Airway Clearance Devices

Bronchiectasis and nontuberculous mycobacterial (NTM) lung disease can make clearing your airways difficult. Mucus that pools in the lungs can cause inflammation, infections, and low levels of oxygen, while also making it hard to breathe.¹ Not all airway clearance methods or devices will work for you. Each person’s body reacts differently, so it is important to understand all the ways you can remove mucus from your lungs. This will help you feel your best and stay as healthy as possible.²

Positive Expiratory Pressure Therapy

Positive expiratory pressure therapy (PEP therapy) uses a one-way valve of pressure that props the airways open. This “propping of airways” allows you to move the mucus from the smaller airways to the larger airways, making it easier to cough out.³ The length of time you do the PEP therapy and the number of treatment cycles you need will be decided by your doctor.

To use a PEP device: The first time you use a PEP device, your health care provider will decide what is the right amount of pressure for you and set the device to that correct setting. Each time you use your PEP device, you will need to make sure it is set to this prescribed setting. To begin: sit up and take 1 or 2 deep breaths. When you are ready to use your PEP device, take a deep breath in and hold it for 2-3 seconds. Place the PEP device between your lips and breathe out slowly and smoothly into the PEP device. Keep a tight seal around the device with your lips. Repeat this step 8-10 times. End the treatment and use deep coughing or huff coughing to get the mucus out of your lungs.

Oscillating PEP Therapy

Oscillating PEP therapy uses positive pressure and “oscillatory” or vibrating airflow when breathing out.⁴ The vibrations that occur when you breathe out help loosen the mucus that is stuck to the airway walls. This makes it easier to cough it out. There are many benefits to using this type of device: 1) The devices are usually small and can be easily used “on the go”; 2) Many of these devices can be used with nebulizers for a short, successful treatment; 3) These devices can be used easily without the help of a caregiver. There is little to no risk to the user.

To use an oscillation PEP device: First, take a deep breath in. Hold your breath for 2-3 seconds. Next, place the device between your lips. Create a seal. Blow out through your mouth and use your stomach muscles to push the air out. Do this until you are done breathing out. Repeat these steps 10-15 times. Stop to cough to clear mucus from your lungs, as needed. Ask your doctor how many times a day you should use your PEP device.

High Frequency Chest Wall Oscillation

High frequency chest wall oscillation (HFCWO) uses a vest or wrap (worn by the patient) that expands and then shrinks to gently compress the chest wall rapidly. This fast, painless compressing and releasing, helps to vibrate the mucus out of the smaller airways and into the large airways. Here it can be coughed out.⁵ HFCWO can reduce “flare-ups” or exacerbations and hospital stays. It can also reduce the need for antibiotics in bronchiectasis patients.⁶ Many patients use their inhaled medicines while performing HFCWO.

Please consult your doctor before adding or making any changes to your therapy. Also call your doctor before using any of these devices if you are: coughing up blood, and/or have nausea, chest pain, or other symptoms. Ask your doctor if you should be seen by a chest physiotherapist, who can help you learn how to use these devices.

References:

¹Clarke SW. Management of mucus hypersecretion. Eur J Respir Dis. 1987;71(Suppl):136-144.
²Lesan A, Lamle AE. Short review on the diagnosis and treatment of bronchiectasis. Med Pharm Rep. 2019;92(2):111-116. doi: https://doi.org/10.15386/cjmed-1060
³Lee AL, Button BM, Tannenbaum EL. Airway-clearance techniques in children and adolescents with chronic suppurative lung disease and bronchiectasis. Front Pediatr. 2017;5:2. doi: https://doi.org/10.3389/fped.2017.00002
⁴Simoni L, dos Santos D, de Souza H, et al. Acute effects of oscillatory PEP and thoracic compression on secretion removal and impedance of the respiratory system in non-cystic fibrosis bronchiectasis. Respir Care. 2019;64(7):818-827. doi: https://doi.org/10.4187/respcare.06025
⁵Strickland S, Rubin B, Drescher G, et al. AARC clinical practice guideline: effectiveness of nonpharmacologic airway clearance therapies in hospitalized patients. Respir Care. 2013;58(12):2187-2193. doi: https://doi.org/10.4187/respcare.02925
⁶Basavaraj A, DeKoven M, Shah D, et al. Impact of high frequency chest wall oscillation on clinical outcomes and healthcare resource utilization in adult patients with non-cystic fibrosis bronchiectasis in the United States: a pre-post cohort analysis. Am J Respir Crit Care Med. 2020;201:A7758. doi: https://doi.org/10.1164/ajrccm-conference.2020.201.1_MeetingAbstracts.A7758