Abstract
In health, secretions produced in the respiratory tract are cleared by mucociliary transport, cephalad airflow bias, and cough. In disease, increased secretion viscosity and volume, dyskinesia of the cilia, and ineffective cough combine to reduce secretion clearance, leading to increased risk of infection. In obstructive lung disease these conditions are further complicated by early collapse of airways, due to airway compression, which traps both gas and secretions. Techniques have been developed to optimize expiratory flow and promote airway clearance. Directed cough, forced expiratory technique, active cycle of breathing, and autogenic drainage are all more effective than placebo and comparable in therapeutic effects to postural drainage; they require no special equipment or care-provider assistance for routine use. Researchers have suggested that standard chest physical therapy with active cycle of breathing and forced expiratory technique is more effective than chest physical therapy alone. Evidence-based reviews have suggested that, though successful adoption of techniques such as autogenic drainage may require greater control and training, patients with long-term secretion management problems should be taught as many of these techniques as they can master for adoption in their therapeutic routines.
- cough
- directed cough
- forced expiratory technique
- autogenic drainage
- active cycle of breathing
- secretion clearance
Footnotes
- Correspondence: James B Fink MSc RRT FAARC, Respiratory Science, Nektar Therapeutics, 2071 Stierlin Court, Mountain View CA 94043. E-mail: jfink{at}nektar.com.
Mr Fink presented a version of this paper at the 39th Respiratory Care Journal Conference, “Airway Clearance: Physiology, Pharmacology, Techniques, and Practice,” held April 21–23, 2007, in Cancún, Mexico.
The author reports no conflicts of interest related to the content of this paper.
- Copyright © 2007 by Daedalus Enterprises Inc.