💨 Airway Clearance and Nebulised Saline

(for ABPA, severe allergic asthma, and bronchiectasis)

Why mucus clearance matters

If you have ABPA (allergic bronchopulmonary aspergillosis), severe allergic asthma, or bronchiectasis:

• The airways can produce thick, sticky mucus.

• Mucus may form plugs that block airflow.

• Trapped mucus increases the risk of flare-ups and infections.

Nebulised saline loosens mucus, but it must be followed by airway clearance to move it out of your lungs.

Airway clearance methods

1. Active Cycle of Breathing Technique (ACBT)

• A structured cycle of relaxed breathing, deep breaths, and “huffing” (forced breaths out).

• Very effective when combined with nebulised saline.

2. Devices (Acapella, Flutter, Aerobika, etc.)

• Use vibrations and back pressure to shake mucus loose.

• Often recommended alongside ACBT.

3. Traditional physiotherapy techniques

• Postural drainage – lying in certain positions to use gravity to drain mucus.

• Chest percussion (clapping) – rhythmic tapping on the chest/back.

• Assisted coughing – for those who can’t cough strongly.

All these techniques remain valid. The key is choosing the one that works for you.

The role of the respiratory physiotherapist

Your respiratory physiotherapist is central to airway clearance care:

• They assess your condition (ABPA, asthma, bronchiectasis pattern).

• They teach and supervise techniques so you can use them safely.

• They tailor a plan – deciding whether ACBT, a device, drainage, or a mix is best.

• They adjust your plan over time – for example:

  • During a flare-up with extra mucus

  • If new treatments (like biologics or antifungals) change your symptoms

  • If you develop new bronchiectasis or infections

👉 The physio is your partner in protecting your lungs.

How nebulised saline helps

• Comes in sterile vials (normal 0.9% or stronger “hypertonic” 3–7%).

• Hydrates and thins sticky mucus.

• Prepares mucus for clearance with ACBT, devices, or drainage.

• Sometimes used with a bronchodilator first to avoid wheeze or tightness.

Putting it together

1. Nebulised saline to loosen mucus

2. Airway clearance technique (ACBT, device, drainage) guided by your physio

3. Regular review with your physio to keep the plan up to date

✅ Key takeaway:
For ABPA, severe allergic asthma, and bronchiectasis, the combination of nebulised saline + airway clearance is one of the most effective ways to keep your lungs clearer and healthier. The respiratory physiotherapist will help you find the right method for your lungs and adjust it as your condition changes.