COPD Airway Clearance Methods

  • A few years back, one of our other COPD health pros, Jane Martin, wrote an informative post about Cough, and Keeping Your Airways Clean. I thought it might be helpful to revisit this topic and update you on the latest techniques and technologies.

     

    COPD Is an Airway Clogging Disease

     

    COPD has three main symptoms:

    • Progressive shortness of breath
    • Mucus-producing cough
    • Wheezing

    And actually, the first and third symptoms listed above are often made worse by the mucus production that triggers coughing. Mucus, also called sputum (by health care professionals) or phlegm (by laypersons) is a thick secretion in the airways that builds up and blocks already narrowed airway passages.

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    Also, if the airways are not cleared sufficiently or quickly enough, the mucus becomes a breeding ground for bacteria and other germs, leading to further complications.

     

    So, learning how to clear your airways effectively can not only make it easier to breathe and stay active, it can also help you stay healthier.

     

    Mucus Is Not Always a Bad Thing

     

    Mucus does play a role in keeping you healthy. That's why your airways and immune system produce it. It's only when it is excessive or doesn't move around in the respiratory system that it becomes a problem.

     

    Mucus is meant to trap unwanted particles, such as dust, hair and germs, and keep them from moving deeper into your airways. The mucus lies over tiny little hair-like structures in the airways called cilia. These cilia move like waves to help move the mucus and what's trapped within it up and out when you cough.

     

    Unfortunately, cigarette smoke and other irritants can prevent the cilia from working as they should. Add to that your weakened lung functioning when you have COPD, and the mucus ends up just sitting in your airways and getting "stickier."

    Cough, and Keeping Your Airways Clean

     

    And that leads to much more difficult breathing.

     

    What You Can Do to Clear Your Airways

     

    There are two approaches to keeping your airways clear. They can involve medication, lifestyle changes and non-invasive therapies. The other approach is to use technology and medical devices. Let's start with the first few strategies.

    • Stay as hydrated as you can. Drink lots of water, unless your doctor advises otherwise, due to other medical issues. Staying hydrated will help thin the secretions in your airways, making the mucus less "sticky."
    • Learn how to cough effectively. So often, people who have COPD cough shallowly, resulting only in not producing mucus and increased breathlessness. To cough effectively and productively, sit up straight but bending slightly forward with your arms supported.

      Take a few deep breaths and relax as much as you can.  Next, breathe in deeply, letting your belly expand. Pause & hold the breath for 3 seconds or so, then open  your mouth to exhale, coughing shortly and sharply. Try to spit any mucus you bring up into a tissue right away, but if you must inhale, do it by taking short nasal sniffs through the inhalation. This will help keep you from re-inhaling the mucus.

      You may have to follow this procedure several times to get rid of all the mucus. Using your bronchodilator medicine or your nebulizer before working on your cough can also help greatly to loosen things up and relax your airways.
    • Ask your doctor about chest physiotherapy. This is usually a combination of two techniques, called postural drainage and percussion. With postural drainage, you position yourself in such a way that gravity helps to clear the secretions from your airways. There are many different positions that can be used, depending on your individual needs.

      Percussion is a way of cupping the hands and clapping on the chest and back to loosen secretions, thereby making them easier for you to cough up. It is often performed by a respiratory therapist, but a caregiver can also be trained in the technique.
    • Take an expectorant or mucolytic medication. These come in both prescription and over-the-counter varieties, but always check with your physician before adding any kind of medication to your treatment plan. If approved, expectorants can be helpful in loosening mucus and making it easier for you to cough up. Mucolytics thin your thick and sticky mucus.

    Using Technology to Clear Your Airways

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    Using the methods above is certainly the place to start when it comes to clearing your airways on a daily basis. But some people may need a little more help, and that's where modern technology can give traditional medicine a boost. Airway clearing devices can vibrate and loosen mucus, making it easier for you to cough it out.

     

    The good news is that these devices are easy to get hold of (with a prescription) and also relatively inexpensive to buy. If your doctor recommends using one of these devices, be sure to get a respiratory therapist to show you and/or your caregiver how to use it effectively.

     

    Here are some of the airway clearance devices you may have available to you:

    • Positive Expiratory Pressure Therapy, or PEP for short. This type of device requires you to inhale through a mask or mouthpiece and then exhale against a one-way valve that provides some level of resistance. This creates a pressure in your airways that helps them to open and move the mucus higher, where it can be coughed out. The level of resistance is set by your healthcare team. There are various brands of PEP devices, including AeroPEP®, PariPEP® and AstraPEP®.
    • High-Frequency Chest Wall Oscillator, or HFCWO for short. This device uses an inflatable vest that vibrates and massages the chest wall, similarly to chest percussion. It also helps to loosen your mucus, so that you can cough it up. Current brands of HFCWO devices include the Medpulse® Respiratory Vest System and the Vest™Airway Clearance System.
    • Combination Devices. These airway clearing devices combine PEP therapy with a chest wall oscillator. The most common brands are the Flutter™ and the Acapella™. You use the Flutter while standing or sitting and the Acapella while lying down.
    • Acoustic Impedence Device. This type of handheld device is a similar concept to the others, but it uses the vibration of low-frequency sound waves to get the mucus moving up out of your lower airways. The Lung Flute® is the most common brand in this category.

    In Summary

     

    Most people who have COPD and experience the symptom of excess mucus production will need to use one or more of these airway clearance methods. Work closely with your health care team to determine which strategy will be right for you.

     

    Provide feedback to your team as to effectiveness of the methods you use and ask for help as needed. If you practice consistent pulmonary hygiene, it will help you to avoid such complications as a respiratory infection.

    Cough, and Keeping Your Airways Clean
Published On: February 14, 2014