Importance of Airway Clearance

The airways of the lungs are made up of a series of branching tubes called bronchi and smaller ones called bronchioles. These tubes help the lungs bring oxygen into the body and remove carbon dioxide from the body. The airways have a coating of mucus to help remove dust, bacteria, and debris from the airways. Tiny hair-like structures, known as cilia, help move the mucus along the airways to help clear away mucus. Over time, the mucus is swallowed or coughed up and out of the airways.

Different respiratory conditions and infections can cause mucus to build up in the airways, creating an ideal environment for bacteria to grow and thrive. This excess mucus buildup can lead to recurring chest infections if not properly cleared out of the airways. Each repeated infection damages the airways a little more and increases the chance for reinfection. Over time, these repeated infections can permanently damage the walls of the airways, causing the airways to widen, scar and thicken, resulting in less efficient transfer of oxygen from the lungs to the body.

Accumulation of excess mucus accounts in large part for the restriction of air in and out of the lungs, causing airway obstruction and repeated damage to the airways. This is a result from recurring mucus buildup, retention, infection, and inflammatory changes, also known as the vicious cycle.

The coughing mechanism, which is the body’s natural airway clearance, is effective and efficient in removing mucus from the lungs. However chronic pulmonary disorders such as cystic fibrosis (CF), COPD and bronchiectasis (BE) alter the production and composition of mucus and lung function, making it harder to cough up the thick, sticky mucus. Neuromuscular diseases can impact the control of motor nerves, and interrupt or weaken respiratory muscle function. In these cases, airway clearance therapy is needed to assist in clearing away mucus from the lungs to help prevent recurring infections and exacerbations and to improve lung function.

What is Airway Clearance Therapy?

Nonpharmacologic Airway clearance therapy (ACT) is indicated for individuals whose function of the cough mechanics are altered and whose ability to mobilize and cough up airway secretions is compromised. For decades, airway clearance therapy has been considered one of the cornerstones of therapy for the prevention and treatment of pulmonary diseases and respiratory dysfunction to aid in the removal of the mucus that cause airway obstruction. Early diagnosis and implementation of ACT, coupled with management of infections and airways inflammation, can help break the vicious cycle associated with chronic pulmonary and neuromuscular respiratory diseases.

Various airway clearance techniques are utilized to help loosen thick, sticky mucus from the airways and mobilizing them so that it can be cleared from the lungs. Airway clearance therapy can utilize physical or mechanical means to aid the in the mobilization of bronchial drainage and facilitate coughing up the mucus. Breathing maneuvers, gravity assisted drainage, manual chest physiotherapy or mechanical devices can be used to mobilize mucus and produce a cough.

Airway Clearance Therapy Techniques

Chest Physiotherapy (CPT)

Chest physiotherapy consists of clapping or percussion of the chest wall with a cupped hand, or mechanical device in a rhythmic fashion to loosen mucus from the bronchial walls.

High Frequency Chest Wall Oscillation (HFCWO)

High frequency chest wall oscillation (HFCWO) is performed with a mechanical vest worn by patients that deliver vibratory forces that oscillate through the chest wall into the lungs to loosen and mobilize secretions.

Huff Coughing

Huff coughing is one of the easiest airway clearance techniques and helps to release mucus from the lungs and passed into airways for clearing. It involves taking a breath in, holding it, and actively exhaling.

Positive Expiratory Pressure (PEP)

The PEP device consists of a face mask or mouthpiece and a one-way valve attached to an expiratory resistor to hold airways open for patients to breath in and out against the resistance.

Oscillating Positive Expiratory Pressure (OPEP)

OPEP therapy devices use a mechanical means to interrupt flow, and an expiratory resistor to create air flow oscillations during active exhalation of breath through the device.

Autogenic Drainage

Autogenic drainage uses low breathing to loosen mucus, normal breath volume to collect mucus, and a large breath to maximize expiratory flow and move mucus from the central airways where they can be cleared by a cough.

Postural Drainage

Postural drainage includes the use of patient positioning to assist gravity in facilitating the movement of lung mucus from peripheral airways to the larger bronchi where they can be cleared out by coughing.

Active Cycle of Breathing Technique

ACBT uses alternating cycles of breathing control or relaxed breathing, and chest expansion exercises to mobilize lung mucus, and the forced expiration technique to facilitate secretion removal.

Choosing the Right Therapy

When choosing an airway clearance therapy, it is important to take into consideration both the patient’s and the physician’s suggestions and preferences. An airway clearance regimen should be effective, efficient, easy to use, able to be undertaken independently or with minimal assistance, and should improve lung function. It should also be flexible, comfortable and adaptable to meet the changing needs of the individual patient.

Adherence to airway clearance therapy can significantly influence outcomes of the therapy, therefor it is important to select a therapy that the patient will comply to regularly. Several studies have suggested that poor adherence to prescribed ACT exists across all age ranges. Lack of adherence has been linked to lengthy treatment times, perceived lack of efficacy, coping mechanisms, level of knowledge of the therapy, and personal preference for the ACT device or therapy.

The Choice is Yours

AffloVest, a tried true and proven airway clearance therapy with more than 10,000 plus already in clinical use, is the first battery-operated High Frequency Chest Wall Oscillation therapy that let patients with bronchiectasis, cystic fibrosis, and neuromuscular diseases receive state-of-the-art airway clearance therapy on the go.

AffloVest has eight mechanical oscillating motors scientifically engineered to target all 5 lobes of the lungs, front and back, with direct dynamic oscillation which allows patients to be fully mobile during use. With no bulky hoses or generators, the AffloVest is engineered to encourage treatment adherence and compliance by allowing patients to experience an improved quality of life during airway clearance treatments.

AffloVest can be an effective airway clearance therapy for improving bronchial drainage by enhancing mobilization of mucus in the treatment of respiratory diseases, such as bronchiectasis, cystic fibrosis, and neuromuscular respiratory diseases. By being prescribed AffloVest, patients can come out of the shadows and experience full mobility during treatment, which helps them adhere to their therapy. The choice is yours.