Airway Clearance Techniques

Question 1

Airway Clearance Techniques

Answer 1

1. Cough (supported; assisted)
2. Active Cycle of Breathing Technique (ACBT)
3. Positive Expiratory Pressure (PEP)
4. Autogenic Drainage (AD)
5. Postural Drainage (PD, MPD)
6. Percussion and Vibration (P & V)
7. Inhalation therapy
8. Exercise Therapy
9. Suction (M2)

Question 2

Cough

Components

Answer 2

1. Inspiratory volume
2. Closure of glottis
3. ITP
4. Abdominal muscle contraction
5. IAP and ITP against a closed glottis
6. Opening of glottis
7. Ascent of diaphragm
8. Forceful expulsion of air and/or secretions/foreign bodies

Question 3

Problems Associated with Coughing

1. Dec. Lung Volume

Answer 3

1. Dec. Lung Volume
•	Pain
•	Restriction
•	Obstruction
•	Fear/anxiety
•	Muscle weakness
•	Neurological impairment

Mx: Inc. Inspiration Volume

Question 4

Problems Associated with Coughing

2. Dec. Expiratory force

Answer 4

2. Dec. Expiratory force
•	Pain (e.g. incision)
•	Muscle weakness
•	Poor elastic recoil (e.g. emphysema)
•	Inability to close glottis (e.g. bulbar palsy)
 Expiratory Force:
•	Supported cough
•	Assisted cough
•	Substernal angle compression
•	Subcostal thrust

Question 5

Techniques to Improve Coughing

Supported - Pain

Answer 5

Mechanism
• inc. IAP with support
• dec. Tension on the wound during contraction
• dec. ROM through which the muscle contracts
> Force > inc. Effectiveness of cough

Assist Using:
• Pillow
• Towel
• Binder

Question 6

Techniques to Improve Coughing

Assisted - Pain

Answer 6

Mechanism
• Aim is to assist generation of explosive force

Variable Positions:
• Bibasal compression – if compliant chest + flaring
• AP sternal compression – if apical movement
• Substernal angle compression – assist diaphragm ascent
• Subcostal thrust used for people with SCI

Question 7

Active Cycle of Breathing Technique

Answer 7

Components
¬	BC
¬	TEE ( IH)
¬	Huff/FET (low, mid, high volume)
BC  TEE  BC  FET [HUFF/BC]  BC

Question 8

A) [BC] Breathing Control

Answer 8

• Gentle tidal breathing
• Emphasise lower chest, not upper chest
• Minimal effort expended
• Inspire through nose to warm, humidify and cleanse air (but through mouth if nose is blocked)
• Intersperse throughout other techniques for recovery to prevent airflow obstruction
• Duration of BC depends on patient’s presentation
2-3 breaths, up to minutes

Question 9

Thoracic Expansion Exercises

Answer 9

• Aim = Lung volume
• Slow, laminar flow Emphasise inspiration
• Encourage lower chest expansion (can use proprioceptive stimulation)
• Inspiratory Hold (~3sec)
• ‘Sniff’ manoeuvre
3-4 TEE, then BC (> 5 TEE may hyperventilation/fatigue)
Can be used during P & V to hypoxaemia

Question 10

Forced Expiratory Technique – FET/HUFF

Answer 10

• Huff with BC
• Emphasis on expiration (squeeze not wheeze)
• Different lung volumes (low, mid, high) mobilise then remove secretions
• Uses Equal Pressure Points (EPP’s)
• BC prevents airflow obstruction
Duration of BC depends on patient Longer BC (10-20 sec) if bronchospasm or easily fatigued

Question 11

FET – Equal Pressure Points

Answer 11

o Compression when Pal ≤ Ppl
o Need to emphasize the mobilisation of secretions in the periphery of the lung
o Want EPP to work from periphery towards the airway

Question 12

ACBT: Duration

Answer 12

• Generally 10 to 30 mins
• If productive usually 10 mins in productive position
• If minimal secretions (e.g. asthmatics) less time
Repeat until effective huff to low long volume has become dry sounding and non-productive, OR
When/if fatigue occurs (~2 positions per Rx session)