Airway clearance techniques: which one?
AbstractS.A.Prasad Cystic Fibrosis Unit, Great Ormond Street Hospital for Children, London WC1N 3JH, UK Normal mucus clearance mechanisms are impaired in many respiratory disorders. Excess bronchial secre- tions are most commonly associated with altered mucociliary clearance, altered mucus rheology and abnormal cough mechanics. A variety of interventions can be used to enhance mucus clearance in disorders where excess secretions cause impairment of respira- tory function, including drug therapies (eg, inhaled mucolytics) and chest physiotherapy incorporating a variety of airway clearance techniques. Chest physiotherapy plays an important part in managing respiratory disorders associated with copi- ous, often purulent, bronchial secretions such as bronchiectasis and cystic fibrosis (CF). Airway clearance techniques, as a component of chest physio- therapy regimens, aim to enhance sputum clearance, reduce airway resistance, and improve ventilation, with the ultimate goal of delaying disease progression. Traditionally treatment comprised the use of gravity assisted positioning (postural drainage) to `drain' air- way secretions in combination with manual physio- therapy techniques such as percussion and vibrations applied to the chest wall and interspersed with cough- ing. In the past 25 years the `face' of chest physiother- apy has changed dramatically. To tackle the problems of sputum retention, several different airway