SPUTUM CLEARANCE for spontaneously-breathing patients manual and mechanical techniques, cough, minitracheostomy, drugs and cough
(SEE ALSO cystic fibrosis, humidification)
BTS GUIDELINES for the management of cough in adults (2006). Thorax, 61 (Suppl 1) i1-i24
www.brit-thoracic.org.uk/Portals/0/Clinical%20Information/Cough/Guidelines/coughguidelinesaugust06.pdf
AARC Clinical Practice GUIDELINE (1993): Directed cough. Respir Care, 8, 5, 4959
www.rcjournal.com/cpgs/dccpg.html
AARC Clinical Practice GUIDELINE: Use of positive airway pressure adjuncts to bronchial hygiene therapy. Respir Care, 38, 5, 51621
www.rcjournal.com/cpgs/papcpg.html
NICE GUIDELINES on urinary incontinence.
www.nice.org.uk/nicemedia/live/10996/30279/30279.pdf
video on the Acapella:
link.brightcove.com/services/player/bcpid4862024001
Alves LA et al (2008) Performance analysis of the Flutter CRP1 under different flows and angles. Respir Care, 53, 3, 316-23
Anderson J, Hasney K, Beaumont N (2005) Systematic review of techniques to enhance peak cough flow and maintain vital capacity in neuromuscular disease: the case for mechanical insufflationexsufflation. Phys Ther Rev, 10, 1, 25-33
Baldwin (1994) Effect of addition of exercise to chest physiotherapy on sputum expectoration and lung function in CF adults. Respir Med, 88, 49-53
exercise increases mucociliary clearance
Butler SG, Sutherland RJ (1998) Current airway clearance techniques. NZ Med J, 111, 183-6
overview of manual techniques, breathing techniques, devices and exercise
Button BM et al (1994) Postural drainage exacerbates gastroesophageal reflux in patients with lung disease. Ped Research, 36, 1, 2.
gastrooesophageal reflux worsened by head-down PD
Bye (1997) Exercise performance and rehabilitation in CF. Crit Rev Phys Rehab Med. 9, 1, 1-33
exercise increases mucociliary clearance
Campbell (1988) Minitracheotomy and laryngeal function. J Laryngology Otology, 102, 49-52
Cantin AM, Bacon M, Berthiaume Y (2006) Mechanical airway clearance using the frequencer electro-acoustical transducer in cystic fibrosis. Clin Invest Med, 29, 3, 159-65.
www.ncbi.nlm.nih.gov/pubmed/17058435
Cecins NM, Jenkins SC, Pengelley J, Ryan G (2002) The active cycle of breathing techniques--to tip or not to tip? Respir Med, 93, 660-5
head-down tip during ACBT may reduce adherence
Dallimore K, Jenkins S (1998) Respiratory and cardiovascular responses to manual chest percussion in normal subjects. Austr J Physioth, 44, 267-74
chest percussion increases sputum volume, oxygen consumption and heart rate
Eaton T (2007) A randomized evaluation of the acute efficacy, acceptability and tolerability of Flutter and active cycle of breathing with and without postural drainage in non-cystic fibrosis bronchiectasis. Chron Respir Dis, 4: 23-30
ACBT with postural drainage is more effective than ACBT alone or the Flutter, but is more acceptable to patients than the Flutter:
Elkins MR, Jones A, van der Schans C (2004) Positive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis. The Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD003147. DOI: 10.1002/14651858.CD003147.pub2
www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003147/frame.html
PEP is preferred by some patients
Feng W, Deng WW (1998) Short-term efficacy of RC-Cornet in bronchiectasis. Chest, 114, 320
the Cornet decreases sputum viscosity
Fink JB (2002) Positioning versus postural drainage. Respir Care, 47, 769-77
use of turning, mobilization and exercise and postural drainage
Fink JB (2002) Positive pressure techniques for airway clearance. Resp Care, 47, 786-96
mechanism of PEP therapy
Giles (1995) Short-term effects of postural drainage with clapping vs autogenic drainage in CF. Chest, 108, 952-4
autogenic drainage is less likely to reduce saturation than postural drainage and percussion
Goodfellow LT (2002) Bronchial hygiene therapy. Am J Nurs, 102, 1, 37-42
Hardy (1993) Advances in our understanding of CF. Resp Care, 38, 282-9.
autogenic drainage improves airflow in small airways which are normally inaccessible
Haas CS, Loik PS, Gay SE (2007) Airway clearance applications in the elderly and in patients
with neurologic or neuromuscular compromise. Respir Care, 52, 10,13621381
www.rcjournal.com/contents/10.07/10.07.1362.pdf
Hassam M, Williams M (2003) Education via simulation: teaching safe chest percussion for pre-term infants. HK Physiother J, 21, 22-8
Hess DR (2002) Secretion clearance techniques: absence of proof or proof of absence? Respir Care, 47, 7, 757-8
www.rcjournal.com/contents/07.02/07.02.0757.cfm
Hess DR (2007) Airway clearance: physiology, pharmacology, techniques, and practice
Respir Care, 52, 10, 13921396
www.rcjournal.com/contents/10.07/10.07.1392.pdf
Hirayama F (2010) Breathlessness is associated with urinary incontinence in men. BMC Pulm Med, 10, 2, doi:10.1186/1471-2466-10-2
theres a significant association between incontinence and breathlessness in middle-aged and older men
for women with CF and asthma, stress incontinence is related to chronic coughing which raises intra-abdominal pressure and damages the pelvic floor
Holland AE, Button BM (2006) Is there a role for airway clearance techniques in chronic obstructive pulmonary disease? Chronic Respir Dis, 3, 2, 83-91
www.ingentaconnect.com/content/sage/crd/2006/00000003/00000002/art00005
PEP and autogenic drainage are thought to be effective, but it may be advisable to avoid techniques that involve forced expiration
Holz O (2000) Update on sputum methodology. Eur Resp J, 16, 355-9
Homnick DN (2007) Mechanical insufflation-exsufflation for airway mucus clearance. Respir Care, 52, 10, 12961305
www.rcjournal.com/contents/10.07/10.07.1296.pdf
includes physiology of cough
Houtmeyers (1999) Regulation of mucociliary clearance. Eur Resp J, 13, 1177-88
Houtmeyers E, Gosselink R (1999) Effects of drugs on mucus clearance. Eur.Resp.J, 14, 452-67
www.erj.ersjournals.com/content/14/2/452.full.pdf+html
Irwin RS (1998) Managing cough. Chest, 114, 133S-178S
causes, complications and pharmacology of acute and chronic cough
Jarad NA, Powell T, Smith E (2010) Evaluation of a novel sputum clearance techniquehydro-acoustic therapy in adult patients with cystic fibrosis. Chronic Resp Dis, 7, 4, 217-27
crd.sagepub.com/content/7/4/217.abstract?etoc
acoustic waves can clear secretions by creating vibrations through a fluid, for patients who are willing to sit in a bath
King M (1997) Mucoactive therapy. Ped Pulmonol, suppl.14, 122-3
how oscillations reduce viscosity of secretions
Lapin CD (2002) Airway physiology, autogenic drainage and active cycle of breathing. Respir Care, 47, 778-85
equal pressure point, huffing, collateral ventilation + literature review
Marchant WA, Fox R (2002) Postoperative use of a cough‐assist device in avoiding prolonged intubation. Br J Anaesth, 89, 6447
bja.oxfordjournals.org/content/89/4/644.full
cough assist successfully treated sputum retention and avoided a tracheostomy.
Marks JH et al (2004) Pulmonary function and sputum production in patients with cystic fibrosis: a pilot study comparing the percussiveTech HF device and standard chest physiotherapy. Chest, 125, 1507-11
McCarren B, Alison JA, Herbert RD (2006) Vibration and its effect on the respiratory system. Austr J Physiother, 52, 39-43
vibrations create greater peak expiratory flow than chest compressions.
McIlwaine PM et al (2001) Long-term comparative trial of positive expiratory pressure versus oscillating positive expiratory pressure (flutter). J Ped, 138, 845-50
www.jpeds.com/article/PIIS0022347601343494/abstract
PEP more effective than Flutter
Miller S, Hall DO, Clayton CB (1995) Chest physiotherapy in CF - a comparative study of autogenic drainage and active cycle of breathing with postural drainage. Thorax, 50, 165-9.
thorax.bmjjournals.com/cgi/content/abstract/50/2/165?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexactfulltext=and&searchid=1139247086941_3170&FIRSTINDEX=0&sortspec=relevance&volume=50&firstpage=165&resourcetype=1&journalcode=thoraxjnl
mucus clearance is faster with AD than ACB and less likely to cause desaturation
Myers TR (2007) Positive expiratory pressure and oscillatory positive expiratory pressure therapies. Respiratory Care, 52, 10, 1308-26
www.rcjournal.com/contents/10.07/10.07.1308.pdf
PEP and Flutter compared, with no evidence of inferiority to other methods.
Naylor JM, Chow C-M (2005) Cardiovascular responses to short-term head-down positioning in healthy young and older adults. Physiother Res Internat, 10, 1, 32-47
precaution to head-down PD is reduced cardiac reserve.
Newbold E et al (2005) The Flutter device versus the PEP mask in the treatment of adults with cystic fibrosis. Physiother Canada, 57, 199-207
effects of flutter and PEP mask are equivalent.
OShea M, Morgan C (2012) Lung herniation after cough-induced rupture of intercostal muscle. N Engl J Med, 366, 1, 74
Pedersen J (1998) Minitracheotomy in the treatment of postoperative sputum retention and atelectasis. Acta Anaesth Scand, 32, 426-8
Phillips GE (1998) Airway response of children with primary ciliary dyskinesia in exercise and β2 agonist challenge. Eur Resp J, 11, 1389-91
exercise is more beneficial than drugs in aiding bronchodilation before PT
Plebani (1997) Usefulness of chest physiotherapy with PEP in HIV-infected children. Acta Paed, 86, 1195-7
PEP reduces chest infections and improves lung function
Preston IM, Matthews HR, Ready AR (1986) Minitracheotomy. Physiotherapy, 72, 494-6
Ragavan AJ (2010) Interactions of airflow oscillation, tracheal inclination, and mucus elasticity significantly improve simulated cough clearance. Chest, 137, 355-361
airflow oscillation and sitting upright facilitates mucus clearance
Randell (1990) Minitracheotomy: complications and follow-up with fibreoptic tracheoscopy. Anaesthesia, 45, 875-9.
Rubin BK (2002) The pharmacologic approach to airway clearance. Resp Care, 47, 818-22
classification of mucoactive agents
Rubin BK (2002) Physiology of airway mucus clearance. Respir Care, 47, 761-8
mucus, cilia, surfactant, cough, chest physical therapy
Savci S (2000) A comparison of autogenic drainage and the active cycle of breathing in COPD. J.Cardiopulm.Rehab. 20, 37-43 Eur.Resp.J, 11, 1389-91
AD showed greater increase in SaO2 and peak flow than ACBT
Selvadurai HC (2002) Randomized controlled study of in-hospital exercise training programs in children with CF. Pediatr Pulmonol, 33, 194-200
both aerobic and resistance training benefit people with CF
DJ, Ionescu AA (2004) Mucus hypersecretion: a common symptom, a common mechanism? Eur Respir J, 23, 797-798
www.erj.ersjournals.com/content/23/6/797.full
mechanism of mucus hypersecretion with particular reference to CF
Sivasotahy P et al (2001) Effect of manually assisted cough and mechanical insufflation on cough flow of normal subjects, patients with COPD, and patients with respiratory muscle weakness. Thorax, 56, 438-44
manual or mechanical cough assistance is beneficial for weak patients
Sontag MK et al (2010) Lessons learned from a randomized trial of airway secretion clearance techniques in CF. Ped Pulmonol, 45, 291-300
satisfaction is higher with the vest or flutter than with postural drainage
Syed N (2009) Active cycles of breathing technique (ACBT) versus conventional chest physical therapy on airway clearance in bronchiectasis a crossover trial. Adv Physiother, 11, 4, 193-8
both techniques equally effective, but patients tend to prefer ACBT
Thomas J (1995) Chest physical therapy management with CF. Am J Respir Crit Care Med, 151, 646-50
exercise improves FEV1
Thompson CS, Harrison S, Ashley J (2002) Randomised crossover study of the flutter device and the active cycle of breathing technique in non-cystic fibrosis bronchiectasis. Thorax, 57, 446-8
flutter is as effective as ACBT for bronchiectasis
Tsang SMH, Jones AYM (2003) Postural drainage or flutter device in conjunction with breathing and coughing compared to breathing and coughing alone. Hong Kong Physiotherapy J, 21, 29-35
breathing techniques are as good as postural drainage and flutter for bronchiectasis
Vianello A (2005) Mechanical insufflation-exsufflation improves outcomes for neuromuscular disease patients with respiratory tract infections. Am J Phys Med Rehabil, 84, 83-8.
mechanical device to help clear secretions in patients with a weak cough
Volsko TA, DiFiore JM, Chatburn RL (2003) Performance comparison of two oscillating positive expiratory pressure devices: acapella versus flutter. Respir Care, 48, 124-30.
mechanism of both devices, including ability of acapella to be used at any angle
Wallis C, Prasad A (1999) Who needs chest physiotherapy? Moving from anecdote to evidence. Arch Dis Child, 80(4): 3937
adc.bmjjournals.com/cgi/content/full/80/4/393?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexactfulltext=and&searchid=1140301359787_2558&FIRSTINDEX=0&sortspec=relevance&volume=80&firstpage=393&resourcetype=1#B28
related to paediatrics but useful info for all ages
Patel AS, Watkin G, Willig B et al (2011) Improvement in health status following cough-suppression physiotherapy for patients with chronic cough. Chron Respir Dis, 8, 253-8
crd.sagepub.com/content/8/4/253.abstract?etoc
control of unnecessary coughing by education, breathing retraining and vocal hygiene
Williams (1995) Chest physiotherapy and CF. Why is the most effective form of treatment still unclear? Chest, 106, 1872-82.
literature review
Williams MT, Parsons DW, Frick RA (2000) Energy expenditure during physiotherapist-assisted and self-treatment in CF. Physiother Theory Pract, 16, 57-67.
AARC = American Association for Respiratory Care
ACBT = active cycle of breathing techniques
CF = cystic fibrosis
FEV1 = forced expiratory volume in one second
PD = postural drainage
PEP = positive expiratory pressure