Clearing your airway of mucus is the heart of bronchiectasis treatment. When done regularly and correctly, it can help with these concerns:
Lower your risk of infection
Make breathing easier
Minimize hospital visits
Reduce flare-ups
Slow or prevent disease progression
“Making sure you’re clearing the mucus that’s in the lung is what reduces the risk of recurrence of infections,” says Virginia-based Amit “Bobby” Mahajan, MD, the national medical spokesperson for the American Lung Association and system chief of interventional pulmonology at Inova Health System.
Active Cycle of Breathing Technique
Active cycle of breathing technique (ACBT) is one of the best ways to help clear mucus from your lungs, and it is a daily ritual for many people with bronchiectasis. It’s simple, flexible, and doesn’t require any special equipment.
ACBT works by moving mucus from the lower parts of your lungs up to your throat so you can expel it more easily. It uses three repeating steps: breath control (slow, relaxed belly breathing to keep airways open), deep breathing (slow, deep breaths with a brief pause to loosen mucus), and huffing (a strong exhale with an open mouth, as if you’re fogging a mirror, to move mucus upward).
Most people with bronchiectasis perform ACBT once or twice a day when they’re in stable condition. During flare-ups, it may be done more often. Each session usually lasts 10 to 30 minutes. Research shows that ACBT can clear mucus as well as many airway clearance devices, with regular use linked to better breathing and fewer flare-ups.
Airway Clearance Devices
If breathing exercises aren’t enough to clear mucus, mechanical devices can help loosen and move it so you can expel it more easily. Many people with bronchiectasis use devices along with breathing techniques as part of their daily routine.
Oscillating positive expiratory pressure (OPEP) devices are small, handheld devices resembling a pickle that you exhale through to get mucus moving, says Dr. Mahajan. They work by creating both gentle resistance and tiny vibrations that thin mucus and push it upward, effectively reducing both symptoms and flare-ups.
High-frequency chest wall oscillation, commonly called “the vest,” is a wearable wrap that vibrates rapidly to compress and release your chest gently. The movement it creates helps move thick mucus from deep, narrow airways into larger spaces from where it can be expelled. It’s an ideal choice for people with bronchiectasis who find manual breathing exercises or handheld tools too exhausting. Consistent use is shown to reduce flare-ups, reduce the need for antibiotics, and help prevent hospital stays related to the lung condition.
Positive expiratory pressure (PEP) devices use a mask or mouthpiece to create gentle back pressure while you exhale. The pressure helps hold your airway open so air can get behind the mucus, making it much easier to expel. Research shows that PEP therapy is just as effective as other clearance methods at maintaining lung function and improving quality of life, provided it’s used regularly.
Intrapulmonary percussive ventilation (IPV) uses a small machine to deliver a fine mist, sometimes with medication, along with gentle, rapid pulses of air to the lungs. These pulses create vibrations inside the airway that help move mucus so that it’s easier to expel.
Physiotherapy and Manual Techniques
The European Respiratory Society’s clinical practice guidelines strongly recommend involving a physiotherapist who is experienced in bronchiectasis in your care plan. They can help jump-start your routine using intensive, hands-on mechanical force techniques, as well as advise on the best airway clearance techniques for improving mucus removal and reducing symptoms.
Chest physical therapy (CPT) involves the therapist using cupped hands to clap on your back and chest to help loosen mucus from the lungs so it can be expelled. They can also advise you on electronic chest clappers or vests that you can use to perform CPT at home.
Postural drainage is a technique that involves laying in specific positions, sometimes with your head below your waist, to let gravity naturally drain mucus from the deeper parts of your lungs toward your throat. A physiotherapist can evaluate your lungs to help identify which areas (or lobes) are congested, then teach you the specific positions that will work best for your body.