In our large clinical system, we have a Lung Health Clinic with a staff Respiratory Therapist and 2 RT-Assistants. When I was taught airway clearance, they emphasized these things: Hydrate first, inhaler or neb (as prescribed) to open airways, a brisk walk or other exercise to get the lungs moving, then neb saline. When the urge to cough first occurs, suppress it, but when it becomes very strong, stop the neb and do a clearance cycle. Mine was 4 cycles of active breathing, 4 cycles of Aerobika. Then restart the neb. Repeat until there is no more sputum coming out or you finish the saline. Many days, I only need 2-3ml of saline, or sometimes none at all, to get the mucus out. I don't need postural drainage to clear, but I do sometimes need to get up and move to encourage it - bending and picking up around the house, or weeding in the garden starts me coughing stuff up pretty well.
After finishing the neb, I was told to do no more than 10 minutes of breathing/Aerobika OR 20 minutes of postural drainage. More just seemed to cause a sore throat and or sore chest muscles. Also, I was told to be careful to "huff cough" to get the mucus out, not clear my throat or cough through my vocal chords.
If you cannot see a respiratory therapist, there are many excellent videos on active breathing, using the Aerobika or Acapella, postural drainage, etc.
Please consult your pulmonologist for your specific instructions. And if possible, ask to be seen by an RT experienced in treating bronchiectasis or cystic fibrosis for coaching. This will help you find a schedule you can stick to long term. Just like any other life change, one that interferes too much soon gets tossed aside! On a typical day, my airway clearance takes less than 20 minutes, and has kept me off antibiotics for over 3 years with few exacerbations.
Sue
I think it really does depend on where you are at with your whole Bronchiectasis situation. For many people a shorter time may be sufficient but for some longer is necessary. I spend a good hour for my first clearance and have to. My pulmonologist agrees that I should spend that much time and he specializes in pulmonary infections, Bronchiectasis etc. He said most people do not want to spend the time that they should.