6 Airway Clearance Therapies for COPD Mucus Treatment

airway clearance therapy, copd mucus treatment, copd mucusIn many patients with chronic obstructive pulmonary disease (COPD), increased mucus production and retention of excess mucus are persistent problems increasing the risk of lung infections. Because frequent lung infections damage lung tissue even further and worsen COPD, learning how to effectively clear mucus from the air passages is an important part of living with the disease.

Airway clearance therapy helps people with COPD clear mucus from their lungs. There is little scientific evidence supporting one airway clearance technique over another so patient preference plays a starring role in deciding which airway clearance technique works best for you. The following are 6 airway clearance therapies that you may want to consider if excess COPD mucus is a problem:

Controlled Coughing

A strong cough is one of the most effective airway clearance therapies available, but people with COPD who have a weakened cough reflex often find mustering up an effective cough difficult. That’s where controlled coughing comes in handy. Follow the steps below to initiate an effective, more productive cough:

  1. Sit upright in a chair with your feet firmly on the ground. Take a few deep breaths allowing your body to relax.
  2. Place the fist of your dominant hand just under your ribcage. Wrap your non-dominant hand firmly around your fist. Inhale deeply through your nose pushing your belly outward. Try to hold your breath for 3 seconds.
  3. While exhaling slowly, lean slightly forward. With your mouth partially open, cough two to three times while pushing inward on your abdomen with your fists. Keep your elbows straight out and your coughs short and sharp. If you feel your diaphragm (breathing muscle) move upward when you cough then you’re doing it correctly.
  4. Inhale slowly through your nose “sniffing repeatedly” through the entire inhalation to prevent mucus from draining back into your air passages.
  5. Spit your mucus into a tissue and observe. Report any changes in your mucus to your health care provider.
  6. Rest and repeat as necessary.

Chest Physiotherapy

Chest physiotherapy (CPT) involves a therapist or caregiver clapping gently but firmly on the chest and back to loosen thick secretions in the air passages. This makes them easier to expel, or cough up. CPT can be performed manually with the hands or with the assistance of a mechanical, hand-held percussive device. CPT works best after treatment with a bronchodilator.

Postural Drainage

Often coupled with CPT, postural drainage is an airway clearance therapy that uses gravity to facilitate mucus clearance from the air passages.  Each postural drainage position (there are at least 10) is designed to promote drainage from a different segment of the lung. Postural drainage can be done alone or with the assistance of a caregiver, friend or family member. Several studies suggest that combining postural drainage with CPT increases mucus clearance in the lungs.[1]

High Frequency Chest Wall Oscillation

High frequency chest wall oscillation (HFCWO) is performed with an inflatable vest that gently compresses and releases the chest wall many times per second. This process is thought to mobilize thick secretions in the air passages making them easier to clear. Studies suggest that HFCWO improves lung function and quality of life in some COPD patients and should be included among the principle options in chest physiotherapy.[2] Devices that incorporate HFCWO include The Vest, SmartVest and the AffloVest systems.

Positive Expiratory Pressure (PEP) Therapy

PEP therapy was developed in the 1970’s as an alternative to standard CPT. With PEP therapy, patients take in a normal breath and then exhale slowly into a facemask or mouthpiece against gentle resistance. The device allows more air into the smaller air passages which creates pressure behind thick secretions and pushes them toward the larger air passages where they can be expelled. In clinical studies, PEP therapy was found to improve mucus clearance, increase patient comfort (compared to standard CPT), reduce lung infections, and reduce hospital stays.[3] Examples of PEP therapy devices include the Astra PEP Mask and the AeroPEP.

Oscillating PEP therapy combines the benefits of standard PEP therapy with high frequency oscillations to loosen lung secretions. Examples of oscillating PEP therapy devices include the Acapella and the Flutter device.

Vibralung Acoustical Percussor

The Vibralung Acoustical Percussor applies vibratory sound waves over a wide range of frequencies during inhalation and exhalation to loosen mucus in the air passages so it can be easily expelled. Unlike other devices that require considerable breathing effort to be effective, the Vibralung requires only minimal patient effort with normal breathing. Vibralung vibrates the airways and mucus directly, as opposed to indirectly through the chest wall like a HFCWO vest. In clinical studies, Vibralung was equally effective at mucus expectoration and increasing lung function when compared to the vest. Patients who used both the vest and the Vibralung during their hospital stay were discharged on time, which further establishes the efficacy of the Vibralung device.[4]

[1] CP van der Schans PT PhD. Conventional Chest Physical Therapy for Obstructive Lung Disease. RC Journal. 2007.

[2] Nicolini, Antonello, et. al. “Effectiveness of treatment with high-frequency chest wall oscillation in patients with bronchiectasis”. BMC Pulmonary Medicine 2013, 13:21  doi:10.1186/1471-2466-13-21.

[3]Hristara-Papadopoulou, A. et. al. “Current devices of respiratory physiotherapy”. Hippokratia. 2008 Oct-Dec; 12(4): 211–220

[4] Wheatley, Courtney M., PhD, et. al. Influence of the Vibralung Acoustical Percussor on Pulmonary Function and Sputum Expectoration in Patients with Cystic Fibrosis: A Preliminary Safety and Efficacy Study Conducted on Behalf of Westmed, Inc. Accessed September 19, 2015.

By Deborah Leader RN, BSN, PHN


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