Physiotherapy for airway clearance in adults

Techniques for augmenting, when necessary, the normal mucociliary and cough clearance mechanisms of the lungs are not new, but, in more recent years, techniques have been developed which are effective, comfortable and can be used independent of an assistant in the majority of adolescents and adults. Postural drainage with chest clapping and chest shaking has, in most parts of the world, been replaced by the more effective techniques of the active cycle of breathing, autogenic drainage, R-C Cornet, Flutter, positive expiratory pressure mask, high-frequency chest wall oscillation and intrapulmonary percussive ventilation. Glossopharyngeal breathing is being considered again and is often a useful technique for increasing the effectiveness of cough in patients with tetraplegia or neuromuscular disorders. The evidence in support of these techniques is variable, and the literature is confusing and conflicting. There may or may not be significant differences among the techniques in the short or long term. Many of the regimens now include the forced expiratory manoeuvre of a "huff" and this has probably increased the effectiveness of airway clearance. If objective differences are small, individual preferences and cultural influences may be significant in increasing adherence to treatment and in the selection of an appropriate regimen or regimens for an individual patient.

This article has been cited by other articles:

				E. Daviskas, S. D. Anderson, S. Eberl, and I. H. Young Effect of increasing doses of mannitol on mucus clearance in patients with bronchiectasis Eur. Respir. J., April 1, 2008; 31(4): 765 - 772. [Abstract] [Full Text] [PDF]

				E. H. J. Hulzebos, P. J. M. Helders, N. J. Favie, R. A. De Bie, A. Brutel de la Riviere, and N. L. U. Van Meeteren Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA, October 18, 2006; 296(15): 1851 - 1857. [Abstract] [Full Text] [PDF]

				C. C. Reardon, D. Christiansen, E. D. Barnett, and H. J. Cabral Intrapulmonary Percussive Ventilation vs Incentive Spirometry for Children With Neuromuscular Disease Arch Pediatr Adolesc Med, June 1, 2005; 159(6): 526 - 531. [Abstract] [Full Text] [PDF]

				K. Chatham, A.A. Ionescu, L.S. Nixon, and D.J. Shale A short-term comparison of two methods of sputum expectoration in cystic fibrosis Eur. Respir. J., March 1, 2004; 23(3): 435 - 439. [Abstract] [Full Text] [PDF]

				W. P. Wong, J. D. Paratz, K. Wilson, and Y. R. Burns Hemodynamic and ventilatory effects of manual respiratory physiotherapy techniques of chest clapping, vibration, and shaking in an animal model J Appl Physiol, September 1, 2003; 95(3): 991 - 998. [Abstract] [Full Text] [PDF]

				A. F. Barker Bronchiectasis N. Engl. J. Med., May 2, 2002; 346(18): 1383 - 1393. [Full Text] [PDF]

				C S Thompson, S Harrison, J Ashley, K Day, and D L Smith Randomised crossover study of the Flutter device and the active cycle of breathing technique in non-cystic fibrosis bronchiectasis Thorax, May 1, 2002; 57(5): 446 - 448. [Abstract] [Full Text] [PDF]