Airway Clearance Techniques
Airway clearance techniques (ACTs) help people with asbestos-related disease stay healthy and breathe easier. They loosen thick sticky mucus and move it from small to large (more central) airways to be coughed or huffed out. Clearing the airways reduces lung infections and improves lung function.
Mucus in the Lungs
- The lungs make mucus to help defend against germs.
- Mucus builds and lines the lungs airway walls.
- If air does not get behind mucus, mucus is hard to move.
- Asbestos-related disease scars the lungs, and the lining around the lungs, making it difficult to move air that would clear the lungs of mucus. Mucus that does not get coughed or huffed out is where infections can occur.
- Infections cause inflammation or swelling of the lungs.
- Both infections and inflammation cause more mucus to be made. More mucus in the lungs can lead to more infections.
- The cycle of infection, inflammation, and more mucus can hurt the lungs and lower lung function. In addition, lung infections can result in serious complications for people with lung disease.
Airway Clearance Techniques
Coughing is a reflex that helps clear mucus with high-speed airflow. Sometimes mucus cannot be cleared just with a lot of coughing. Coughing a lot can make you feel more short of breath.
A technique called huffing is done by taking a breath in and forcefully exhaling. Start huffing softly and work your way up to a more deep and forceful huff, like “huffing” onto a mirror or window to steam it up. Huffing is not as forceful as a cough but can work better and be less tiring.
Active Cycle of Breathing (ACBT)
Start with Breathing Control which is a normal, gentle breathing with the lower chest while relaxing the upper chest and shoulders. Then utilize Thoracic Expansion Exercises which involves deep breaths in. Some use a three-second breath-hold to get more air behind the mucus. This may be done with chest clapping or vibrating, followed by breathing control. Finish with Forced Expiration Technique – huffs of varied lengths with breathing control, which can be changed to meet each person’s needs. It gets air behind the mucus to the mucus can be cleared from the lungs.
Autogenic Drainage (Self Drainage)
Autogenic drainage uses varied airflows to move mucus. It aims to reach very high airflows in different lung parts. The person inhales to different levels and then adjusts how they breathe out to maximize airflow and move mucus. Breathing out may best be done by huffing with this airway clearance technique.
Special Equipment for Airway Clearance
Postural Drainage and Chest Physical Therapy (CPT)
With postural drainage, the person gets in varied positions (postures) that drain mucus from different lung parts. Gravity pulls mucus from small to large airways where it can be coughed up. With chest percussion the chest is clapped and vibrated to dislodge and move mucus. This is done in varied positions to drain all lung parts. These methods must be learned from a medical provider.
Oscillating Positive Expiratory Pressure (Oscillating PEP)
The person blows all the way out many times through a device. The vibration caused by this device thins, dislodges and moves mucus. These devices vibrate the large and small airways. After blowing through the device many times, the person coughs or huffs. Repeat this process several times.
Types of Oscillating PEP devices include: Flutter™, Acapella™, Cornet™, and Intrapulmonary Percussive Ventilation (IPV).
High Frequency Chest-Wall Oscillation (The Vest)
A special vest is attached to a machine that vibrates the vest at a high frequency. Small amount of pressure are applied to the chest through vibration of the vest. The vest vibrates and moves mucus into the bigger airways so they can be coughed up. The person stops the machine and coughs or huffs as needed.
Positive Expiratory Pressure (PEP)
PEP gets air into the lungs and behind the mucus using extra airways. A PEP system includes a mask or mouthpiece attached to a resistor. The person breathes in normally and breathes out a little harder against the resistance. This method creates a pressure in the lungs that keeps them open and allows mucus and air to get out easier.
Important Reminders of Airway Clearance Techniques
- Do ACTs even when you are feeling well.
- Do them more often when you are sick.
- ACTs are often used with other treatments, like inhaled bronchodilators and antibiotics.
- Bronchodilators should be taken before or with ACTs to open airways.
- Inhaled antibiotics should be taken after ACTs to treat opened airways.
- If an ACT is causing you pain, then talk to your health care provider about trying a new ACT. You may also apply pressure against a sore spot using your hand or a pillow during an ACT to reduce pain.