Airway Clearance Therapy: Overview and Practice Questions

Airway clearance therapy plays a vital role in the management of respiratory conditions characterized by mucus buildup or impaired mucociliary function.

By utilizing targeted techniques and specialized devices, this therapy facilitates the mobilization and removal of secretions from the airways, thereby making it easier for patients to breathe while reducing the risk of respiratory infections and complications.

In this article, we’ll explore the key methods of airway clearance therapy, how they work, and why clearing mucus is essential for maintaining optimal lung function and overall respiratory health.

What is Airway Clearance Therapy?

Airway clearance therapy is a group of techniques and treatments used to help remove mucus and secretions from the lungs and airways. It’s especially important for patients with conditions like cystic fibrosis, chronic bronchitis, bronchiectasis, or neuromuscular disorders that impair the natural ability to clear mucus.

By clearing excess mucus, this therapy helps improve airflow, enhance gas exchange, prevent infections, and reduce the work of breathing.

Common methods include chest physical therapy (CPT), postural drainage, positive expiratory pressure (PEP) therapy, high-frequency chest wall oscillation, and mechanical devices like flutter valves.

Types of Airway Clearance Therapy

Airway clearance therapy includes a wide range of techniques designed to help patients mobilize and expel mucus from the lungs. These methods are especially important for individuals with chronic respiratory conditions that impair natural mucus clearance.

Here are the most commonly used types of airway clearance therapy:

Chest Physiotherapy (CPT)

Chest physiotherapy is a traditional yet effective method that uses manual percussion and postural drainage to clear mucus from the lungs. A respiratory therapist or caregiver rhythmically claps on the patient’s chest and back using cupped hands to loosen mucus stuck to the airway walls.

This is typically done while the patient is positioned so gravity can assist in draining secretions from different parts of the lungs—a technique known as postural drainage.

CPT is often performed several times a day and is especially beneficial for patients who produce large volumes of sputum, such as those with cystic fibrosis or bronchiectasis. Although it can be time-consuming and requires assistance, it remains a cornerstone therapy in many care plans.

Positive Expiratory Pressure (PEP) Therapy

PEP therapy involves breathing out against resistance using a handheld device, creating back pressure that helps keep the airways open during exhalation. This back pressure promotes collateral ventilation and pushes air behind mucus blockages, helping move secretions from the peripheral to central airways where they can be coughed out.

There are standard PEP devices and oscillating PEP devices, like the Flutter® or Acapella®, which combine resistance with vibrations to further loosen mucus. PEP therapy is simple, portable, and can be done independently, making it an excellent option for long-term management.

Autogenic Drainage

Autogenic drainage is a controlled breathing technique that uses varying lung volumes to mobilize secretions through the airways without external devices or manual percussion.

The method is divided into three phases:

1. Unsticking phase – low-volume breathing loosens mucus from small airways
2. Collecting phase – mid-volume breathing gathers mucus from the intermediate airways
3. Evacuating phase – high-volume breaths move the secretions into the large airways for expulsion

Note: This technique is highly effective but requires good self-awareness, discipline, and training. It’s best suited for patients with the cognitive ability and respiratory strength to perform it independently.

High-Frequency Chest Wall Compression (HFCWC)

HFCWC, often referred to as the “vest therapy,” uses an inflatable vest connected to an air pulse generator. The machine rapidly inflates and deflates the vest, creating gentle vibrations over the chest wall at high frequencies. These oscillations help break up mucus and promote its movement toward the larger airways.

Vest therapy is particularly effective for individuals who need frequent, consistent airway clearance at home, such as those with neuromuscular diseases or cystic fibrosis. It can be performed independently and is often used in combination with coughing or suctioning for best results.

Mobilization and Physical Activity

Regular movement and physical exercise naturally enhance mucus clearance by increasing respiratory rate and promoting deeper breaths. Activities like walking, jogging, or aerobic workouts stimulate airflow, loosen mucus, and engage the muscles involved in breathing.

While not a replacement for formal airway clearance techniques, mobilization is a valuable adjunctive therapy. It is especially useful for hospitalized patients to prevent complications related to immobility, such as pneumonia or atelectasis.

Active Cycle of Breathing Technique (ACBT)

ACBT is a structured breathing approach that cycles through different phases to facilitate mucus clearance. It consists of:

• Breathing control – relaxed breathing to prevent airway spasm
• Thoracic expansion exercises – deep breaths to expand the lungs and mobilize secretions
• Forced expiration techniques – “huff” coughing to move mucus toward the mouth

Note: This method requires no special equipment and can be performed in virtually any setting. ACBT is especially popular because it’s easy to teach, non-invasive, and effective across a wide range of pulmonary conditions.

Intrapulmonary Percussive Ventilation (IPV)

IPV is a mechanical form of airway clearance that delivers rapid bursts of air or aerosolized medications through a mouthpiece or mask. These pulses create internal vibrations in the lungs, helping to loosen and mobilize mucus throughout the airway tree.

The device can be used with or without medication and is often employed in acute care settings or in patients who have not responded well to other clearance methods. IPV is especially useful in treating atelectasis and managing complex lung diseases.

Mechanical Insufflation-Exsufflation (MIE)

Also known as the “cough assist” machine, MIE mimics a natural cough by delivering a positive pressure breath into the lungs, followed by a quick switch to negative pressure to suck the air out. This rapid change in pressure simulates the explosive force of a real cough and helps to dislodge and remove mucus from the airways.

This technique is essential for patients with neuromuscular disorders, spinal cord injuries, or weakened respiratory muscles who cannot produce a strong cough on their own. It can be used via a mask, mouthpiece, or tracheostomy.

 

Note: Each method of airway clearance therapy can be tailored to a patient’s unique needs, taking into account their condition, age, physical capabilities, and treatment goals. In many cases, a combination of techniques yields the most effective results. Working closely with a healthcare team ensures the most appropriate and effective airway clearance strategy is selected.

Airway Clearance Therapy Practice Questions

1. What is the primary goal of airway clearance therapy?
To help mobilize and remove retained secretions with the ultimate aim to improve gas exchange, promote alveolar expansion, and reduce work of breathing.

2. What are the indications for airway clearance therapy?
Copious secretions, acute respiratory failure with retained secretions, acute lobar atelectasis, and V/Q abnormalities caused by unilateral lung disease.

3. Before airway clearance therapy is started, what is something that may be administered to help improve the overall effectiveness of the treatment?
Bronchodilator

4. Why are coughing and suctioning important aspects of airway clearance therapy?
Because when airway clearance therapy is applied, it only helps move secretions into the central airways. This means that they still need to be removed, and you do that by coughing or suctioning.

5. How does positive expiratory pressure (PEP) help to move secretions into the larger airways?
By filling under-aerated segments through collateral ventilation and preventing airway collapse during expiration.

6. The proper instructions for positive expiratory pressure include all of the following EXCEPT:
Exhale forcefully and maintain an expiratory pressure of 10 to 20 cmH2O.

7. A physician orders bronchodilator drug therapy in combination with positive expiratory pressure (PEP). Which of the following methods could you use to provide this combined therapy?
You could attach a metered-dose inhaler to the system’s one-way valve inlet and place a small-volume nebulizer in-line with the PEP apparatus.

8. What is the movement of small volumes of air back and forth in the respiratory tract at high frequencies?
Oscillation

9. Which of the following parts are required to conduct high-frequency external chest wall compression?
A variable air-pulse generator and a non-stretch inflatable thoracic vest

10. All of the following are typical of high-frequency external chest wall compression therapy EXCEPT:
Long inspiratory oscillations

11. Which of the following determines the effectiveness of high-frequency external chest wall compression therapy?
Compression frequency and flow bias

12. Which airway clearance technique uses a pneumatic device to deliver compressed gas mini-bursts to the airway at rates above 100/min?
Intrapulmonary percussive ventilation

13. Which of the following is true about exercise and airway clearance?
Exercise can enhance mucus clearance, improve pulmonary function, improve V/Q matching, and cause desaturation in some patients.

14. Patients can control a flutter valve’s pressure by changing what?
Their expiratory flow

15. Advantages of the flutter valve over other bronchial hygiene methods include all of the following EXCEPT:
Greater effectiveness

16. What is the primary goal of bronchial hygiene therapy?
To improve gas exchange and reduce the patient’s work of breathing.

17. What should be considered when selecting a bronchial hygiene strategy?
The patient’s goals, motivation, and preferences; effectiveness and limitations of technique or method; patient’s age, ability to learn, and tendency to fatigue; and the need for assistants, equipment, and cost.

18. Which of the following airway clearance techniques would you recommend for a 15-month-old infant with cystic fibrosis?
Postural drainage, percussion, and vibration

19. Which of the following airway clearance techniques would you recommend for a patient with a neurologic abnormality and intact upper airway?
Postural drainage, percussion, and vibration and mechanical insufflation-exsufflation.

20. While assessing an adult outpatient for bronchial hygiene therapy, you note that they have (1) no history of cystic fibrosis or bronchiectasis, (2) sputum production of 30 to 50 ml/day, (3) an effective cough, and (4) good hydration. Which of the following would you recommend?
Positive expiratory pressure therapy

21. Why do strenuous expiratory efforts in some COPD patients limit the effectiveness of coughing?
Because high expiratory pleural pressures compress the small airways

22. Under which of the following conditions would mechanical insufflation-exsufflation with an oronasal mask probably NOT be effective?
If the glottis collapses during exsufflation or in the presence of a fixed airway obstruction.

23. Whether using traditional methods or the FET, a period of diaphragmatic breathing and relaxation should always follow attempts at coughing. What is the purpose of this approach?
To restore lung volume and minimize fatigue

24. All of the following are goals of bronchial hygiene therapy except:
Reverse the underlying disease process

25. Soon after you initiate postural drainage in a Trendelenburg position, the patient develops a vigorous and productive cough. Which of the following actions would be appropriate at this time?

26. All of the following conditions impair secretion clearance by affecting the cough reflex EXCEPT:
Chronic bronchitis

27. A typical mechanical insufflation-exsufflation treatment session should continue until what point?
Secretions are cleared; The vital capacity (VC) returns to baseline; and The SpO2 returns to baseline.

28. What are the best documented preventive uses of bronchial hygiene therapy?
Prevent retained secretions in the acutely ill; and maintain lung function in cystic fibrosis.

29. The primary objectives for turning include all of the following except to:
Prevent postural hypotension

30. Which of the following acutely ill patients is LEAST likely to benefit from the application of chest physical therapy?
Patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD).

31. A physician orders postural drainage for a patient with aspiration pneumonia in the anterior segments of the upper lobes. Which of the following positions would you recommend for this patient?
Patient supine with a pillow under the knees, bed flat.

32. During chest physical therapy, a patient has an episode of hemoptysis. Which of the following actions would be appropriate at this time?
Stop therapy, sit the patient up, give O2, and contact the physician.

33. A chronic obstructive pulmonary disease patient cannot develop an effective cough. Which of the following would you recommend to help this patient generate a more effective cough?
Enhancing expiratory flow by bending forward at the waist, using short, expiratory bursts or the “huffing” method, and using only moderate (as opposed to full) inspiration.

34. Which of the following is NOT a hazard or complication of postural drainage therapy?
Pulmonary barotrauma.

35. Which of the following is the only absolute contraindication to turning?
When the patient has unstable spinal cord injuries.

36. A physician orders postural drainage for a patient with aspiration pneumonia in the superior segments of the left lower lobe. Which of the following positions would you recommend for this patient?
Patient prone with a pillow under the abdomen, bed flat.

37. In which of the following patients would you consider modifying any head-down positions used for postural drainage?
A patient with unstable blood pressure, a patient with a cerebrovascular disorder, a patient with systemic hypertension, and a patient with orthopnea.

38. Which of the following is false about the FET?
It occurs from mid to high lung volume without glottis closure.

39. When assessing the potential need for postoperative bronchial hygiene for a patient, all of the following factors are relevant except:
The number of prior surgical procedures

40. Which of the following measures would you use to ask patients for the presence of copious mucus production?
1 ounce

41. Which of the following occurs during the compression phase of a cough?
Expiratory muscle contraction

42. A patient recovering from abdominal surgery is having difficulty developing an effective cough. Which of the following actions would you recommend to aid this patient in generating a more effective cough?
Coordinating coughing with pain medication, Using the forced expiration technique (FET), and “Splinting” the operative site.

43. The primary objectives for postural drainage include all of the following EXCEPT:
Prevent pneumonia

44. All of the following laboratory data are essential in assessing a patient’s need for bronchial hygiene therapy except:
Hematology results

45. Percussion should NOT be performed over which of the following areas?
Surgery sites, Bony prominences, and Fractured ribs.

46. Conditions that can lead to bronchiectasis include all of the following EXCEPT:
Muscular dystrophy

47. A patient about to receive postural drainage and percussion is attached to an (ECG) monitor and is receiving both intravenous (IV) solutions and O2 (through a nasal cannula). Which of the following actions would be appropriate for this patient?
Inspect and adjust the equipment to ensure function during therapy

48. Properly performed chest vibration is applied at what point?
Throughout expiration

49. In general, chest physical therapy can be expected to improve airway clearance when a patient’s sputum production exceeds what volume?
30 ml/day

50. Which of the following conditions are associated with chronic production of large volumes of sputum?
Bronchiectasis, Cystic fibrosis, and Chronic bronchitis

51. Which of the following are mandatory components of the pre-assessment for postural drainage?
Vital signs and Auscultation

52. Which of the following should be charted after completing a postural drainage treatment?
Amount and consistency of sputum produced, Patient tolerance of procedure, Position(s) used (including time), and Any untoward effects observed.

53. Maintaining an open glottis during coughing (as with the FET) can help minimize increases in pleural pressure and lessen the likelihood of bronchiolar collapse. Which of the following techniques can aid the teaching the patient this maneuver?
Having the patient phonate or “huff” during expiration

54. Key considerations in initial and ongoing patient assessment for chest physical therapy include which of the following?
Posture and muscle tone, breathing pattern and ability to cough, sputum production, and cardiovascular stability.

55. While reviewing the chart of a patient receiving postural drainage therapy, you notice that the patient tends to undergo mild desaturation during therapy (a drop in SpO2 from 93% to 89% to 90%). Which would you recommend to manage this problem?
Increase the patient’s FIO2 during therapy

56. Conditions that can affect airway patency and cause abnormal clearance of secretions include which of the following?
Foreign bodies, Tumors, Inflammation, and Bronchospasm

57. Which of the following is/are necessary for normal airway clearance?
Patent airway, Functional mucociliary escalator, and Effective cough

58. The application of gravity to achieve specific clinical objectives in respiratory care best describes which of the following?
Postural drainage therapy

59. For which of the following patients directed coughing might be contraindicated?
Patients with poor coronary artery perfusion and patients with an acute unstable spinal injury.

60. All of the following are contraindications for directed coughing except the presence of:
Necrotizing pulmonary infection

61. Which of the following is/are TRUE of postural drainage?
It is most effective in disorders causing excessive sputum, It is most effective in head-down positions greater than 25 degrees, and It requires adequate systemic hydration to be effective.

62. A key consideration in teaching a patient to develop an effective cough regimen includes which of the following?
Strengthening of the expiratory muscles, Instruction in breathing control, and Instruction in proper positioning.

63. All of the following are considered bronchial hygiene therapies EXCEPT:
Incentive spirometry

64. Directed coughing is useful in helping to maintain bronchial hygiene in all of the following cases except:
Acute asthma

65. What type of patients do you recommend EzPAP for?
To patients with a decreased FRC

66. Which of the following are potential indications for positive airway pressure therapies?
Reduce air-trapping in asthma or chronic obstructive pulmonary disease, Help mobilize retained secretions, Prevent or reverse atelectasis, and Optimize bronchodilator delivery.

67. Contraindications for positive airway pressure therapies include all of the following EXCEPT:
Air-trapping/pulmonary overdistention in chronic obstructive pulmonary disease.

68. All of the following are hazards of positive airway pressure therapies (EPAP, PEP, CPAP) EXCEPT:
Improvement of the ABG values

69. Hazards of positive airway pressure therapies associated with the apparatus used include which of the following?
Increased work of breathing, Claustrophobia, Increased ICP, Vomiting and aspiration, and Skin breakdown and discomfort.

70. A physician orders positive expiratory pressure therapy for a 14-year-old child with cystic fibrosis. Which of the following should be monitored?
Sputum production, breath sounds, pulse rate, and breathing pattern.

71. Which of the following best describes positive expiratory pressure (PEP) therapy?
Expiration against a variable flow resistance

72. What is the most important protective reflex?
Cough

73. What are the four distinct phases of a normal cough?
Irritation, inspiration, compression, and expulsion.

74. What disease state is the airway permanently damaged, dilated, and prone to constant obstruction by retained secretions?
Bronchiectasis

75. What are the most common conditions that affect the cough reflex?
Musculoskeletal and neurologic disorders

76. What are the five general approaches to airway clearance therapy?
(1) CPT, (2) coughing, (3) PAP, (4) High Frequency Compression/Oscillation Methods, and (5) Mobilization and physical activity.

77. What does CPT consist of?
Percussion, postural drainage, and vibration.

78. What type of therapy involves the use of gravity and mechanical energy to help mobilize secretions?
Postural drainage

79. What should be used during postural drainage if hypoxemia is suspected?
A pulse oximeter

80. How long should you administer postural drainage?
3–15 minutes

81. What should you do between positions?
Pause for relaxation and breathing control to prevent hypoxemia.

82. When a patient is in the head-down position, what should the patient avoid?
Strenuous coughing to avoid an increased ICP.

83. Will there be an immediate production of secretions during postural drainage therapy?
No, not always.

84. What type of breath sounds would you hear once postural drainage therapy has been administered?
Breath sounds may worsen. You may hear coarse crackles after treatment.

85. What is involved in the application of mechanical energy to the chest wall by the use of either hands or various electrical or pneumatic devices?
CPT, i.e. percussion and vibration

86. How should hands be positioned when percussing?
Parallel to the ribs

87. What type of cough is a deliberate maneuver that is taught, supervised, and monitored?
Directed cough

88. What type of patients may not be able to do the direct cough regimen?
Those that are obtunded, paralyzed, uncooperative patients, patients with COPD and neurologic, muscular and skeletal abnormalities. Also, dehydration, thick secretions, artificial airways, and depressants can thwart direct cough techniques.

89. In patients with muscle weakness, such as COPD patients and patients with neuromuscular disease, what must be done to help remove their secretions?
Either suctioning or mechanical insufflation-exsufflation.

90. What is the term used for when a clinician can use his or her hands to support the area of incision during the expiratory phase of a cough?
Splinting

91. What type of breathing method is useful for COPD patients who can’t get an effective cough?
Use pursed lip breathing while leaning forward.

92. What are the three categories of chest percussion?
Manual, pneumatic, and electrically powered devices.

93. Impaired airway clearance and retention of secretions can be a result of what?
Any abnormality that alters airway patency, such as mucociliary function, the strength of the inspiratory or expiratory muscles, thickness of secretions, or effectiveness of the cough reflex.

94. What are the results of mucus plugging?
It can result in atelectasis, impaired oxygenation secondary to shunting, WOB, air trapping, overdistention, and ventilation/perfusion imbalance.

95. What disease has the solute concentration of the mucus altered because of abnormal sodium and chloride transport?
Cystic fibrosis

96. What is the condition called where the respiratory tract cilia do not function properly?
Ciliary dyskinetic syndrome

97. What is the disease where the airway is permanently damaged, dilated, and prone to constant obstruction by retained secretions?
Bronchiectasis

98. What are the clinical signs of patients with retained secretions?
Audible abnormal breath sounds, deteriorating arterial blood gases, chest x-ray changes.

99. How much sputum production must be produced in order for therapy to be initiated?
25-30 ml per day for airway clearance therapy.

100. What therapy uses gravity and mechanical energy to help mobilize secretions?
Postural drainage

101. How often should postural drainage techniques be performed on critically ill patients and patients on mechanical ventilation?
Every 4-6 hours. The frequency should be determined by assessing the patient’s response to therapy.

102. To avoid gastroesophageal reflux and the possibility of aspiration, how long should you wait before treatment after a meal?
1.5 to 2 hours before or after feedings

103. What should you do as a respiratory therapist if you know the patient will be in pain during postural drainage therapy?
Correlate their therapy sessions with scheduled pain medications.

104. Why should a patient avoid coughing when using the head-down position during therapy?
It markedly increases ICP.

105. What kind of breath sounds may you hear after therapy?
Coarse crackles. Their breath sounds may get worse due to the secretions moving into the larger airways.

106. What are the potential problems with mechanical vibration devices?
Noise, excess force, electrical shock, and mechanical failure.

107. What are the six adjunctive breathing techniques?
Directed cough (controlled cough), Diaphragmatic breathing, Unilateral chest expansion, Acute chest expansion, Pursed-lipped breathing, and Forced expiratory technique (FET).

108. In what area of the lungs is cough most effective?
In the central area, not the peripheral.

109. What are the three most important aspects involved in patient teaching with directed cough?
(1) Instruction in proper positioning, (2) instruction in breathing control, and (3) exercises to strengthen the expiratory muscles.

110. In patients with neuromuscular conditions, what three options are there to help them get rid of retained secretions since cough is hard for them to obtain?
(1) The placement of an artificial airway, (2) manually assisted cough, and (3) manual insufflation-exsufflation.

111. What 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?
Huff cough or forced expiratory technique.

112. What maneuver may a patient do to help clear secretions with less change in pleural pressure and less likelihood of bronchiolar collapse?
Huff cough, or FET

113. What technique uses diaphragmatic breathing to mobilize secretions by varying lung volumes and expiratory airflow in 3 distinct phases?
Autogenic drainage

114. What is known as the artificial cough machine, cough assist device, or coughlator?
MIE (mechanical insufflation-exsufflation)

115. What term refers to the rapid vibratory movement of small volumes of air back and forth in the respiratory tract?
Oscillation

116. What are the two general approaches to oscillation?
External chest wall application and airway application.

117. What is the external application of oscillation referred to?
High-frequency chest wall compression (HFCWC)

118. What does airway application of oscillation methods include?
The flutter valve and intrapulmonary percussive ventilation

119. What device uses a two-part system with a variable air pulse generator and a non-stretch inflatable vest that covers the patient’s entire torso?
High-frequency chest wall oscillation

120. What are the hertz ranges for high-frequency chest wall oscillators?
5–25 hertz

121. How long do you typically perform HFCWO?
30 minutes

122. What device is an airway clearance device that uses a pneumatic device to deliver a series of pressurized gas mini-bursts at rates of 100 to 225 cycles per minute to the respiratory tract, usually via a mouthpiece?
Intrapulmonary percussive ventilation (IPV)

123. What is a popular approach to PEP therapy?
The flutter valve

124. What kind of devices are believed to work based on the principle of collateral ventilation, which suggests that airflow can occur between adjacent lung segments through the canals of Lambert and through the pores of Kohn?
Airway oscillating devices that produce PEP with oscillations in the airway during expiration.

125. What airway clearance device can decrease the viscoelasticity of mucus within the airways modifying mucus and allowing it to be cleared more easily by cough?
Flutter valve

126. What advantage does the Acapella have over the flutter valve?
It can be used in any position.

127. What are the appropriate airway clearance techniques that may be used for CF, ciliary dyskinesia syndrome, and bronchiectasis?
PDPV

128. What is the recommended airway clearance technique for a patient with atelectasis?
PEP, PDPV, ACBT

129. What is the recommended airway clearance technique for a patient with asthma with mucus plugging?
Exercise, PEP, PDPV, Flutter valve, and HFO

130. What is the recommended airway clearance technique used for a patient with neurologic abnormalities?
PDPV, suction, and MIE

131. What is the recommended airway clearance technique used for a patient with musculoskeletal weakness such as muscular dystrophy, myasthenia gravis, and poliomyelitis?
PEP and MIE

132. What is the Acapella?
It has a customizable frequency and flow resistance. It can be used in any posture and is NOT as portable as the flutter valve.

133. Adding exercise to mobilization and coughing can do what?
It can enhance mucus clearance, improve V/Q matching, improve pulmonary function, and result in oxygen desaturation.

134. Aerosol drug therapy may be added to a PEP session by means of what?
A handheld nebulizer or an MDI (attached to a one-way valve inlet of the system).

135. Before starting postural drainage, what assessments should be completed?
Vital signs and chest auscultation

136. What are the bronchial hygiene methods?
Postural drainage therapy (including percussion and vibration), Positive airway pressure (PAP), and Oscillation.

137. Bronchial hygiene would not be beneficial to patients with what condition?
Acute exacerbation of COPD

138. Chronic conditions that may cause copious secretions and indicate the need for bronchial hygiene include?
Cystic Fibrosis, bronchiectasis, and chronic bronchitis.

139. What is the clinical procedure for PAP therapy?
Instruct the patient to: Take in a breath that is larger than normal but do not completely fill your lungs, Exhale actively, but NOT forcefully, Perform 10-20 breaths, and Repeat the cycle four to eight times but do not exceed 20 minutes.

140. The clinical signs that there is a problem with retained secretions are?
Loose, ineffective cough, Labored breathing pattern, Course inspiratory and expiratory crackles, and Fever.

141. What are the contraindications for a directed cough?
Patients with pathogens transmitted by droplets (TB), Presence of an elevated ICP, Poor coronary artery perfusion, and a spinal cord injury.

142. What are the contraindications for PAP adjuncts to bronchial hygiene therapy?
An ICP greater than 20 mmHg, Untreated pneumothorax, Recent facial, oral, skull surgery or trauma.

143. A directed cough is useful in helping maintain bronchial hygiene in patients with what?
Patients with CF, Patients with bronchiectasis, and Patients with a spinal cord injury.

144. The documentation of postural drainage therapy should include what?
The position(s) used, Time in each position, Patient tolerance, Amount and consistency of sputum produced, and Any untoward effects observed.

145. The factors that may hinder an effective cough include?
Severe restrictive disorders, Fear of pain, Systemic dehydration, Thick, tenacious secretions, Artificial airways, and the use of CNS depressants.

146. What are the factors that provoke a cough?
Infection, foreign bodies, and irritating gases.

147. If a patient experiences hemoptysis during postural drainage therapy, what action should be taken?
Stop the therapy, return the patient to their previous resting position, administer or increase their FIO2, and contact the physician.

148. If the procedure causes a vigorous cough, you should have the patient should do what?
Get into a sitting position until the cough subsides.

149. The indications for PAP adjuncts to bronchial hygiene therapy include what?
To reduce air trapping, To aid in the mobilization of retained secretions, To prevent or reverse atelectasis, and To optimize the delivery of bronchodilators in patients receiving bronchial hygiene therapy.

150. What is Intra-pulmonary Percussive Ventilation (IPV)?
An airway clearance technique that uses a pneumatic device to deliver a series of pressurized gas mini-bursts at rates of 100 to 225 cycles per minute.

151. Key considerations in assessing a patient for CPT include what?
Posture, muscle tone, Effectiveness of cough, Sputum production, Breathing pattern, and Cardiovascular stability.

152. Lab data and other essentials needed for assessment of the need for bronchial hygiene therapy include?
Chest x-ray, PFT results, ABG values, or oxygen saturation.

153. What common conditions affect the cough reflex?
Muscular dystrophy, Amyotrophic lateral sclerosis, and Cerebral palsy.

154. What common drugs can impair mucociliary clearance in intubated patients?
General anesthetics, Opiates, and Narcotics

155. What is the recommended airway clearance technique for patients with cystic fibrosis, ciliary dyskinesia, bronchiectasis, or infants?
PDPV (postural drainage, percussion, vibration)

156. What postural drainage position would be used for a patient with an abscess in the right middle lobe?
Right lateral segment

157. What postural drainage position would be used for a patient with aspiration pneumonia in the superior segments of the left lower lobe?
Superior segments

158. What postural drainage position would be used for a patient with aspiration pneumonia of the anterior upper lobes?
Anterior Segments

159. When using flutter, patients can control the pressure by?
By changing their expiratory flow

160. What is Chest Physical Therapy?
Collection of therapeutic techniques designed to aid clearance of secretions, improve ventilation, and enhance the conditioning of the respiratory muscles; includes positioning techniques, chest percussion and vibration, directed coughing, and various breathing and conditioning exercises.

161. How do you know if a patient is having issues with retained secretions?
Look at the physical findings such as a loose, ineffective cough, labored breathing pattern, decreased or bronchial breath sounds, coarse inspiratory and expiratory crackles, tachypnea, tachycardia, or fever may indicate a potential problem with retained secretions. A chest radiograph often shows atelectasis and areas of increased density in such cases.

162. What are the indications for the directed cough?
Need to aid in the removal of retained secretions from central airways, Presence of atelectasis, Prophylaxis against postoperative pulmonary complications, Routine part of bronchial hygiene in patients CF, bronchiectasis, chronic bronchitis, necrotizing pulmonary infection, spinal cord injury, To obtain sputum specimens for diagnostic testing.

163. What does mucous plugging lead to?
Mucous plugging can result in atelectasis and impaired oxygenation secondary to shunting. By restricting airflow, partial obstruction can increase the work of breathing and lead to air trapping, overdistention, and ventilation/perfusion (V/Q) imbalances.

164. What is an example of cough stimulation caused by mechanical stimulation?
Foreign bodies

165. What is an example of cough stimulation caused by an inflammatory process?
Infection

166. What is an example of cough stimulation caused by chemical stimulation?
When irritating gases are inhaled, such as cigarette smoke.

167. What is an example of cough stimulation caused by thermal stimulation?
Cold air

168. What is considered a copious production of secretions?
25 to 30 ml/day, which is about 1 ounce or about the size of a shot glass.

169. What is the triple S rule?
Whenever you observe an untoward patient response during postural drainage, the respiratory therapist should stop the therapy (return the patient to the original resting position) and stay with the patient until he/she is stabilized.

170. What landmarks should the respiratory therapist avoid during manual percussion?
Avoid tender areas or sites of trauma or surgery, and one should never percuss directly over bony prominences, such as the clavicles or vertebrae

171. What position should the patient be in while performing the directed cough?
The patient should assume the sitting position with one shoulder rotated inward and the head and spine slightly flexed. The patient’s feet should be supported to provide abdominal and thoracic support for the patient. If the patient is unable to sit up, the clinician should raise the head of the bed and ensure that the patient’s knees are slightly flexed with the feet braced on the mattress.

172. When should the postural drainage order be reevaluated?
At least every 48 hours for patients in critical care, at least every three days for other hospitalized patients, and every three months for patients receiving home care.

173. Without an effective cough, most airway clearance techniques cannot succeed in what?
In fully clearing secretions

174. What are the three things needed for normal airway clearance?
A patent airway (open airway), functional mucociliary escalator, and effective cough. That is because an effective cough can move mucus from the lower airways to the upper airways for removal.

175. What are the diseases associated with abnormal clearance?
Asthma, lung cancer, kyphoscoliosis, chronic bronchitis, acute infections, Cystic fibrosis, Bronchiectasis, and neuromuscular diseases.

Final Thoughts

Airway clearance therapy is an essential component of respiratory care for patients with conditions that impair natural mucus clearance. By utilizing various techniques—from manual CPT and breathing exercises to advanced mechanical devices—healthcare providers can tailor treatment plans to meet individual patient needs.

These modalities not only improve lung function and ease breathing but also reduce the risk of infection and hospitalization. Incorporating regular airway clearance into a patient’s routine can lead to better long-term outcomes, especially when combined with other treatments like medications, hydration, and physical activity.

Whether managing a chronic condition or recovering from an acute illness, effective mucus clearance can make a significant difference in respiratory health and quality of life. With the right approach, patients can breathe easier and live more comfortably.