4, 7 In addition, studies using the Flutter found that oscillatory waves with varying frequencies are transmitted through the airways, resulting in shearing forces that reduce viscoelasticity of bronchial secretions 8 and easier transportation. The pressure generated by PEP during expiration stabilizes airways, assists mucus movement, and prevents airway closure, thereby improving ventilation. 6 The Flutter (Aptalis Pharma, Bridgewater, New Jersey) and the Lung Flute (Medical Acoustics, Buffalo, New York) are 2 commercially available intrathoracic oscillatory positive expiratory pressure (PEP) devices designed to augment sputum expectoration. Several airway clearance devices are commercially available to aid in sputum expectoration and optimizing outcomes, but to date, no single device has demonstrated clear superiority. 4, 5 Any effective secretion clearance regime needs to be able to be performed independently, be integrated into normal daily activities, and be cost-effective. 3 Active-cycle-of-breathing technique, gravity-assisted drainage, and manual techniques are often difficult for elderly patients and those with severe disease due to comorbidities and reduced respiratory muscle and cough strength. 2 These techniques are used in combination with forced expiration technique to move the mobilized secretions to proximal airways to be cleared, which then may require subsequent cough. 2 Respiratory therapists and physiotherapists use a spectrum of airway clearance maneuvers such as active-cycle-of-breathing technique with or without gravity-assisted drainage and manual techniques as well as positive pressure devices with or without oscillations. 1Īirway clearance techniques are integral to the management of bronchiectasis, clearing conducting airways, improving pulmonary ventilation, and reducing cough and breathlessness. Impaired clearance of this mucus predisposes to mucus retention and recurrent respiratory infections. ![]() The mucus becomes colonized by bacteria and then hyperviscous and purulent. 1 In the affected areas, there is excess production of mucus due to glandular hyperplasia. ![]() Bronchiectasis is associated with damaged ciliated epithelium and compromised mucociliary clearance. Bronchiectasis is a lung disease characterized by repeated cycles of airway infection and inflammation that ultimately result in airway and lung parenchyma destruction.
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