Clinical Brief: Airway Clearance Techniques in Bronchiectasis Management
Main Discussion Topics
- Airway clearance is a mainstay of bronchiectasis management, particularly for symptomatic patients.
- Multiple technique options include manual methods, exercise, devices, and nebulized therapies.
- Pulmonary rehabilitation provides structured exercise support, but access may be challenging.
Key Points for Physicians
- Recommend airway clearance for patients with:
- Chronic productive cough
- Mucus impaction on CT imaging
- Technique options include:
- Manual techniques (chest physical therapy, postural drainage, active cycle breathing)
- Exercise (walking particularly helps with oscillation effects)
- Mechanical devices (positive expiratory pressure devices, high-frequency chest wall oscillation)
- Nebulized hypertonic saline
- Consider pulmonary rehabilitation for patients with limited exercise tolerance.
- Virtual pulmonary rehabilitation may help overcome access barriers.
Notable Insights
Walking exercises are particularly beneficial as heel striking mimics the oscillation that helps mobilize mucus, augmenting airway clearance.
Clinical Significance
A comprehensive airway clearance approach combining multiple techniques is essential for effective bronchiectasis management and preventing exacerbations.
