Airway Clearance Therapy for NTM Patients
With over 51 million people in the U.S. having a chronic lung disease and over 200,00 deaths each year due to respiratory illnesses (pre-pandemic) there needs to be a continued focus on respiratory care¹’². Since Respiratory Care Week is fast approaching it is time for an added focus on why and how to promote respiratory care.
Why is this Respiratory Care Week important? It is two-part. First, it allows a focus on the importance of keeping lungs healthy and secondly, it promotes the growing respiratory field with a need for more respiratory therapists as the Baby Boomers are aging and in need for more specialized care.
It is projected that the need for respiratory therapists will grow 19% by 2028 due to, besides the aging population, advances in preventing and detecting disease, improved medications, and the development of more sophisticated treatments.³
A little history about Respiratory Care Week⁴
President Reagan’s proclamation for National Respiratory Care Week stated, “Chronic lung diseases constitute an important health problem in the United States, and they need to be addressed.”
It is no different 37 years later. Chronic lung diseases are an important health problem, and the prevalence is increasing, in addition to treating patients during a pandemic.
“Now, more than ever before, the role of the respiratory therapist is vital to the health of our nation,” said AARC Executive Director Tom Kallstrom, MBA, RRT, FAARC. “Respiratory therapists sacrifice and dedicate themselves to helping their patients and their communities during this time of COVID-19.”⁵
As a vital member of the care team for people needing respiratory care, respiratory therapists (RTs) can help patients work on breathing problems in a variety of medical settings.
Treatment of chronic respiratory diseases tends to focus on the “big ones” like COPD and asthma. But to get treatment you need to get the proper diagnosis. What can be difficult is that many symptoms of respiratory diseases are similar, or they can be categorized as “overlap syndromes” like ACOS (Asthma-COPD Overlap Syndrome). Some of the symptoms of these diseases are dyspnea (shortness of breath), chronic cough, potential for daily sputum production, and airflow obstruction.⁶ Another reason diagnosis can be difficult is a lack of access to health care resources for diagnostic investigations like a CT scan.⁷
What about the other respiratory diseases? Bronchiectasis may be the 3rd most common chronic airway disease after asthma and COPD, particularly with those of advanced age.⁷ Did you know 42% of patients with COPD may have bronchiectasis?⁸ That equates to 5 million people diagnosed for COPD that may be misdiagnosed or have an underlying or overlapping condition of bronchiectasis. There needs to be a focus on the diagnosis so that the appropriate treatment — preventative and reactive — can be administered to the at-risk respiratory patient.
It is time to promote good, bronchial hygiene for at-risk pulmonary patients so they can be in the best health possible for normal, everyday living now and in the future. Early detection and intervention among symptomatic patients are key. Initial diagnosis and implementation of airway clearance therapy can reduce morbidity and mortality.⁹
Airway clearance therapy is treatment that uses a number of techniques to clear the respiratory airways of mucus and other secretions. Airway clearance therapy aims to reduce airway damage by halting the vicious cycle of bacteria and subsequent inflammation, reduce the number of pulmonary exacerbations and hospitalizations and improve health-related quality of life.¹⁰
The goals of treatment in bronchiectasis are to facilitate airway clearance, suppress bacterial infection and prevent exacerbations. Patients should be made aware of the range of available airway clearance techniques including High Frequency Chest Wall Oscillation (HFCWO) vest therapy, huff coughing, bronchodilators, hypertonic saline, positive expiratory pressure and exercise. Patient preference and adherence to treatment should be considered when recommending and discussing airway clearance techniques. The frequency and duration of the airway clearance technique should be tailored to the individual and may alter during periods of exacerbation.
Respiratory care is important and vital to those with respiratory illnesses be it acute or chronic. Respiratory therapists have a multitude of jobs and responsibilities to help their patients from conducting lung function tests and administering inhaled drugs to developing smoking cessation plans for patients and educating patients on the different airway clearance therapy options available to them. These are just a few examples of the “day in the life” of a respiratory therapist – pre-pandemic.
We thank you for the tireless work you do every day for your patients!
2. Top Ten Causes of Death in America. U.S. News and World Report. January 2020.
3. Respiratory Therapists: Occupational Outlook Handbook. U.S. Bureau of Labor Statistics. September 2020.
5. Respiratory Therapists: Warriors in the Fight Against COVID-19. March 26, 2020. www.aarc.org
6. Athenazio, R. Airway Disease: Similarities and Differences Between Asthma, COPD and Bronchiectasis. Clinics. 2012; 67(11):1335-1343.
7. Martinez-Garcia, M. et al. Bronchiectasis and Chronic Airway Disease: It Is Not Just About Asthma and COPD. CHEST. 2018; 154(4):737-739.
8. Kosmas, E. et al. Bronchiectasis in Patients with COPD: An Irrelevant Imaging Finding or a Clinically Important Phenotype? CHEST. 2016; 150(4):894A.
9. Volsko, T. Airway Clearance Therapy: Finding the Evidence. Respiratory Care. October 2013.
10. O’Neill, K. et al. Airway Clearance, Mucoactive Therapies and Pulmonary Rehabilitation in Bronchiectasis. Respirology 2019.