Mucociliary clearance in health and disease
What can physiotherapy do to help with impaired mucociliary clearance?
Following are brief descriptions of the application, uses and rationale for each technique:
- Intermittent Positive Pressure Breathing (IPPB): The machine delivers a positive pressure breath to the patient during inspiration, aiming to increase tidal volume and mobilise secretions using the principles of collateral ventilation.
- Manual techniques: Chest percussion, shaking or vibrations can be used to help 'loose' secretions, speed up expiratory airflow and aid secretion expectoration.
- Suctioning: If patients are unable to cough effectively and clear their secretions independently, suction may be used. This involves a small tube which applies negative pressure to the airways, aiding secretion removal.
- Incentive Spirometry: Provides visual feedback to patients regarding volume of inspiration. It is often used to encourage active thoracic expansion in patients post surgery or with collapse of the small airways and lung bases.
- Oscillating positive expiratory pressure (PEP) devices: Devices such as the flutter or accapella involve patients breathing out against a resistance combined with an oscillation in airflow. This serves to hold open airways by breathing out against a resistance, and the oscillations aim to 'loosen' secretions, making them easier to clear.
- Mobilisation: Increases lung volumes and promotes secretion clearance.
