Airway Clearance

Question 1

What does CF look like on a chest xray?

Answer 1

Lungs are have scattered white areas within, indicative of scaring.

Question 2

How does one get CF and what is the life expectancy?

Answer 2

Autosomal recessive genetic disorder from both parents

38 yo

Question 3

What is the pathophysiology of CF?

Answer 3

Impaired chloride, sodium and water secretion in cells
-includes GI tract, pancreas, sweat glands and lungs

Excretion of greater amounts of salt

Question 4

Considering the pathophys of CF, why is mucus thick and difficult to remove from the lung?

Answer 4

Decreased water content makes mucus thick and sticky.

-collects in small airways

Question 5

What direction does mucus plugging happen with CF and what chronic disease does this cause?

Answer 5

Distal to proximal airways.

-causes bronchiectasis

Question 6

What are the PT implications of CF?

Answer 6

Airway clearance
Aerobic training
Postural Re-education (do before dysfunction)
Anerobic training
Strength training
Balance

Question 7

How does aerobic training mobilize secretions?

Answer 7

Adding moisture

• also increases tidal volume first, then RR increases
• moves secretions proximally

Question 8

How many generations down can a cough mobilize secretions?

Answer 8

Only 5-8.

Question 9

Name the 9 types of airway clearance techniques.

Answer 9

1. Percussion
2. Vibration
3. Postural drainage
4. HFCWO vest
5. Positive expiratory pressure (PEP)
6. Oscillatory PEP: Flutter and acapella
7. Active cycle of breathing
8. Autogenic drainage
9. Forced expiratory technique: huff

Question 10

What types of patients should not be tipped during manual clearance techniques and why?

Answer 10

Infants (aspiration) and patients with GERD (reflux).

Question 11

Postural drainage uses gravity to move secretions from lobes to the bronchus. How fast is a normal sputum elevator?

Answer 11

2-3 hours, 3-5mL per minute.

Question 12

What is the procedure for percussion?

Answer 12

2-5 minutes per lobe in postural drainage position, followed by FET with vibration.

• 2-3 second breath hold
• 3-10 exhalations
• cough at end
• auscultate before and after

Question 13

List a few side effects of percussions. Any contraindications?

Answer 13

Decreased CO
Decreased PaO2 (short term)
Bronchoconstriction

CONTRA

• Unstable angina or arrhythmias
• Any fracture or bone disease

Question 14

There are 3 phases to active cycle of breathing technique to mobilize secretions. Name them and their parameters.

Answer 14

BREATHING CONTROL

• diaphragmatic, 30-60s
• hands on belly and upper chest
• tell patient to breath into hands
• tidal volume breathing
• goal to decrease work of breathing

THORACIC EXPANSION

• tactile and verbal cues
• lateral costal expansion 15-30s

FORCED EXPIRATORY TECHNIQUE
-clear secretions

Question 15

What is the purpose of lateral costal expansion?

Answer 15

Helps open alveoli that may be blocked by distal air secretions.
-works by collateral passage between lungs.

Question 16

How do you instruct a patient to do lateral costal expansion?

Answer 16

Provide force with your hands on their lateral ribs. Tell them to breathe into your hands. Provide resistance at first and gradually reduce. Not res. for exp.

• emphasize TLC insp.
• breath hold 2-3s

Question 17

The forced expiratory technique (FET) consists of 2-3 huffs from mid to low lung volume. What is the best way to teach it and what is the main thing to avoid?

Answer 17

Demonstration works best (like fogging a mirror).
-avoid contracting throat muscles or using vocal cords.

Helps stabilize airways from collapse to mobilize secretions.

Question 18

How much FEV1 do people with CF lose per year? How can mobilizing secretions helps?

Answer 18

2-4%.

Reduce that to 1/4% per year.

Question 19

How long do you continue diaphragmatic breathing during autogenic drainage?

Answer 19

30 seconds.

-cough suppressed throughout cycle.

Question 20

What are the 3 phases of autogenic drainage?

Answer 20

1. Loosening
2. Collecting
3. Evacuation

Question 21

Can autogenic drainage sometimes cause bronchospasms? Is it otherwise useful?

Answer 21

Yes.

Yes, can yield tremendous results if therapist and patient have skill to complete it.

Question 22

With a HFCWO vest, how often should a FEP technique be used?

Answer 22

Every 5 minutes. Need to clear secretions after they are loosened.

Question 23

With are HFCWO vest parameters?

Answer 23

20-30 minutes

12-16 hz

Question 24

How does positive expiratory pressure (PEP) work, and what are its parameters?

Answer 24

Pt breathes against 10-20cm H2O. Pressure stabilizes smaller airways preventing collapse, reducing air trapping.

Pt usually sits upright with elbows on desk or table.

Diaphragmatic breathing, 2-3s hold, PEP, huff. 3-5x.

Question 25

When might you use a PEP?

Answer 25

Post-op, atelectasis.

CONTRAINDICATED
-pneumothoracies, chest tubes

Question 26

How does an oscillatory PEP help remove secretions?

Answer 26

Reduces the viscosity by shearing forces, thinning them.

Question 27

What are the parameters for an acapella PEP?

Answer 27

3/4 inhilation, hold 2-3s, exhale into device, 5-10 times followed by full inhilation with FET huff.
-repeat 2-3x

Question 28

What’s a downside to oscillatory PEP?

Answer 28

Tends to cause bronchospasm.

Question 29

How does exercise help people with CF?

Answer 29

Increase of minute ventilation increases turbulent airflow and brings secretions more proximally.
-also hydrates secretions.

Minimum 15 mins.
-2-4 DOE, 11-14 RPE, 60-85% 3x/wk