Ahpra registration PHY0002298174
How these guides are written and reviewed →
Autogenic drainage ("self-drainage") is a refined airway clearance technique that uses gentle, controlled breathing at different lung volumes to move mucus from the small airways up to where it can be cleared easily. It is quiet, needs no equipment and avoids forceful coughing, which suits many people once they have learned it. Because it takes practice and good body awareness, it is taught step by step with a physiotherapist. It is a valuable option alongside or instead of other techniques. This page explains autogenic drainage and how it works.
Autogenic Drainage
Autogenic ("self-generated") drainage is a refined, equipment-free airway clearance technique that uses precisely controlled breathing at different lung volumes to move mucus from the smallest airways to the large ones, where it can be cleared with minimal coughing. It is one of the most elegant techniques in the field — and one of the most independent for the patient who masters it.1
The three phases
- Unstick — gentle breathing at low lung volumes to mobilise secretions in the peripheral airways.
- Collect — breathing at mid lung volumes to gather the loosened mucus in the middle airways.
- Evacuate — breathing at high lung volumes to move the mucus into the central airways, ready for a single huff or gentle cough.
How it is performed
The patient controls the speed of each breath out to the fastest flow that does not cause the airways to collapse or wheeze — felt and heard as the mucus moving — and deliberately avoids coughing until the secretions have reached the central airways. This "highest tolerated expiratory flow without collapse" is the heart of the technique.2 A session usually takes 20–30 minutes and is performed sitting upright.
Who it suits
Autogenic drainage suits motivated patients who can concentrate on, and feel, their own breathing — making it a strong option in cystic fibrosis and bronchiectasis.3 It is less suited to young children or anyone who finds the sustained concentration difficult. It can be combined with nebulised hypertonic saline, and for patients who find it demanding, an oscillating PEP device or ACBT may be easier to sustain.4
Evidence
Autogenic drainage is as effective as other airway-clearance techniques and is frequently preferred by patients for its comfort and independence.5 As with every technique, the best one is the one performed consistently — so we teach it carefully and review it at each visit.
References & evidence base
- Agostini P, Knowles N. Autogenic drainage: the technique, physiological basis and evidence. Physiotherapy 2007;93(2):157–163.
- Fink JB. Forced expiratory technique, directed cough, and autogenic drainage. Respir Care 2007;52(9):1210–1223.
- Hill AT, Sullivan AL, Chalmers JD, et al. British Thoracic Society guideline for bronchiectasis in adults. Thorax 2019;74(Suppl 1):1–69.
- McIlwaine M, Bradley J, Elborn JS, Moran F. Personalising airway clearance in chronic lung disease. Eur Respir Rev 2017;26(143):160086.
- Burnham P, Stanford G, Stewart R. Autogenic drainage for airway clearance in cystic fibrosis. Cochrane Database Syst Rev 2021;(12):CD009595.
References are numbered in citation order (Vancouver/BMJ style) and were current at the time of writing. Guidelines are living documents — verify against the latest version before clinical use.
More than one of our services applies here, and which combination suits you depends on what your assessment shows.
Corrections: If something on this page is wrong, out of date or unclear, we want to know. Email reception@inspireclinic.au with the page name and what you believe is incorrect. Substantive corrections are made promptly, and the guide’s version and last-updated date are changed to reflect it.