Airway clearance therapy

Airway clearance therapy is treatment that uses a number of airway clearance techniques to clear the respiratory airways of mucus and other secretions.[1] Several respiratory diseases cause the normal mucociliary clearance mechanism to become impaired resulting in a build-up of mucus which obstructs breathing, and also affects the cough reflex. Mucus build-up can also cause infection, and inflammation resulting in damage to the airways, and the lung tissue.[1][2]

Airway clearance therapy

All airway clearance therapy involves the techniques of coughing, or huffing that need to be used in conjunction with another airway clearance technique.[3] Respiratory therapists give guidance for appropriate airway clearance therapies, and instruction in the use of various airway clearance techniques.

Clearance techniques

Airway clearance therapy uses different airway clearance techniques (ACTs) in a number of respiratory disorders including, cystic fibrosis, bronchitis, bronchiectasis, and chronic obstructive pulmonary disease to maintain respiratory health, and prevent the damaging consequences of inflammation.[4][5][1][2] Techniques used are breathing, manual, and mechanical. They all need to be used with either coughing or huffing which moves mucus from the large airways.[3] To move mucus from the small airways an additional ACT needs to be employed.

Huffing

Huffing or a huff cough, is also called forced expiration technique, and helps to move mucus away from the lung wall so that it can finally be coughed out. Huffing needs to be carried out in a sitting position with the chin raised a little, and the mouth remaining open. A deep breath is taken to fill the lungs about 75 per cent, and held for two or three seconds. Breathing out is forceful and slow which helps to move the mucus from the smaller to the larger airways. A normal urge to cough at this point is repressed, and the breathing pattern is repeated a few times. A strong cough then follows to expel the mucus.[3] Huffing forms part of the active cycle of breathing.

Breathing

Breathing techniques include the active cycle of breathing which includes huffing, and autogenic drainage.[1]

Autogenic drainage

Autogenic drainage is a very controlled airway clearance technique using different depths of inhalation, and different speeds of exhalation that enables mucus to be moved up the airway producing a voluntary cough. This method needs training, attention, and effort.[2]

Manual

Chest physical therapy is a manual airway clearance technique that uses percussion – clapping and vibration, and postural drainage.[1][6] However, it is labour-intensive, and time-consuming, and other devices are often used instead.[4]

Mechanical

Mechanical devices used include positive expiratory pressure (PEP), intrapulmonary percussive ventilators, and mechanical insufflation-exsufflation known as a mechanically assisted cough,[1][7] and airway oscillatory devices.[8]

References
  1. Volsko, TA (October 2013). "Airway clearance therapy: finding the evidence". Respiratory care. 58 (10): 1669–78. doi:10.4187/respcare.02590. PMID 24064626.
  2. McCormack, P; Burnham, P; Southern, KW (6 October 2017). "Autogenic drainage for airway clearance in cystic fibrosis". The Cochrane database of systematic reviews. 10: CD009595. doi:10.1002/14651858.CD009595.pub2. PMID 28984368.
  3. Bethesda, Cystic Fibrosis Foundation 4550 Montgomery Ave Suite 1100 N. "Coughing and Huffing". www.cff.org. Retrieved 19 June 2020.
  4. Hristara-Papadopoulou, A; Tsanakas, J; Diomou, G; Papadopoulou, O (2008). "Current devices of respiratory physiotherapy". Hippokratia. 12 (4): 211–20. PMID 19158964.
  5. O'Sullivan, BP; Freedman, SD (30 May 2009). "Cystic fibrosis". Lancet (London, England). 373 (9678): 1891–904. doi:10.1016/S0140-6736(09)60327-5. PMID 19403164.
  6. Bethesda, Cystic Fibrosis Foundation 4550 Montgomery Ave Suite 1100 N. "Airway Clearance". www.cff.org. Retrieved 21 June 2020.
  7. Homnick, DN (October 2007). "Mechanical insufflation-exsufflation for airway mucus clearance". Respiratory care. 52 (10): 1296–305, discussion 1306-7. PMID 17894900.
  8. McKoy, NA; Saldanha, IJ; Odelola, OA; Robinson, KA (12 December 2012). "Active cycle of breathing technique for cystic fibrosis". The Cochrane database of systematic reviews. 12: CD007862. doi:10.1002/14651858.CD007862.pub3. PMID 23235649.
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