Airway Clearance Therapy

Question 1

Described the primary techniques

used to assist with clearing secretions from the airways.

Answer 1

Chest Physical Therapy

Question 2

How many secretions does a healthy individual produce in a daily basis and that are cleared by this mucociliary escalator?

Answer 2

10 to 100 mL

Question 3

Four distinct phases to a normal cough:

Answer 3

• IRRITATION
• INSPIRATION
• COMPRESSION
• EXPULSION

Question 4

In this phase, an abnormal stimulus provokes sensory fibers in the airways to send impulses to the medullary cough center in the brain.

Answer 4

Irritation phase

Question 5

In normal adults, the inspiration averages _____

Answer 5

1 to 2 L

Question 6

During this phase, reflex nerve impulses cause glottic closure and a forceful contraction of the expiratory muscles and normally about 0.2 seconds, and result in a rapid increase in pleural and alveolar pressures, often greater than 100 mm Hg.

Answer 6

Compression phase

Question 7

Most common disorder that alter mucociliary clearance.

Answer 7

Cystic fibrosis`

Question 8

Diseases Associated With Abnormal Clearance

Answer 8

• diseases affecting airway patency
• composition and production of mucus
• ciliary structure and function
• normal cough reflex

Question 9

The primary goal of ACT is to;

Answer 9

• assist the patient to mobilize and remove retained secretions.

Question 10

When coordinating the sequence of the following
therapies relating to bronchopulmonary clearance,
which should the respiratory therapist do first?

Answer 10

Bronchodilator therapy

Question 11

Patients with acute conditions in whom ACT may be indicated

include:

Answer 11

• acutely or chronically ill patients with copious secretion
• patients with retained secretions or ineffective cough (coarse crackles, worsening oxygenation and/or ventilation, volume loss on chest radiograph)
• possibly patients with acute lobar atelectasis
• patients with abnormalities

Question 12

Acute conditions for which ACT is probably not indicated include:

Answer 12

• routine care of chronic obstructive pulmonary disorder (COPD)
• pneumonia without clinically significant sputum production
• routine postoperative care
• uncomplicated asthma

Question 13

Causes of Impaired Mucociliary Clearance in Intubated Patients

Answer 13

• Endotracheal or tracheostomy tube
• Tracheobronchial suction
• Inadequate humidification
• High FiO2 values
• Drugs
• General anesthetics
• Opiates
• Narcotics
• Underlying pulmonary disease

Question 14

The most common conditions affecting the cough reflex

Answer 14

musculoskeletal and NMDs,
 including muscular dystrophy, 
ALS, 
spinal muscular atrophy,
myasthenia gravis,
poliomyelitis, and 
cerebral palsy

Question 15

Sputum production must exceed __ to __ ml/day for airway clearance therapy to improve secretion removal significantly

Answer 15

20 to 30 ml/day

Question 16

Indications for Airway Clearance Therapy

Answer 16

ACUTE CONDITIONS
• Copious secretions
• Inability to mobilize secretions
• Ineffective cough

CHRONIC CONDITIONS
•	 CF
•	 Bronchiectasis
•	 Ciliary dyskinetic syndromes
•	 COPD patients with retained secretions

Question 17

The best-documented preventive uses of airway clearance therapy include

Answer 17

(1) body positioning and patient
mobilization to prevent retained secretions in acutely ill patients

 (2) ACT combined with physical activity to maintain lung 
function in patients with CF

Question 18

It is a deliberate maneuver that is taught, supervised, and monitored. It aims to assist in creating a productive cough in patients unable to clear secretions with an effective spontaneous cough

Answer 18

Directed cough

Question 19

To determine the effectiveness of directed cough techniques, therapists should evaluate the patient for any of the following
outcome changes:

Answer 19

• increased sputum production,
• decreased pulse and respiratory rate,
• clearing of the breath sounds,
• improved oxygen saturation, and
• possibly clearing of infiltrates on the chest radiograph.

Question 20

To expel secretions the device simulates an effective cough by using positive airway pressure on inspiration to increase tidal volume and then switching to a negative pressure to increase peak expiratory cough flows

Answer 20

Mechanical insufflation-exsufflation (MIE)

Question 21

To loosen and move secretions into the larger airways the patient breathes in and actively exhales against short, rapid positive airway pressure pulses.

Answer 21

High- Frequency oscillation devices

Question 22

Patients who participate in physical activity that results in increased tidal volume, heart rate, and cardiac output, and improved physical condition.

Answer 22

Mobilization and physical activity

Question 23

An effective directed cough is impossible in what patient condition

Answer 23

unresponsive, paralyzed, or uncooperative patients.

Question 24

This technique consists of one or two forced expirations of middle to low lung volume without closure of the glottis, followed by a period of diaphragmatic breathing and relaxation.

Answer 24

Forced Expiratory Technique ( huff cough )

Question 25

It is an external application of pressure to the thoracic cage or epigastric region, coordinated with a forced exhalation.

Answer 25

Manual Assisted Cough ( quad-cough )

Question 26

In this technique, the patient takes as deep an inspiration as possible, assisted as needed by the application of positive pressure using a self-inflating manual resuscitation bag or ventilator. At the end of the patient’s inspiration, the RT exerts pressure under the diaphragm (lateral costal margins or epigastrium) abruptly.

Answer 26

Manual Assisted Cough

Question 27

Involves gentle diaphragmatic breathing at normal tidal volumes for 5 to 10 seconds with relaxation of the upper chest and shoulders.

Answer 27

Breathing control

Question 28

ACBT

Answer 28

Active Cycle of Breathing Technique

- consists of repeated cycles of breathing control, thoracic expansion, and FET
- combines different techniques that help clear mucus from the lungs
- can be performed while sitting or laying down with your hips elevated above your chest.

Question 29

Is another modification of directed coughing, designed as an airway clearance mechanism that can be performed independently by trained patients.

Answer 29

Autogenic drainage (AD)

Question 30

this device (also called cough-assist device or “coughlator”) has gained popularity in its use to manage secretions in patients with certain neuromuscular disorders.

Answer 30

Mechanical Insufflation-Exsufflation

Question 31

This phase of ACBT is designed to help loosen secretions, improve
the distribution of ventilation, and provide the volume needed
for FET.

Answer 31

The thoracic expansion

Question 32

High-frequency positive airway pressure devices are also

referred to as

Answer 32

intrapulmonary percussive ventilation (IPV).

Question 33

involves active expiration against a fixed orifice
flow resistor or variable orifice threshold resistor capable of
developing pressures of 10 to 20 cm H2O

Answer 33

Positive Expiratory Pressure (PEP)