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Mucociliary Escalator: What is your airway clearance routine?

Posted by becleartoday @becleartoday, Apr 26, 2022

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

Interested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.

Mentor
Sue, Volunteer Mentor | @sueinmn | Oct 19, 2023
In reply to @sweethighland "Thank you so much Sue. I'm learning a lot from you. I will try and do..." + (show)
@sweethighland

Thank you so much Sue. I'm learning a lot from you. I will try and do that. The culture result I get is always "light growth" or "scant growth" , "no acid AFB in 6 weeks". Never about species differentiation, colony counts and medications sensitivities. At the clinic, my doctor can see all these but I cannot see them in my portal.

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Well, that is probably good news and explains your lack of further info - No AFB at 6 weeks means the culture did not grow any NTM. The scant or light growth on the slide was likely from your mouth, fingers, the air or lab contamination.
Do you know for sure that you currently have MAC/ NTM from a positive culture or is it just suspected?
Sue

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1 reply
sweethighland | @sweethighland | Oct 19, 2023
In reply to @sueinmn "Well, that is probably good news and explains your lack of further info - No AFB..." + (show)
@sueinmn

Well, that is probably good news and explains your lack of further info - No AFB at 6 weeks means the culture did not grow any NTM. The scant or light growth on the slide was likely from your mouth, fingers, the air or lab contamination.
Do you know for sure that you currently have MAC/ NTM from a positive culture or is it just suspected?
Sue

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Thank you Sue for explaining. I now understand lack of further info on Mychart. I do not have MAC/NTM but just Burkholderia cepecia that has colonized/infected since April 2021 and never went away. That buy is causing a lot of lungs issues and very hard to treat/eradicate. I coughed up a lot of blood (just like vomiting) in March and had to rush to ER, stayed in the hospital for 5 days from infection/flare up. CT in June stated chronic infection. I produce yellow/green mucus every day (2 tablespoon).

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1 reply
Mentor
Sue, Volunteer Mentor | @sueinmn | Oct 19, 2023
In reply to @sweethighland "Thank you Sue for explaining. I now understand lack of further info on Mychart. I do..." + (show)
@sweethighland

Thank you Sue for explaining. I now understand lack of further info on Mychart. I do not have MAC/NTM but just Burkholderia cepecia that has colonized/infected since April 2021 and never went away. That buy is causing a lot of lungs issues and very hard to treat/eradicate. I coughed up a lot of blood (just like vomiting) in March and had to rush to ER, stayed in the hospital for 5 days from infection/flare up. CT in June stated chronic infection. I produce yellow/green mucus every day (2 tablespoon).

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Have they treated your infection with medication?
Also, from what I read, airway clearance and is very important if you have it.

What airway clearance do you do? And since it is hard to eradicate, how do yu sterilize any equipment you use for clearance?

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kshore | @kshore | Oct 20, 2023

I am fairly new at the treatment and I'm very interested to know more about the breathing and exercise to help clear the lungs.

thank you

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isabellad | @isabellad | Oct 21, 2023

I have been doing airway clearance once a day since March. I nebulize with arbuterol and saline solution and use the Aerobica device. I HATE doing it.
I have just been diagnosed with MAC and will be going on the antibiotics protocol as soon as the final culture test comes in. The respiratory therapist told me that I must do airway clearance twice a day. Sometimes the process goes well; but there are times that the coughing is so intense that it totally exhausts me and the thought of repeating the process at the end of the day is prohibitive.

REPLY
2 replies
angeles31 | @angeles31 | Oct 22, 2023
In reply to @isabellad "I have been doing airway clearance once a day since March. I nebulize with arbuterol and..." + (show)
@isabellad

I have been doing airway clearance once a day since March. I nebulize with arbuterol and saline solution and use the Aerobica device. I HATE doing it.
I have just been diagnosed with MAC and will be going on the antibiotics protocol as soon as the final culture test comes in. The respiratory therapist told me that I must do airway clearance twice a day. Sometimes the process goes well; but there are times that the coughing is so intense that it totally exhausts me and the thought of repeating the process at the end of the day is prohibitive.

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I sympathize. I find it t be exhausting .
I do my once a day in the evening because I will be going g to bed right away .

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scoop | @scoop | Oct 22, 2023
In reply to @isabellad "I have been doing airway clearance once a day since March. I nebulize with arbuterol and..." + (show)
@isabellad

I have been doing airway clearance once a day since March. I nebulize with arbuterol and saline solution and use the Aerobica device. I HATE doing it.
I have just been diagnosed with MAC and will be going on the antibiotics protocol as soon as the final culture test comes in. The respiratory therapist told me that I must do airway clearance twice a day. Sometimes the process goes well; but there are times that the coughing is so intense that it totally exhausts me and the thought of repeating the process at the end of the day is prohibitive.

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I liken the experience to a loss -- loss of my prior seemingly carefree life! From initial denial to finally acceptance, you'll get there. Treatment is done in the comfort of your own place, no need to get hooked up to machine somewhere. Buy extra nebulizers so the cleaning process is less onerous. If you are too exhausted at the end of the day, perhaps you are huffing/coughing too hard. That has happened to me more than once! It's a royal pain no matter how you look at it -- you are in good company.

REPLY
1 reply
isabellad | @isabellad | Oct 22, 2023
In reply to @scoop "I liken the experience to a loss -- loss of my prior seemingly carefree life! From..." + (show)
@scoop

I liken the experience to a loss -- loss of my prior seemingly carefree life! From initial denial to finally acceptance, you'll get there. Treatment is done in the comfort of your own place, no need to get hooked up to machine somewhere. Buy extra nebulizers so the cleaning process is less onerous. If you are too exhausted at the end of the day, perhaps you are huffing/coughing too hard. That has happened to me more than once! It's a royal pain no matter how you look at it -- you are in good company.

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Thank you for your encouraging words. I know I haven't gotten to full acceptance yet. Hopefully I'll get there soon.

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busyyaya | @busyyaya | Oct 29, 2023

I’m not able to produce sputum samples, had to get bronchoscopy for culture, pending. Using flutter valve 10x(3reps) with coughing x3 between reps. Bronch dr said I have a lot to clear out but can’t seem to make progress with this.
Trying to understand how nebulizer is helpful if you’re supposed to stay away from steamy hot tubs? Would a salt water hot tub work as well?

REPLY
1 reply
scoop | @scoop | Oct 29, 2023
In reply to @busyyaya "I’m not able to produce sputum samples, had to get bronchoscopy for culture, pending. Using flutter..." + (show)
@busyyaya

I’m not able to produce sputum samples, had to get bronchoscopy for culture, pending. Using flutter valve 10x(3reps) with coughing x3 between reps. Bronch dr said I have a lot to clear out but can’t seem to make progress with this.
Trying to understand how nebulizer is helpful if you’re supposed to stay away from steamy hot tubs? Would a salt water hot tub work as well?

Jump to this post

You nebulize sterile saline unlike hot steamy tubs which are not sterile; that's the difference.

Want to take a deep dive? Read this!
Reducing Exposure to Nontuberculous Mycobacteria (Reducing-Exposure-to-Nontuberculous-Mycobacteria.pdf) or
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141831/

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