Airway Clearance Techniques

Vol. 1 • Issue 1 • Page 10

Patient primer
By Stephanie Ogozaly

Cystic fibrosis (CF) is a hereditary disease that causes thick, sticky mucus to build in the lungs, digestive tract and other areas of the body. In children and young adults, CF is one of the most common chronic lung conditions. With the advances in treatments and care that have occurred in previous decades, many CF patients have a better quality of life than was possible in the past.

While there is no cure for this life-threatening disorder, there are a number of airway clearance techniques (ACTs) that can be used to assist the body in removing mucus from the lungs.

The following are some of the techniques that can be used to help reduce complications and ease symptoms:

Coughing clears mucus with high-speed airflow and is the most basic ACT. Coughing can make you feel short of breath and sometimes may not clear mucus effectively. You can try “huffing” instead, as it is not as forceful as coughing and will be less likely to tire you out. Huffing involves taking a breath and exhaling, similar to when you “huff” onto a mirror or window to fog it up.

Postural drainage and percussion involves positioning your body so that your windpipe (trachea) is inclined downward and below the affected chest area. This position allows for the drainage of mucus from different areas in the lungs and can be modified depending on your condition. Deep breathing exercises and chest clapping often are added to this treatment. During postural drainage, you may cough or huff to help clear mucus from the airway. Chest percussion (see below) also may be used during this technique.

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Chest percussion is done by using a cupped hand to clap the back or chest. Specialized equipment may also be used for chest percussion. Some of this equipment includes an inflatable, vibrating vest that is connected to an air compressor and a hand-held device that is used on the lungs to break up mucus.

Positive expiratory pressure therapy involves breathing through a mouthpiece or face mask that is attached to a piece of equipment that causes pressure to build in the lungs. This pressure holds the airways open and allows air to get behind mucus and loosen it. These secretions can then move into the main airway and be cleared by coughing or huffing. This method also can help deliver medication deeper into the lungs when it is done with nebulized bronchodilator therapy.

Oscillating positive expiratory pressure works in the same way as positive expiratory pressure therapy, but it also makes use of vibration caused by air flowing over a magnet or steel ball inside the device as you exhale. The vibration helps to further loosen mucus.

Manual oscillatory positive expiratory pressure is performed by holding the hand in a fist, placing the thumb side of the hand in front of the mouth, taking a deep breath in through the mouth, holding your breath for three seconds and then blowing air out through the closed fist. It is usually used as an adjunct to other ACT therapies.

High-frequency chest wall oscillation involves wearing an inflatable vest that is attached to a machine that makes it vibrate. As in the oscillating positive expiratory pressure technique, this vibration loosens the mucus in the lungs. After using the vest, you stop the machine and cough or huff to clear your airway. You repeat this procedure as directed by your healthcare provider.

Active cycle of breathing technique is a process used to clear secretions from your lungs. It involves a cycle of breathing control, deep breathing exercises, and coughing or huffing. The breathing control and deep breathing exercises allow air to travel into the lungs and get behind mucus. The mucus is then expelled by huffing and coughing.

Autogenic drainage is a breathing technique that allows you to control inhalation and exhalation levels to get maximum airflow in your airways. This airflow moves the mucus from small to large airways. Unlike in postural drainage, you may perform autogenic drainage in a sitting position.

Airway clearance techniques can vary based on many factors, including your disease and your care center. Your healthcare provider will help you choose the right ACT for you.

Information adapted from National Institutes of Health, Cystic Fibrosis Foundation, Cystic Fibrosis Canada, and Atlantic Health/Morristown Medical Center.

Stephanie Ogozaly is on staff at ADVANCE.

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