Effective Coughing Is an Essential Airway Clearance Technique

How to Do Effective and Huff Coughing Techniques

Doctor Auscultating a patient
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Airway clearance is an important part of daily life for people with cystic fibrosis. Not everyone uses the same airway clearance technique (ACT) or a combination of techniques, but coughing is usually included in the routine.

By itself, coughing is not a particularly effective method of airway clearance for those with CF — but it is an essential step in removing the mucus that is loosened up by other ACTs.

For this reason, controlled coughing can arguably be considered the most important ACT that people with cystic fibrosis (CF) can use.

Effective Coughing

Coughing is a reflex that all people with healthy neuromuscular systems have. Coughs are triggered by the body when it needs to remove irritants and mucus from the airways. People with CF cough reflexively just as everyone does, but reflexive coughing is different than the type of cough that is done as an ACT.

Unlike reflexive coughing, which can sometimes be spasmodic and shallow, ACT coughing is purposeful, deep, and controlled. After other techniques have loosened the mucus, effective coughing will help bring it out. The goal is to get as much air behind the mucus as possible, so the force of the cough will propel it outward. To do engage in effective coughing, the following four steps are recommended:

  1. Take a big deep breath, your aim being to fill the lungs as completely as possible.
  1. Consciously contract (squeeze) the upper abdominal muscles.
  2. Expel (force out) all of the air using one forceful cough.
  3. Repeat the cough process one or two times until the loosened mucus is removed from the airway.

Try coughing into a tissue to avoid spreading germs, then throw the tissue away and wash your hands (or use an alcohol-based hand gel) immediately after.

Coughing vs. Huffing

In some people with cystic fibrosis, the force of coughing can actually cause the airways to collapse. In this case, you can use a Forced Expiratory Technique (FET) known as huffing instead of coughing. In those that can tolerate coughing, huffing can also be used as a first step to bring mucus to the upper airways, followed by a forceful cough to bring the mucus all the way out. Huffing is similar to coughing but is not quite as forceful. To do the huff coughing technique try these steps:

  1. Sit up straight, open your mouth and tilt your chin forward slightly.
  2. Take a big, slow and deep breath, filling the lungs at about at about 75% of their capacity.
  3. Hold your breath for two or three seconds.
  4. Blow the air out in slow, forceful bursts through an open mouth while saying “huh,” as if you are blowing steam onto a mirror.
  5. Repeat steps 1-4 a few more times before following with one strong cough to clear the mucus from the larger airways.
  6. As a part of your airway clearance exercises every day, do a cycle of four to five huff coughs.

Though huffing is not as forceful as a cough, it still works and can be less tiring. Breathing in and holding your breath allows the air to get behind the mucus in the lungs and separates it from the lung wall so that you can then huff it out of your airway system and eject the mucus.


McCool, F. D. MD, FCCP, and Rosen, M.J. MD, FCCP. “Nonpharmacologic Airway Clearance Therapies: ACCP Evidence-Based Clinical Practice Guidelines”. Chest. 2006;129:250S-259S. 

Cystic Fibrosis Foundation. Coughing and Huffing.