Airway Clearance Therapy (ACT): An Effective Tool for Treating COPD Airway Obstruction

One of the most common questions we hear COPD patients ask is, “how can I clear my airways when they get congested?” As a COPD patient, you’re likely to experience coughing fits that are brought on by the buildup of mucus and sputum in the airways and lungs. And sometimes, no matter how hard you try, you feel like you can’t clear them in order to catch a breath of fresh air. This is far more common than you might expect and it can be a frustrating and sometimes even scary experience.

 

Another thing that many people don’t realize is that airway clearance can be a lot more complicated than learning how to cough correctly. There are many different techniques that can be applied, and it’s also helpful to know why your airways are becoming congested in the first place. In this post, we’ll help you understand some of these concepts and provide you with a step-by-step guide on how to clear your airways safely.

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As always, it’s imperative that you speak to your doctor if you experience ongoing issues with coughing, wheezing, or shortness of breath. These symptoms tend to get worse over time unless the root cause is dealt with. What’s more, coughing fits can lead to flare-ups and exacerbations which can put you in the hospital.

 

Why does COPD Make it Difficult to Clear Your Airways?

There are two different types of chronic lung disease: obstructive and restrictive. A restrictive lung disease like pulmonary fibrosis or interstitial lung disease is one that affects the lungs’ ability to expand. An obstructive lung disease like COPD or bronchiectasis, however, prevents you from fully expelling air from the lungs. This is especially problematic when the patient tries to cough because they may not have the force necessary to clear mucus and other substances from the airways.

 

 

Another reason that COPD makes it more difficult to clear your airways is that this disease is associated with changes in the way that mucus and sputum are produced in the body. In a healthy individual, mucus plays a vital role in the body’s immune function. The body carefully regulates the mucus lining the airways and lungs so that there is enough to trap bacteria but not so much that you choke or can’t breathe naturally. However, in COPD patients, there is usually an overproduction of mucus due to oversized mucus glands and an overabundance of goblet cells. 

 

If you’re a current smoker, this could be another reason that you’re experiencing issues with airway obstruction. According to the Centers for Disease Control and Prevention (CDC), as many as 38 percent of COPD patients are current smokers. This study published in the Karger medical journal found that moderate and heavy smokers have a higher impairment in mucociliary clearance than their non-smoking counterparts. One of the key ways that smoking affects airway clearance is by damaging and killing cilia. These are tiny hair-like organelles that help to push mucus and other debris out of the airways. 

 

 

Since there are so many different causes of airway obstruction in COPD, it’s important to have a comprehensive treatment plan to deal with these symptoms. Airway clearance therapy can and should be used, but it won’t be as effective if you aren’t following all other aspects of your treatment plan that your doctor has designed for you. Ideally, if you’re following your treatment plan carefully, you won’t experience mucus buildup as frequently and you’ll only need to use airway clearance techniques in rare circumstances. 

 

What is Airway Clearance Therapy (ACT)

Airway clearance therapy, or sometimes called airway clearance techniques, is a group of scientifically backed methods used for clearing mucus from the airways. These techniques were developed as a more controlled version of our body’s natural airway clearance techniques like coughing and wheezing. A chronic and persistent cough or episodes of wheezing can be extremely unhealthy, especially if they lead to you losing sleep or feeling lightheaded or fatigued. Airway clearance techniques aim to not only make COPD patients more aware of how they’re coughing, but also provide them with some entirely new methods that may be more effective.

 

 

Generally speaking, airway clearance techniques are divided into seven different categories. Everyone has a slightly different way of practicing these techniques, so don’t be alarmed if your pulmonologist tells you something that differs from what you have read here. Our goal is simply to provide you with an overview so that you can better understand how airway clearance therapy works.

 

1.) Controlled Coughing 

Like we mentioned before, uncontrolled coughing is problematic in COPD patients. Without understanding how your lungs, airways, and mucus work, simply expelling air in an attempt to dislodge any obstruction can be more effort than it’s worth. One of the biggest problems associated with normal coughing or wheezing is that it often causes the airways to collapse, meaning that no matter how hard you cough, the mucus will be stuck. If you hear a wheezing or whistling noise when you cough, this is a sure sign that your airways collapse when you cough.  Controlled coughing is focused on keeping the airways open so that you’re not wasting valuable energy and oxygen.

 

 

The first rule of controlled coughing is to avoid inhaling sharply through your mouth. This can send mucus back down the airways and be very counterproductive. Instead, inhale slowly but deeply through your nose. This way you have enough oxygen to cough correctly. It’s best to practice controlled coughing while sitting down and you should try to relax as much as possible. Especially try to eliminate the tension in your shoulders and chest because this can contribute to the airways becoming narrow.

 

Once you’re seated, lean forward slightly and place your hands on your abdomen. You’re going to cough three times and you should really focus on the quality of each one to ensure that the mucus is moving out of your airways rather than back down into your lungs. Be sure to take a deep breath through your nose between each cough to ensure that you move enough air. If you need to take a moment to relax between each cough, this can be helpful.

 

 

Another technique that’s similar to controlled coughing is huff coughing. For the most part, you will follow the same steps as you would for controlled coughing. However, instead of coughing, you’re going to be forcing air through your airways similar to how you would fog up a mirror or how you would clean a phone screen or your glasses. In other words, you’re expelling air out your mouth without creating any vibrations in your chest or throat.

 

2.) Autogenic Drainage (AD)

The aim of autogenic drainage is to move mucus from the smaller airways into the larger airways (peripheral airways into central airways). By doing this, it is much easier to dislodge the mucus because it’s all in one area. The rationale for autogenic drainage is based on a principle of solid mechanics called shear force. This is when unaligned forces are applied to an object causing it to bend in two different directions. In the case of autogenic drainage, the mucus and other secretions in the airways are the object that’s being manipulated. This is done through a series of carefully monitored breathing techniques.

 

3.) Postural Drainage and Percussion (PDP)

Postural drainage and percussion, also known as chest physical therapy (CPT), is a technique that involves using your hands to assist with airway drainage. While you can do PDP on your own, it’s often recommended that you have someone assist you with it, whether it’s a friend, loved one, or your physical therapist. Like autogenic drainage, PDP is a technique that will take some time to perfect so it helps to be patient as you learn the ins and outs of this method.

 

The reason this method is called “postural” drainage is that you are going to use different positions that leverage gravity in order to drain the mucus from your airways. The general rule of thumb is that your hips should be higher than your chest. Whether this means laying on your back, side, or stomach, you can do whatever is most comfortable for you. Many people prefer to use pillows or blankets to elevate their hips. 

 

Once you’ve found a comfortable position you can begin the percussion. Most specialists recommend cupping your hand and placing it palm down on your chest. This will allow you to break up the mucus in your chest without hurting yourself. The percussion can also be done on your back but it’s best to have a partner to help you out with this.  

 

4.) Positive Expiratory Pressure (PEP) Therapy

Essentially, the term positive expiratory pressure means experiencing greater resistance when you’re exhaling than when you’re inhaling. This is done with a PEP device which you hold to your mouth and breath into. The device allows you to inhale normally, but when you go to exhale, you experience resistance about four times greater than what you would normally experience. What this does is keeps your airways open as you exhale and allow the force of your air to get behind the mucus and push it out of the airways.

 

5.) Oscillating Positive Expiratory Pressure

Oscillating positive expiratory pressure therapy is very similar to the method above. However, an oscillating PEP device uses high-frequency oscillations that break up mucus as you exhale. Oscillating PEP devices look similar to traditional PEP devices but they have a ball inside that rattles around as you exhale. This is what creates the vibrations in your upper chest. After blowing into the device several times, you can take a break to clear out any mucus that the device brought up. Then simply repeat the process.

 

6.) High-Frequency Oscillating Vest

A high-frequency oscillating vest is another tool that can be used for airway clearance. This is an inflatable device that looks a lot like a life vest. The oscillating vest is connected to an air compressor via two hoses. Once it’s turned on, the vest inflates and deflates in rapid succession. The basic principle is that it uses positive and negative pressure changes in the chest to augment peripheral and tracheal mucus movement towards the airway opening. After a set period of time, the device is stopped and the patient can cough to bring up the mucus.

 

 

While high-frequency oscillating vests are very effective, they aren’t without disadvantages. These vests can be very expensive to purchase and maintain. What’s more, they’re not very portable in comparison to the PEP devices which we discussed earlier. If you’re someone who travels a lot you might find that high-frequency oscillating vests are more trouble than they’re worth.   

 

7.) Active Cycle of Breathing Technique (ACBT)

The active cycle of breathing technique is an airway clearance method that combines positioning, breathing, and coughing. Since this is the most complex airway clearance technique it’s also the most flexible when it comes to being adapted to fit a variety of patient’s needs. The goals of ACBT include improving the effectiveness of your coughs, improving lung ventilation, and clearing secretions from the lungs. Below are the three different phases of ACBT:

 

Phase 1 - Breathing Control and Relaxation

The first step in ACBT is to bring your breathing under control and completely relax your body. The majority of the tension in your body will be located in your shoulders, chest, and back, and many people are unaware of how much this can affect the way you breathe. Start by closing your eyes and placing your hands on your stomach. Sit with your back straight and begin to practice pursed lips breathing. This is where you inhale slowly through your nose and exhale fully through pursed lips.

  

Phase 2 - Thoracic Expansion Exercises

As the title suggests, the aim of phase 2 in the active cycle of breathing technique is to expand the chest. During this step, you will take 3 to 5 deep breaths in through your nose and out through your mouth while keeping your shoulders and chest relaxed. At the peak of each inspiration, you will hold your breath for 2 to 3 seconds. After the allotted time, simply release the air rather than trying to force it out.

 

Phase 3 - Forced Expiratory Technique (FET)

The forced expiratory technique is another way of saying “huff” cough. Like we described under the “controlled coughing” section, a huff cough is a way of clearing mucus without allowing the airways to collapse. You’re simply pushing air out the lungs but putting more air behind it than you would with a normal breath. You should repeat this after each thoracic expansion that you do.

 

Other Ways to Prevent Airway Obstruction With COPD

 

Drink Plenty of Water

Your ability to prevent airway obstruction depends heavily on your level of hydration. Mucus is made up of about 97 percent water. However, slight variations in this can cause it to become extremely thick and difficult to clear from the airways. Since every organ in your body uses water, it’s imperative that you aren’t starving yourself of this vital resource. According to COPD.net, the average COPD patient should drink between 8 and 12 glasses of water every day.

 

 

As you work to increase your water intake, it’s also important to reduce your intake of other types of fluid. Milk, and dairy products in general, are known for thickening your mucus so you’re going to want to avoid these as much as possible. Much like salt, sugar has the ability to dehydrate you, so you should avoid sugary sodas, fruit juices, or sweetened tea. If you absolutely have to drink something other than water, try unsweetened hot green tea which will not only thin your mucus but has a number of other health benefits as well.

 

Maintain a Balanced Diet

Healthy eating is all about getting the right balance of nutrients that your body needs to stay healthy. For COPD patients and people with other respiratory illnesses, this could mean consuming less sodium and salt which contributes to problems like airway obstruction. You should also avoid highly processed foods which can contribute to bloating and thus making it more difficult to breathe. Most COPD patients tend to do better with a diet that is high in protein and healthy fat which is easy to digest and will support healthy lung function.  

 

 

Use COPD Medications Effectively

Depending on how severe your COPD is, your doctor has likely prescribed you some medication for coping with your symptoms. One of the most common medications for COPD is called bronchodilators. These medications open up the airways so that you can breathe easier and they can make it easier for you to perform the airway clearance techniques listed above. Ask your doctor about changing up your treatment schedule to assist with airway clearance. 

 

 

Another medication that can help with airway clearance is a class of drugs called expectorants. These are medications are designed to thin the mucus in your airways making it easier to clear. Expectorants aren’t designed specifically for COPD patients because they’re also used to treat congestion associated with the common cold and the flu. While expectorants are available for over-the-counter purchase, you should be sure to ask your doctor before using them because they may have adverse interactions with the COPD medications you already take.

 

Pulmonary Rehabilitation

Pulmonary rehabilitation (PR) is an exercise and education program focused on improving lung strength and function. COPD patients should begin pulmonary rehabilitation right after they’re diagnosed so that they learn the best way to take care of their lungs and slow the progression of COPD. Another benefit of PR that many people don’t realize is that it can help with airway clearance. According to a study published in the European Respiratory Journal, exercise improves mucosal clearance in the small airways by releasing moderators that increase fluid secretion and stimulate cilia beat frequency. What’s more, PR increases lung strength and endurance which can help you perform the airway clearance techniques listed above.

 

 

Get More Restful Sleep

Getting restful sleep is a problem that many people face for their whole lives. According to the Sleep Association, around 50 to 70 million people suffer from a sleep disorder in the United States. So, as you can imagine, there is a lot of overlap between people suffering from COPD and people suffering from sleep disorders. If you’ve never been diagnosed with a sleep disorder or provided with treatment for your sleep disorder, now is the best time to seek help. Addressing your sleep problems will have undeniable benefits when it comes to helping you manage your COPD. If you’d like to learn more about getting restful sleep with COPD, please read through this article.

 

 

Conclusion

Airway clearance therapy is an incredibly important skill for all COPD patients to learn. However, it’s not an all-in-one solution. Drinking enough water, getting enough sleep, eating right, and exercising are all great ways to prevent airway obstruction and prevent the need for alternative therapies. If you’re experiencing frequent coughing or wheezing, we recommend contacting your pulmonologist immediately so that you can address your concerns.

 

Here at LPT Medical, we specialize in life-saving oxygen equipment which can help you maintain your oxygen levels if you are experiencing a coughing fit or COPD exacerbation. We will help you get the best deal on the market for portable oxygen concentrators like the Caire FreeStyle Comfort or the Inogen One G5. These devices are much lighter and reliable than traditional oxygen delivery devices allowing you to go more places without worrying about whether or not you’re getting enough oxygen. Since the oxygen is administered through a nasal cannula you can still do all of the airway clearance techniques above while you’re receiving oxygen.

 

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It’s very important to us that you receive the oxygen concentrator that’s right for you. When you reach out to us, you will be connected with a respiratory specialist who will ask you questions about your oxygen use and lifestyle. If cost is a concern for you, we also have a variety of different buying options including new, used, and refurbished concentrators. We also have financing options available if you’d like to pay in easy monthly installments. Reach out to us either by phone or email for more information.