Airway Clearance Therapy Overview and Practice Questions

Airway Clearance Therapy: Overview and Practice Questions

by | Updated: Jan 28, 2023

Airway clearance therapy is a type of respiratory care that helps clear mucus and secretions from the lungs.

Patients with lung conditions such as chronic bronchitis, bronchiectasis, and cystic fibrosis often have difficulty clearing mucus from their lungs. This can lead to dyspnea, infections, and other respiratory issues.

In this article, we will discuss what airway clearance therapy is, how it works, and break it down in a way that’s easy to understand. We included helpful practice questions on this topic as well.

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What is Airway Clearance Therapy?

As previously mentioned, airway clearance therapy (ACT) is a form of therapy that uses noninvasive techniques to help mobilize and remove secretions from the airways of the lungs.

By doing so, it helps improve gas exchange so that patients are able to take in oxygen while removing carbon dioxide.

Types of Airway Clearance Therapy

There are several different types of airway clearance therapy, including the following:

  1. Chest Physiotherapy (CPT)
  2. Positive Expiratory Pressure (PEP) Therapy
  3. Autogenic Drainage
  4. High-Frequency Chest Wall Compression (HFCW)
  5. Mobilization and Physical Activity
  6. Active Cycle of Breathing
  7. Intrapulmonary Percussive Ventilation (IPV)
  8. Mechanical Insufflation-Exsufflation (MIE)

Each type of airway clearance therapy has advantages and disadvantages and requires a different technique for delivery. However, the primary goal of each is to help clear secretions from the lungs.

Chest Physiotherapy

Chest physiotherapy (CPT) is a form of therapy that is designed to help clear secretions, improve ventilation, and strengthen the respiratory muscles of breathing.

It includes chest percussion and vibration, directed coughing, positioning techniques, and other types of breathing and conditioning exercises.

Positive Expiratory Pressure Therapy

PEP therapy is an airway clearance technique where the patient exhales against backpressure to help mobilize secretions into the larger airways.

This essentially creates a pressure gradient that helps with the movement of secretions. Once mucus reaches the larger airways, then it can be removed by coughing or suctioning.

Autogenic Drainage

Autogenic drainage is an airway clearance technique that utilizes different speeds of breathing at different volumes in order to loosen and mobilize secretions into the larger airways for removal.

It is often used in conjunction with other airway clearance techniques, such as positive expiratory pressure (PEP) therapy or chest physiotherapy (CPT).

Mobilization and Physical Activity

Movement, physical activity, and being mobile helps improve the patient’s ventilatory mechanics, heart rate, cardiac output, and improved physical conditioning.

Not to mention, it also helps mobilize secretions, which is why movement and physical activity are considered types of airway clearance therapy.

High-Frequency Chest Wall Compression

High-frequency chest wall compression (HFCW) is a type of therapy commonly used in patients with cystic fibrosis. It involves the use of an inflatable vest that is connected to a machine that provides intermittent compressions of the chest.

This creates oscillations against the patient’s thorax and chest wall, which help to loosen and mobilize secretions for removal.

Active Cycle of Breathing Technique

The active cycle of breathing technique (ACBT) is a type of therapy that helps mobilize secretions by alternating cycles of deep breathing with relaxed breathing and forced expiration maneuvers.

It is often used in patients with bronchiectasis but can be used in patients with other lung conditions as well. The primary goals of the ACBT is to help clear secretions, improve ventilation, and improve the patient’s cough effectiveness.

Intrapulmonary Percussive Ventilation

Intrapulmonary percussive ventilation (IPV) is a type of therapy that uses a pneumatic machine to deliver small pressurized breaths at a fast rate. This causes vibrations in the airways, which helps loosen secretions and promotes airway clearance.

Studies suggest that IPV is beneficial in patients with COPD by improving gas exchange and reducing lengths of hospital stays.

Mechanical Insufflation-Exsufflation

Mechanical insufflation-exsufflation (MIE) is a type of therapy that uses a device to provide alternating positive and negative pressure to the patient’s airways.

This is known as “cough assist” because it creates an artificial cough in order to help mobilize and remove secretions.

A patient with an ineffective cough is at a high risk of retained secretions. This is when a mechanical insufflator-exsufflator device is indicated.

Example TMC Practice Question:

A 55-year-old female patient with a neuromuscular disorder is intubated and receiving vest oscillation to help mobilize secretions into the larger airways. However, she is having difficulty clearing the secretions. Which of the following techniques would you recommend?

A. Mechanical insufflation-exsufflation
B. Positive expiratory pressure therapy
C. Acetylcysteine via small volume nebulizer
D. Postural drainage, percussion and vibration

To get this one correct, you needed to be familiar with the treatment modalities that are listed in the answer choices when it comes to airway clearance therapy.

It’s common for patients with a neuromuscular disorder to have difficultly mobilizing and clearing secretions. Secretions can be mobilized with vest oscillation, postural drainage, percussion and vibration, and IPV therapy.

BUT, after they’re mobilized into the larger airways, then they must be cleared. And, since this patient is unable to cough up the secretions on their own, mechanical insufflation-exsufflation is indicated to help.

PEP therapy would not be indicated, as the patient is intubated. Acetylcysteine (Mucomyst) may help thin the secretions, however, it’s not actually going to help the patient clear them from their airways.

The correct answer is: A. Mechanical insufflation-exsufflation

This practice question was actually taken from our TMC Test Bank, which is a massive bank of premium practice questions that cover every topic students must know in order to pass the TMC Exam.

As you can see, each question comes with a detailed rationale that explains exactly why the answer is correct. This is critical when it comes to learning the information required to earn a passing score.

If you’re interested in getting access to more practice questions like this one, definitely consider checking it out.

Pass the TMC Exam using practice questions, quizzes, and real-life practice exams.

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?

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

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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?

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 effectiveness of high-frequency external chest wall compression therapy?
Compression frequency and flow bias

12. Which airway clearance technique that 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?
Move the patient to the sitting position until the cough subsides

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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 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 barotraumas.

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 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 to 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.

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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?
Patient with poor coronary artery perfusion, and Patient 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?

73. What are the 4 distinct phases to 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?

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 in doing 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 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 patient 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?

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

92. What are the 3 categories of chest percussors?
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, 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 is altered because of abnormal sodium and chloride transport? It increases the viscosity of mucus and impairs its movement up the respiratory tract.
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?

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 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 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 3 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 3 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 the 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?

116. What are the 2 general approaches to oscillation?
External chest wall application and airway application.

117. What is external application of oscillation referred as?
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 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 thru the canals of Lambert and thru the pores of Kohn?
Airway oscillating devices that produce PEP with oscillations in the airway during expiration.

125. What airway clearance device can decrease 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, bronchiectasis?

128. What is the recommended airway clearance technique for a patient with atelectasis?

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 one-way valve inlet of the system).

135. Before starting postural drainage what assessments should be completed?
Patients 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 lungs, Exhale actively, but NOT forcefully, Perform 10 – 20 breaths, 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 (COPD), 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 mobilization of retained secretions, To prevent or reverse atelectasis, and To optimize 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 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 mucocilliary 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 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 postural drainage?
Turning, Inability or reluctance of patients to change body positions, Poor oxygenation associated with position, Potential for or presence of atelectasis, Presence of artificial airway, Evidence or suggestion of difficulty with secretion clearance, Difficulty clearing secretions, with expectorated sputum production greater than 25 to 30 ml/day, Evidence of suggestion of retained secretions in the presence of an artificial airway, diagnosis of diseases such as CF or bronchiectasis, Presence of foreign body in airway.

163. 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.

164. 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, over distention, and ventilation/perfusion (V/Q) imbalances.

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

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

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

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

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

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

171. 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

172. 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.

173. When should the postural drainage order be reevaluated?
At least every 48 hours for patients in critical care and at least every 3 days for other hospitalized patients and every 3 months for patients receiving home care.

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

175. What are the 3 things needed for normal airway clearance?
A patent airway (open airway), functional mucocilliary escalator, and effective cough, because an effective cough can move mucus from the lower airways to the upper airways for removal.

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


What is the Important of Airway Clearance Therapy?

Airway clearance therapy is important for patients with lung conditions because it helps get rid of mucus, prevents respiratory infections, and improves gas exchange. This ultimately improves the patient’s overall quality of life.

Respiratory infections are a common complication in patients with lung conditions. This is because mucus buildup in the lungs provides a breeding ground for bacteria. By clearing the mucus, patients are less likely to develop respiratory infections.

In addition, airway clearance therapy can help improve gas exchange. This is because when mucus collects in the lungs, it can prevent oxygen from reaching the alveoli. Clearing the mucus can help improve oxygenation and overall respiratory function.

What is an Airway Clearance Technique?

Airway clearance techniques (ACT) are a group of therapies that are used to help clear secretions, improve ventilation, and strengthen the respiratory muscles.

The most common types of ACT include chest physiotherapy, positive expiratory pressure therapy, autogenic drainage, high-frequency chest wall compression, and the active cycle of breathing technique.

How Do You Promote Airway Clearance?

There are various ways to promote airway clearance. The most common method is coughing, which helps to expel secretions from the lungs.

Other methods include deep breathing exercises, postural drainage, and airway clearance devices such as positive expiratory pressure (PEP) and mechanical insufflation-exsufflation (MIE) devices.

What are the Most Common Airway Clearance Devices?

The most common airway clearance devices include mechanical insufflation-exsufflation machines, flutter valves, CPT vests, and IPV devices.

These devices can be used to help clear secretions, improve ventilation, and prevent the buildup of mucus in the lungs.

Final Thoughts

Airway clearance therapy serves a vital role in the management of various lung conditions. As a respiratory therapist, it is important to choose the right type for each individual patient.

With the help of airway clearance techniques, patients can improve their lung function and overall quality of life.

We have a similar guide on lung expansion therapy that I think you’ll find helpful. Thanks for reading and, as always, breathe easy, my friend.

Written by:

John Landry, BS, RRT

John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.


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