11–12), 1227–1236. https://doi.org/10.1080/17476348.2023.2169138
Wilson, L. M., Saldanha, I. J., & Robinson, K. A. (2023). Active cycle of breathing technique for cystic fibrosis. Cochrane Database of Systematic Reviews, 2023(2), CD007862. https://doi.org/10.1002/14651858.CD007862.pub5
Yang, H., Ng, I. K. S., Thong, C., & See, K. C. (2026). Positional dyspnea: A brief review. The American Journal of Medicine, 139(3), 287–298. https://doi.org/10.1016/j.amjmed.2025.11.016
Zisi, D., Chryssanthopoulos, C., Nanas, S., & Philippou, A. (2022). The effectiveness of the active cycle of breathing technique in patients with chronic respiratory diseases: A systematic review. Heart & Lung, 53, 89–98. https://doi.org/10.1016/j.hrtlng.2022.02.006
