Options for treating compromised airway clearance

As a first step in treating chronically impaired airway clearance, prior to incorporating high frequency chest wall oscillation (HFCWO) into a patient’s treatment plan, physicians typically prescribe — and most insurance carriers accept for reimbursement — some combination of the following therapies.

Inhaled prescription medications

  • Bronchodilators, such as Albuterol, help open the airways.
  • Mucolytics, including Pulmozyme, break down the structure of mucus.
  • Expectorants increase the volume or hydration of secretions and can induce coughing.
  • Mucokinetics increase movement of mucus via coughing or other natural processes.
  • Abhesives, including surfactants, decrease the ability of mucus to cling to airways.
  • Mucoregulators, such as anti-inflammatories and some antibiotics, reduce production of pulmonary secretions.

Airway clearance techniques

  • Coughing. Enhanced techniques include the “huff cough,” directed cough and the forced expiratory technique.
  • Chest physiotherapy (CPT). Prior to HFCWO’s invention, CPT was standard treatment for diseases and conditions that impair airway clearance. The patient lies in various positions, using gravity to promote drainage, while a therapist or caregiver claps on the chest or back.
  • Active Cycle of Breathing Technique (ACBT).  ACBT employs normal, gentle breathing; deep breaths; and huffing of varied lengths. It also can include clapping or vibrating the chest.
  • Autogenic drainage (also called “self-drainage”). By inhaling to different levels and adjusting on the exhale, patients attempt to boost airflow.

Airway clearance accessories and devices

  • Positive Expiratory Pressure (PEP). PEP employs a mask or mouthpiece attached to a machine that creates resistance to exhaling, holding open the patient’s airways.
  • Oscillatory PEP. These devices provide PEP therapy and also vibrate the large and small airways, which thins, dislodges and moves mucus. Examples include the Flutter, Acapella and Cornet. Intrapulmonary percussive ventilation (one type of oscillatory PEP) administers airway-dilating aerosols in 200 to 300 small bursts per minute, increasing airway humidification and stimulating cough.
  • Mechanical cough-assist device. Also known as a mechanical insufflator-exsufflator, the device increases the volume of air inhaled with negative-pressure breaths, which boosts lung recoil pressure and increases cough airflows.