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Mucociliary Escalator: What is your airway clearance routine?
Did your medical team ever discuss the mucociliary escalator with you? My New York doctors never mentioned it, and I came across the term on the Australian Bronchiectasis Toolbox website,
The “mucociliary escalator” is a term used to describe a built-in mechanism to keep our airways clean. Just as we might run water on a patio to sweep off leaves and debris, this is what happens automatically in our air passages.
This clearing system is complex, but in the simplest terms, it uses mucus to trap dirt, air pollution particles and pathogens. Then cilia, small hairs that undulate in the moving mucus, sweep the unwanted matter towards our throat where it is expectorated or swallowed.
This cleansing system is ongoing in healthy lungs as they too produce daily mucus to clear the decks. However, in diseased lungs such as those in bronchiectasis (BE), the ciliated areas are damaged and therefore, we make more mucus to compensate. The body does its best to sweep the airways clean, but often it is a herculean task that cannot be automatically accomplished day after day.
For this reason, we need to help out our lungs with daily airway clearance. Airway clearance is a broad term describing the effort to help the mucociliary escalator function more effectively. With BE, there are damaged areas in our lungs with little or no cilia allowing mucus to pool. This mucus needs to be removed, otherwise bacteria, viruses and fungi can feed on it and multiply.
Whether we use exercise, breathing and coughing techniques, gravity, or medical devices will depend on availability and preferences. What is important is that we do our best to assist our lungs in clearing airways regardless of how often we cough or how much mucus Linda us throughout the day. Working together with our lungs is essential to maintaining overall health and well being.
How do you feel about airway clearance? Do you do it daily or when you have an exacerbation?
Linda Esposito
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Love this analogy. Thank you. This past month I had to stop big 3 due to lo platelets. So I am now religiously doing airway clearance daily. My routine is 13-15 min. 7% saline nebulizing. ( with intermittent cough clearance). Then aerobika about 20 breaths. Then blow my nose. Then 3 ( or more) slow rise and hold, yoga bridges. (Postural drainage) I intermittently huff cough with a cup by my side). This clears at least 1/4 cup of sputum daily. To finish, I drink 10 oz or more of water.
All these techniques were handed to me from this wonderful group. Thank you to everyone.
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5 ReactionsWow! That sounds like a fantastic routine. The bridges make a big difference for me, too!!
Do you do clearance twice a day? Do you have access to a high frequency chest wall oscillation vest to try it out and see if it clears even more?
Best,
Linda
I was doing clearance twice a day until about 2 months ago. There was a discussion about whether once daily was sufficient. I still work as an clinic rn daily, so didn't fit in 2x very much except when I would catch a cold (not covid) or feel sinuses acting up. I'm only going to an id doctor now through Ochsner. (my pulmonologist np left and I haven't got a new one yet). The vest was never offered. I feel so much better with the 7% saline nebs (only started 4 months ago-was on 3% before for a year), and this new routine (on for 2 months). I no longer cough up sputum during the rest of the day or night. It is a game changer so far.
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3 ReactionsIt sounds like you’re so on top of it! Congratulations for all your hard work. I was doing clearance once a day and exercising until there was a little more progression of my CT scan and we then increased to twice a day. But if you work it is so difficult to fit it all in. Again, congrats!
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1 ReactionLinda, do you know if a “high frequency chest wall oscillation vest” is another name for a”percussion vest? Don
Hi Don!
Yes it is. I have a SmartVest but there are others made by Hill ROM and Respirtech.
Not Linda, but yes.
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1 ReactionI have cut back to once a day; not much is expecrorated after saline neb treatment. I have great O2 levels. Should I do more now?? Thanks for your helpful post.
Hi there! That’s a good discussion to have with your medical team. For a couple years I was doing clearance once a day, but there was some bronchiectasis progression so we decided to increase it to twice a day.
Additional food for thought ...
We floss our teeth to break up the biofilm even when there is no food stuck between them. This is true for clearance as well.
Additionally, hypertonic saline is thought to have anti-microbial properties.
BE well,
Linda Esposito
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2 ReactionsThat is a great discussion to have with your pulmonologist when they have a new CT and lab results to compare with the previous set. I too neb once a day & do clearance (no vest), only moving to twice for a tight feeling, increased cough, when ill, etc. I also only add a levalbuterol neb as needed. Also, if I have an inflammatory flare in my body, I do more to keep it from settling in my lungs. My pulmonologist is fully supportive of my variable schedule.
I also use singulair daily, flovent, Mucinex 600 LA & N acetyl cysteine 600 twice a day.
Caution: I tend to push the limits. Right now that is safe for me as my Bronchiectasis is stable and my general health is as good as it gets. If anything changes, I leap into action.
Sue
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