The lungs of people with chronic obstructive pulmonary disease (COPD), particularly chronic bronchitis, tend to produce lots of secretions that may become thick, hard to cough up, and make breathing difficult. When this happens, it’s very helpful to learn techniques that will help you generate a good, strong cough.
Keep in mind here that lungs are normally sterile. A cough, therefore, is a natural immune response to keep particles in the air from entering sterile lungs. Without this response, germs may enter your lungs and cause infections such as pneumonia.
Sometimes particles will enter the lungs of healthy people. When this happens, these germs will be balled up in a wad of mucus that is brought up to your upper airway to either be swallowed or spit up. Mucus that is ready for swallowing or spitting up is called phlegm.
The natural progression of COPD causes changes that alter this natural response:
Tissue damage: Damage to the tissues lining your air passages reduces your body’s natural mechanisms for moving up secretions.
Airflow limitation: Narrowed air passages and loss of lung tissue makes it so you are unable to generate enough flow to create an effective cough.
The end result here is that secretions become trapped in diseased lungs. These secretions may become thick over time and block air passages, thus making it hard to breathe. Patients in this situation may greatly benefit from what we in the medical profession refer to as the "Pulmonary Toilet." The technical term is bronchial hygiene.
The name "Pulmonary Toilet" may sound kind of gross, but the name is actually quite fitting. It means that the doctor will do anything and everything to help your body break up and remove these secretions.
It usually begins with using an inhaled bronchodilator, either with an inhaler or nebulizer. Bronchodilators open up air passages to make breathing easier and allow for the release of trapped secretions.
The challenge now becomes how to get these secretions to your upper airway. Here are three of the best techniques to help you create an effective cough.** 1.** ** Deep coughing**: Take as deep of a breath as you can, and hold it for 2-3 seconds. Then, using your stomach muscles, force this air out of your lungs. This will help to knock secretions loose and force them to your upper airway.
2. Huff Cough technique: Take a deep breath and, using your stomach muscles, make a series of three rapid exhalations. When you do this you will be making a "ha, ha, ha" sound. This will help vibrate secretions loose and bring them to your upper airway. This is very helpful for people with very severe airflow limitation. Check out this YouTube huff cough video for a quick demonstration.
3. PEP therapy: This is accomplished using a small, handheld device called a flutter valve or acapella. You sit on the edge of a bed or in a chair, and exhale into the device. While exhaling, vibrations will be felt in your air passages that are meant to knock loose secretions sticking to your airways. A positive pressure is also created that keeps your air passages open and helps move these secretions to your upper airway. Continue exhaling into the device until you feel loose secretions in your airway that are ready to be coughed up. A therapy session using this device may take only a few breaths, but for some patients, especially those with very limited airflow, it may take 10-15 minutes, or several exhalations. Check out these Youtube videos: "How to use a Flutter Valve" and "Acapella Vibratory PEP Mucus Clearance Device."
4. Chest Physiotherapy** (CPT)**: This procedure will require the assistance of another person. In the hospital setting this will include your respiratory therapist. You will be required to sit or lie in different positions while the therapist claps on your chest and back over your lungs. The idea here is vibrations caused by the clapping will loosen secretions. The procedure may take anywhere from 5-20 minutes. Due to limitations caused by your disease, you may be limited to sitting, or lying on your side using pillows. This YouTube chest percussion demonstration shows proper technique while sitting. The Cystic Fibrosis Foundation describes the procedure best in this Consumer Fact Sheet.
5. Combination: This is where you use a combination of the above techniques. It will generally start with an inhaled bronchodilator, followed by PEP therapy or CPT, followed by deep coughing or huff coughing.
Bottom line: While most people take coughing for granted, people with certain lung diseases aren’t able to do this. Instead, conscious efforts must be made to loosen and bring up secretions. The ideal method is whatever one you and your physician decide works best for you. These techniques may be performed on an as-needed basis, or scheduled 2-4 times per day.
A Registered Respiratory Therapist and asthmatic