Airway Clearance System

Airway clearance system and bronchial hygiene are terms that refer to various methods and devices that help people with lung conditions clear mucus from their airways. Mucus is a normal substance that protects the lungs from dust, germs, and other particles that enter the airways. However, some people have diseases or disorders that make their mucus too thick, sticky, or abundant, or impair their ability to cough or swallow. This can cause mucus to accumulate in the airways and block the flow of air, leading to breathing difficulties, infections, and inflammation.

Airway clearance system and bronchial hygiene aim to prevent or reduce these complications by loosening and removing the mucus from the lungs. This can improve gas exchange, oxygenation, lung function, and quality of life. There are different types of airway clearance system and bronchial hygiene techniques that can be used depending on the patient’s condition, preference, and availability. Some of the most common ones are:

• Chest physiotherapy: This technique involves using gravity, manual techniques (such as percussion and vibration), and coughing to help drain mucus from the lungs. The patient is positioned in different postures (such as lying on one side or head down) to facilitate the movement of mucus from different parts of the lungs. The caregiver then applies rhythmic tapping or shaking on the chest wall to loosen the mucus. The patient then coughs or is suctioned to expel the mucus.

• Breathing exercises: This technique involves using different breathing patterns (such as huffing, diaphragmatic breathing, pursed-lip breathing) to help mobilize and expectorate mucus. Huffing is a forced expiration with an open glottis that creates a high airflow in the airways. Diaphragmatic breathing is a deep breathing that uses the diaphragm muscle to increase lung volume and airflow. Pursed-lip breathing is a slow breathing with pursed lips that creates a positive pressure in the airways.

• Positive expiratory pressure (PEP): This technique involves using a device that creates a resistance to exhalation, which increases the pressure in the airways and helps open up the collapsed or narrowed areas. This allows more air to enter behind the mucus and push it out. The patient breathes in normally through the device and exhales against the resistance for several breaths, followed by a huff or a cough.

• Oscillatory positive expiratory pressure (OPEP): This technique involves using a device that combines PEP with oscillations, which are vibrations that are transmitted to the airways during exhalation. The oscillations help break up and thin the mucus, while the PEP helps move it out of the lungs. The patient breathes in normally through the device and exhales against the resistance and oscillations for several breaths, followed by a huff or a cough.

• High frequency chest wall oscillation (HFCWO): This technique involves using a device that consists of an inflatable vest that wraps around the chest and a machine that pumps air into it. The machine delivers pulses of air to the vest, which creates rapid pressure changes on the chest wall. These pressure changes create gentle vibrations that travel through the lungs and shake up the mucus, making it easier to cough or suction out. One example of a HFCWO device is The Vest Airway Clearance System.

• Intrapulmonary percussive ventilation (IPV): This technique involves using a device that delivers short bursts of pressurized air into the lungs through a mouthpiece or a mask. The bursts of air create mini-coughs that help loosen and dislodge mucus from the airways. The patient synchronizes their breathing with the device and exhales normally or with a huff or a cough.

Airway clearance system and bronchial hygiene can be used by patients who have conditions that cause mucus retention or impaired clearance, such as cystic fibrosis, bronchiectasis, COPD, neuromuscular disorders, or post-surgical patients. However, not all techniques are suitable for everyone. Some patients may have contraindications or precautions that prevent them from using certain techniques safely or 

effectively. For example, patients who have hemoptysis, pneumothorax, rib fractures, or chest pain should avoid techniques that involve high pressure or vibration on the chest wall. Patients who have heart failure, pulmonary edema, or hypertension should avoid techniques that involve increased intrathoracic pressure. Patients who have asthma, bronchospasm, or airway hyperreactivity should avoid techniques that involve high airflow or oscillations. Patients who have difficulty coordinating their breathing or following instructions should use techniques that are easy to use and understand.

Therefore, it is important to consult with a doctor or a respiratory therapist before starting any airway clearance system and bronchial hygiene technique. They can assess the patient’s condition, needs, and preferences, and recommend the most appropriate and effective technique for them. They can also teach the patient and the caregiver how to use the technique correctly and safely, and monitor the patient’s response and progress.

Airway clearance system and bronchial hygiene are essential components of respiratory care for patients who have mucus retention or impaired clearance. They can help prevent or reduce the complications of mucus accumulation in the lungs, such as infections, inflammation, and airway obstruction. They can also improve the patient’s breathing, oxygenation, lung function, and quality of life. By choosing the right technique for each patient and using it regularly and correctly, airway clearance system and bronchial hygiene can make a difference in the patient’s health and well-being.