Airway clearance techniques: managing mucus with aspergillosis

Common airway-clearance techniques

Most airway-clearance routines use a combination of breathing, positioning and controlled coughing. Your physiotherapist will help you find the combination that clears mucus effectively without leaving you breathless or exhausted.

Breathing control

Breathing control means relaxed, gentle breathing—usually in through the nose and out through the mouth—at a pace that feels comfortable. It is used between more active parts of a routine to settle the airways, reduce breathlessness and avoid a cycle of hard coughing.

Active cycle of breathing techniques

The active cycle of breathing techniques (ACBT) is widely used and does not need any equipment. It usually combines:

• breathing control to keep the chest relaxed;
• deep breaths to help air move behind mucus in smaller airways; and
• huffing to move mucus upwards, followed by a cough only when mucus is ready to come out.

A huff is a firm, controlled breath out through an open mouth, as if you were steaming up a mirror. A longer, gentler huff can help move mucus from smaller airways; a shorter, sharper huff may help bring mucus from the larger airways into the mouth. Your physiotherapist can show you how much effort to use. Repeated hard coughing is often less effective and can make the airways more irritated.

Postural drainage and positioning

Postural drainage uses gravity to help mucus move from a particular part of the lung towards the larger airways. This may involve sitting upright, lying on one side, lying on your front, or using pillows to support a particular position. You may stay in each position for a few minutes while using breathing control, deeper breaths and huffs.

Many people still find postural drainage very helpful, especially where mucus regularly seems to sit in one area of the chest. Your scan results can help a physiotherapist decide which positions are likely to be most useful.

Traditional head-down positions are not right for everyone. They may worsen reflux, make some people dizzy or uncomfortable, and can be unsuitable with certain heart, spine or breathing problems. There are often modified, non-head-down positions that can still be effective. Ask your physiotherapist to check your technique rather than trying positions from the internet.

PEP and OPEP devices

Positive expiratory pressure (PEP) devices are small handheld devices that you breathe out through. The gentle resistance helps keep smaller airways open during breathing out, which may allow air to get behind mucus. Oscillating PEP (OPEP) devices also create vibrations that can help loosen secretions.

Examples include Aerobika, Acapella and Pari O-PEP devices. A typical routine may involve several breaths through the device, followed by breathing control and a huff or cough. The resistance setting, number of breaths and timing should be chosen with a respiratory physiotherapist, not copied from someone else.

Manual techniques

Some people benefit from hands-on techniques such as percussion, vibrations or chest-wall support. These are usually carried out by a physiotherapist or a carer who has been taught the method. They are not required by everyone, but may be useful when someone is very tired, weak or unable to clear mucus independently.

Exercise and movement

Walking, gentle exercise and changes of position can sometimes help loosen mucus and support general lung health. Exercise does not replace an individual airway-clearance plan, but it can be a useful part of it. Pulmonary rehabilitation can provide supported exercise and education for eligible patients.