Airway clearance technique

There are many options/techniques that can be used to help clear your chest of secretions. Some techniques require aids whereas other techniques require no equipment.  

Airway clearance techniques help to clear excess thick sticky mucus from the lungs. It is important to try and clear mucus as it can increase the problems with infection/inflammation and can block the smaller airways, which can result in the lungs not being able to work effectively. In addition to chest physiotherapy, antibiotics and inhaled medicines that help to open the airways and thin the mucus (mucolytics) are also used to help keep the chest clear. The amount of treatment needed depends very much on the individual.

Once the lungs become productive, airway clearance treatment is usually needed on a daily basis, and may be required up to three to four times a day if there is active infection. However, when well, treatment will be needed less frequently, only once or twice a day.

The length of each treatment session will again vary according to need. Sessions may only be 10 to 15 minutes when there are only small amounts of mucus, however longer treatments will be necessary if there is a lot of mucus to be cleared.

This can be done in either an upright sitting position or can be combined with postural drainage positions. ACBT helps the movement of sputum to the upper airways, making it easier for you  to clear. This treatment is a combination of breathing control, deep breathing exercises and huffing (Forced Expiratory Technique or F.E.T.)

The above are done as part of a cycle (hence the name) and this can be repeated several times if required. How many times you repeat the cycle depends on how productive your chest is.

ACBT image.png

  • For each session complete one to three cycles, more than three could cause fatigue
  • If you are feeling not well/productive complete once per day
  • If you are feeling more productive complete three to four sessions

Changing your position can make it easier to remove mucus from your lungs. This is known as postural drainage. Postural drainage is a sputum clearance method using gravity to aid the removal of sputum from the deeper parts of your lungs. It is most effective for people who produce a moderate to large amount of sputum (half a pot per day).

You should not do postural drainage as part of your physiotherapy regime if you have or develop any of the following:

  • Gastro-oesophageal reflux
  • Acid reflux (stomach acid)
  • Significant increase in breathlessness
  • Fresh blood in sputum
  • Recent rib, spine or muscle injury
  • Bronchospasm (wheeze)
  • Nausea

Do not do postural drainage for at least an hour after eating a large meal.

Aim to do at a convenient time for you balancing with when you are at your most productive of sputum.

  • Complete each position
  • Try percussion while in the for 3 to 5 minutes position
  • The diagram belwo shows the correct hand position
  • Practice ACBT while in the chest percussion

postural drainage.png

Hydration

If you become dehydrated you may have difficulty in clearing any mucus on your chest. The mucus can become very thick and sticky. Therefore, ensure that you take in enough fluid, approximately 8 glasses of fluid per day. Try to avoid too much caffeine (tea, coffee) as this can make you more dehydrated.

Humidification

If sputum is particularly thick then hot water baths and steam inhalations may help expectoration.

If you find that your sputum is thick and sticky on a regular basis then discuss this with your GP. There are medications available to help loosen your sputum.

Other options

We recommend trying ACBT and seeing if this technique works for you. If you feel it does not work for you there are other options available. Airway clearance aids, such as the Flutter™ and Acapella™, are available to assist in clearance of your secretions. These devices tend to range in price from £50 to £80.

The Flutter ©

A handheld advice, shaped like an asthma inhaler, which delivers vibration to the airway of your lungs, making it easier to cough out mucus.

Flutter.jpg

The Acapella

A device, shaped like a small torch, that uses a combination of vibration and air pressure to help remove mucas.

Sputum colour

Clear, yellow, white, green, cream, blood stained, brown, none.

Amount

  • Some (up to a teaspoon)
  • A little (up to a tablespoon)
  • Moderate (up to three tablespoons)
  • Alot (an egg or more)

General ways to improve sputum clearance

Managing your lung condition is key in helping reduce the number of infections.

Self management includes:

  • Healthy diet
  • Regular exercise (3 to 5 times per week)
  • Annual flu vaccine
  • Pneumonia vaccine
  • Correct use of medications
  • Using airway clearance techniques regularly
  • Being able to recognise when infections are occurring and making sure you get prompt treatment of infections
  • Early intervention and treatment is important when you have worsening symptoms
  • You should see an improvement in symptoms within three days.

If you are not better and/or your symptoms are getting worse contact your GP for further treatment and seek referral to the Community Respiratory Team.