Long-term cough and increased mucus production are common symptoms in COPD and are linked to frequent exacerbations and a poor quality of life. Airway clearance techniques (ACTs) aim to remove sputum from the lungs and are therefore, an important part of COPD treatment.
Conventional methods of airway clearance include the Huff cough technique, controlled coughing, chest physiotherapy (percussion and vibration) and postural drainage, but these methods have had a modest effect, at best, on those who have tried them.
Airway clearance devices are widely available, easy to use and relatively inexpensive. Combining both methods together may provide a more effective means of airway clearance, than using just one method alone.
Just how effective are airway clearance devices at mobilizing mucus? Let's take a look at what the research has to say:
1. Positive Expiratory Pressure (PEP) Therapy
Positive expiratory pressure (PEP) therapy was developed in the 1970's as an alternative to standard chest physiotherapy (CPT). Using a face- mask or mouthpiece, patients take in a normal breath and then exhale into a one-way valve against gentle resistance that is preset by your health care management team. The device allows more air into the peripheral airways via collateral channels thus creating air pressure behind the secretions that pushes them toward the larger airways where they can easily be expectorated.
The PEP device is easy to use, creating greater independence for patients with lung disease. In clinical studies, it was found to:
- improve mucus clearance
- increase patient comfort compared to standard CPT
- reduce lung infections and antibiotic courses
- improve bronchodilation
- increased patient compliance
- reduce hospital stays
For these reasons, studies suggest that the PEP device is a safe, effective alternative to traditional methods of CPT as well as an acceptable addition to COPD treatment.
Examples of PEP devices include the Astra® PEP mask, Pari PEP® and the AeroPEP.®
HFCWO is performed using an inflatable vest that applies positive pressure air pulses to gently oscillate the chest wall. This action reportedly increases airflow, loosens mucus and increases a patient's cough clearing ability.
Research reports that the HFCWO:
- provides an effective alternative to traditional CPT
- aids in mucus clearance
- contributes to stabilization and improvement of lung function
- increases airflow
- mobilizes more mucus than standard CPT
Despite these benefits, the evidence states that more research is needed to determine this device's role in current treatment strategies.
Examples of the HFCWO include the Vest™Airway Clearance System and the Medpulse® Respiratory Vest System.
3. The Flutter Mucus Clearance System
Using a combination of PEP therapy with high-frequency oscillations, the Flutter™ device has a controlled vibration system that gently oscillates the large and small airways during exhalation loosening mucus, accelerating airflow and facilitating mucus clearance.
Although the flutter device is simple to use and inexpensive, patients with severe airway obstruction may not be able to generate enough airflow to allow the device to work properly.
Clinical studies justify the effectiveness of the Flutter™ in terms of lung function and positive patient outcomes.
Similar devices to the Flutter™ include the Acapella™ and the Cornet.™
Compare prices on the Acapella™ Airway Clearance System.
The Lung Flute® is a hand-held device that generates low-frequency sound waves into the airways as patients vigorously exhale through a mouthpiece over a reed. The waves reportedly travel down into the lower airways and stimulate mucus clearance.
The Lung Flute has FDA clearance for diagnostic, as well as therapeutic uses, because it aids in the collection of sputum samples for laboratory tests and facilitates effective airway clearance for patients.
The device is easy to use and relatively inexpensive. In clinical studies, it was found to be a safe, effective means of sputum induction. Compared to the Acapella, the Lung Flute® was found to be equivalent in beneficial effects.
Choosing the Right Airway Clearance Device
If you're thinking of trying an airway clearance device but don't know which to choose, obtain recommendations from your physician or respiratory therapist before you buy. Be sure to compare features and benefits, along with cost of several different devices before making your final decision.
For more information about airway clearance, read the following:
Holland AE, Button BM. Is there a role for airway clearance techniques in chronic obstructive pulmonary disease? Chron Respir Dis. 2006;3(2):83-91.
A Hristara-Papadopoulou, J Tsanakas, G Diomou, and O Papadopoulou. Current devices of respiratory physiotherapy. Hippokratia. 2008 Oct-Dec; 12(4): 211–220.
Osadnik CR, McDonald CF, Jones AP, Holland AE. Airway clearance techniques for chronic obstructive pulmonary disease.Cochrane Database Syst Rev. 2012 Mar.