Clearing mucus from the airways is central to the treatment of bronchiectasis. When performed regularly and correctly, it can solve problems such as:
- lower the risk of infection
- make breathing easier
- Minimize hospital visits
- reduce flare-ups
- slow or prevent disease progression
“Ensuring that mucus is removed from the lungs reduces the risk of recurrence of the infection,” says Virginia-based Amit “Bobby” Mahajan, MD, national medical spokesperson for the American Lung Association and system director of interventional pulmonology at Inova Health System.
Active cycle of breathing techniques
Active cycle breathing (ACBT) is one of the best ways to clear mucus from the lungs and has become a daily ritual for many people with bronchiectasis. Simple and flexible, no special equipment required.
ACBT moves mucus from the lower lungs to the throat, making it easier to expel mucus. It repeats three steps: breath control (slow, relaxed abdominal breathing to keep the airways open), deep breathing (slow, deep breaths with short pauses to loosen mucus), and huffing (breathing hard with the mouth open, as if fogging up a mirror, to move mucus upward).
Most people with bronchiectasis perform ACBT once or twice a day when their condition is stable. It may occur more frequently during flare-ups. Each session typically lasts between 10 and 30 minutes. Studies have shown that ACBT, like many airway clearing devices, can clear mucus and that regular use can improve breathing and reduce inflammation.
Airway management device
If breathing techniques alone are not enough to remove the mucus, mechanical devices can be used to loosen and move the mucus so that it can be expelled more easily. Many people with bronchiectasis use the device as part of their daily routine, along with breathing exercises.
Oscillating positive expiratory pressure (OPEP) device It’s a small, handheld device similar to a pickle that moves mucus by exhaling, Dr. Mahajan said. They work by creating both gentle resistance and small vibrations that thin mucus and push it upward, effectively reducing both symptoms and flare-ups.
High frequency chest wall vibrationA wearable wrap, commonly referred to as a “vest,” that vibrates rapidly to gently compress and release the breasts. The movement this creates helps move thick mucus from deep, narrow airways into larger spaces where it can be expelled. It is an ideal option for people with bronchiectasis who find manual breathing techniques and handheld tools too tiring. Continued use has been shown to reduce flare-ups of inflammation, reduce the need for antibiotics, and help prevent hospitalizations related to lung conditions.
Positive expiratory pressure (PEP) device Use a mask or mouthpiece to apply gentle back pressure as you exhale. The pressure helps keep the airways open, allowing air to get behind the mucus and making it much easier to expel. Studies have shown that PEP therapy, when used regularly, is as effective as other removal methods in maintaining lung function and improving quality of life.
Intrapulmonary percussion ventilation (IPV) Using a small machine and sometimes drugs, a fine mist is delivered into the lungs with gentle, rapid pulses of air. These pulses create vibrations within the airways that help move mucus and make it easier to expel.
Physical therapy and manual therapy
The European Respiratory Society clinical practice guidelines strongly recommend the involvement of a physiotherapist with experience in bronchiectasis in the care plan. They will help you revitalize your routine with intensive hands-on mechanical force techniques and advise you on the best airway clearance techniques to improve mucus clearance and reduce symptoms.
Chest Physical Therapy (CPT) This involves the therapist tapping your back and chest with cupped hands to loosen and allow mucus from your lungs to drain. We can also advise you on electronic chest beats and vests that you can use to perform CPT at home.
postural drainage This is a technique that involves lying in a specific position, sometimes with your head below your hips, to allow gravity to naturally drain mucus from the depths of your lungs towards your throat. A physical therapist can evaluate your lungs to determine which areas (lobes) are congested and tell you the specific position that is best for your body.
