Your Airways Clear: Ways to Manage Your Airway Mucus

This article was written by Michael W. Hess, MPH, RRT, RPFT

For many people with COPD, frequent coughing that produces sputum (the “junk” you cough out) is a fact of life. It can be uncomfortable, embarrassing, and very hard to control. However, there are things you can do to help manage your airway mucus. These are known as airway clearance techniques.

Coughing and Breathing Techniques

Many airway clearance techniques do not require any special equipment or tools. One of the most common techniques is called huff coughing, as seen in this video from the Cystic Fibrosis Foundation (CFF). With huff coughing, you simply sit down, take a breath deep enough to fill up your lungs, then "huff" the air back out in short bursts. Keep your mouth open so that it sounds like you are saying, "ha, ha, ha." Repeat these steps a couple of times, and you will probably find yourself coughing more strongly. Be sure to keep some tissues handy to cover your cough!

Another airway clearance method combines huff coughing with other breathing techniques. As you'll see in the following CFF video, this is called the active cycle of breathing technique, or ACB. With ACB, you start by taking five or six gentle breaths while placing one hand on your stomach. Purse your lips while you exhale to keep the airways open longer. After that set of breaths, take a very deep breath and hold it for three seconds. This helps get air deeper behind the sputum, helping to drive it out. After the breath hold, use huff coughing to bring the sputum up and out of your lungs.

Handheld Tools for Airway Clearance

If these techniques are not helping keep your airways clear, you may need something a little more powerful. As you'll see in this CFF video, there are several small handheld tools called airway oscillating devices (AODs) that can help manage your airway mucus. A resistance membrane provides pressure that helps keep your airways open longer (like how pursed lip breathing works) while a small flapper in the device bounces back and forth. These back-and-forth movements, called oscillations, send vibrations down into your airways that help to knock the sputum loose. You can then cough it out.

With these tools, it is important to know that while some are available at local stores or online, others may require a prescription. Also, the resistance from these devices may cause problems like increased shortness of breath for people with more severe COPD symptoms. Be sure to talk with your health care provider before using one.

A cough assist device is a more powerful airway clearance tool that always requires a prescription. These machines use pressure to push air into the lungs and then quickly reverse to suction. That switch helps you exhale more fully and makes your cough more productive. Because the cough assist device is much more complicated to use than the handheld devices (and is not suitable for everyone with COPD), you will need a prescription and special training to use it safely.

Chest Vests for Sputum Production

The final type of therapy is perhaps the bulkiest and most complicated, but it is also one of the most powerful. This CFF video features high-frequency chest wall oscillation (HFCWO) vests covering your back and chest. HFCWO vests use rapid vibration and shaking effects to shake the sputum loose so you can cough it up more effectively. Some vests use air pressure to inflate and deflate sections of the vest to create the effects. These vests must be plugged into an electrical outlet when in use, which can limit your mobility. Other vests use small electric motors and have batteries, allowing you to walk around and do household activities while also doing your therapy.

Other Tips for Airway Clearance

While airway clearance techniques can be very helpful, you can also do things to thin out your sputum. The thinner it is, the easier it will be to cough up! Make sure you drink an appropriate amount of water (based on your health care provider's instructions) and stay hydrated. Sometimes, over-the-counter medications called expectorants can help thin out sputum, especially if you have an exacerbation (flare-up). If you have trouble clearing your airway mucus, your clinician may prescribe other medications such as nebulized hypertonic saline to thin the mucus in your airways. Make sure you follow your health care provider's instructions and keep those airways clear!