Bronchial Hygiene Techniques
Key Points
- Bronchial hygiene (airway clearance therapy) supports secretion mobilization and airway patency.
- Technique selection should match secretion burden, disease pattern, and patient tolerance.
- Common options include CPT/PDPV, PEP/OPEP devices, HFCWO vest therapy, cough techniques, and mechanical insufflation-exsufflation.
- Timed cough/expectoration during treatment improves secretion removal effectiveness.
Pathophysiology
Excess mucus and impaired mucociliary clearance increase airway resistance and promote gas-exchange failure. Retained secretions also create conditions for atelectasis and infection progression by obstructing airflow and reducing effective ventilation.
Bronchial hygiene interventions apply mechanical energy, expiratory resistance, oscillation, or guided breathing to dislodge mucus from airway walls and move it toward central airways for expectoration or suction removal. This reduces obstruction burden and improves ventilation-perfusion efficiency.
Classification
- Manual/mechanical mobilization: Postural drainage, percussion, and vibration (PDPV/CPT).
- Expiratory resistance methods: PEP/OPEP devices such as flutter, Acapella, and Aerobika.
- Oscillatory systems: HFCWO vest therapy (about 5-25 Hz) with periodic cough breaks.
- Cough-assist approaches: Huff cough/FET, active cycle of breathing, autogenic drainage, quad cough, and MIE therapy.
Nursing Assessment
NCLEX Focus
Priority questions often ask which airway-clearance method best fits secretion retention and patient ability.
- Assess secretion volume, viscosity, and cough effectiveness before selecting intervention.
- Auscultate to localize lung segments with retained secretions before postural drainage planning.
- Monitor tolerance during therapy, including fatigue, desaturation, and hemodynamic instability.
- Reassess breath sounds and expectorated secretion output after treatment cycles.
Nursing Interventions
- Position target lung segments superior to the carina during postural drainage and hold position for about 3-15 minutes as tolerated.
- Coordinate percussion and vibration timing with expiratory phases for secretion mobilization.
- Coach OPEP technique: upright posture, deep inhalation, controlled exhalation through device, then cough.
- During HFCWO, pause roughly every 5 minutes within 20-30 minute sessions for secretion expectoration.
- Teach huff cough/FET and deep-breathing cycles (often repeated around ten times hourly) to reduce atelectasis risk.
Mismatch and Fatigue Risk
Inappropriate technique choice or poor tolerance can worsen dyspnea and reduce clearance effectiveness.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| bronchodilators | Inhaled bronchodilator context | May improve airflow and enhance secretion mobilization before clearance sessions. |
| mucolytics | Secretion-thinning therapy context | Can support mucus mobilization when viscosity limits expectoration. |
Clinical Judgment Application
Clinical Scenario
A patient with bronchiectasis has thick sputum, coarse breath sounds, and ineffective spontaneous cough despite standard care.
Recognize Cues: Persistent retained secretions and reduced spontaneous clearance. Analyze Cues: Current airway-clearance approach is insufficient for secretion burden. Prioritize Hypotheses: Immediate priority is selecting a more effective mobilization strategy with guided cough support. Generate Solutions: Combine segment-targeted drainage, oscillatory device therapy, and coached huff cough cycles. Take Action: Implement airway-clearance bundle and monitor tolerance/output. Evaluate Outcomes: Increased sputum clearance, improved breath sounds, and reduced work of breathing.
Related Concepts
- airway-suctioning - Suction may be needed when mobilized secretions cannot be expectorated effectively.
- tracheostomy-and-tracheostomy-care - Airway-clearance strategies are central for tracheostomy secretion management.
- noninvasive-positive-pressure-ventilation - Ventilatory support can be coordinated with secretion-clearance sessions.
- respiratory-failure - Retained secretions can precipitate decompensation.
- ventilator-associated-events - Secretion management is part of complication-prevention strategy in ventilated patients.
Self-Check
- How does technique choice change between weak-cough and strong-cough patients?
- Why are timed cough pauses used during longer oscillatory therapy sessions?
- Which findings indicate bronchial hygiene is improving airway patency?