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The pulmonary team has just recommended mucomyst, hypertonic saline, and a flutter valve for your patient with retained secretions. There’s just one problem. You don’t know what any of that means. So today let’s go over the basics of airway clearance therapy here on In the Nick of Time. This is really a brief introduction for those new to the floors about what these different airway clearance therapies are and the basics of how they work. Okay? So first off, some basics. Secretions get a pretty bad rep, but they’re there for a reason. They’re mostly made up of water salt and this really sticky glycoprotein called mucin. So what does that do for us? Well the secretions can hydrate the airway, they can insulate the airway, and if any debris or pathogens get in, they can stick to the secretion so they don’t get further into the airway. But in order for secretions to be helpful, three things need to be true. One, the mucus has to be thin and watery enough that it will easily come out of the airway. Two, the airways have to be open. And three, we have to be able to mobilize that mucus. That’s through a combination of all the cilia on the respiratory epithelium being functional, doing their job, and the ability to generate a strong cough.
So if those are the three conditions in order for secretions to be helpful for us, when do secretions become unhelpful? Well, let’s think about it. Number one, what if the mucus isn’t thin enough for us to clear? You can get thick, harder to mobilize mucus in conditions like chronic bronchitis or bronchiectasis where there’s chronic inflammation.
Two, what if the airways aren’t open? Poor airflow can lead to more atelectasis and more retained secretions. And three. What if we can’t mobilize mucus very well? Those who have inflammation in the airways have less functional cilia and respiratory muscle weakness can lead to a weaker cough. So these are the same three principles that underlie how airway clearance therapy works. One, it can make those secretions thin, watery, easy to mobilize again. Two, they can open up airways that have collapsed.