What is the management of bronchial mucous plugging in the lungs?

From the Guidelines

Management of bronchial mucous plugging in the lungs involves a combination of medications and physical techniques to clear airways and improve breathing, with the primary goal of improving quality of life and reducing morbidity and mortality. The most effective approach is to start with inhaled N-acetylcysteine (NAC) 3-5 mL of a 20% solution via nebulizer 2-3 times daily to break down mucus, as recommended by the European Respiratory Society guidelines for the management of adult bronchiectasis 1.

• Combine this with inhaled albuterol (2.5 mg via nebulizer or 2 puffs from an inhaler) before NAC to open airways, as suggested by the guidelines 1.
• Nebulized hypertonic saline (3-7%) can be used 2-4 times daily to further thin secretions.
• Implement chest physiotherapy, including percussion and postural drainage, for 20-30 minutes 2-3 times daily, as recommended by the guidelines 1.
• Encourage oral hydration with at least 2-3 liters of water daily, unless contraindicated. These interventions work synergistically: mucolytics break down mucus proteins, bronchodilators relax airway muscles, and hydration thins secretions, all facilitating easier mucus clearance. Adjust the regimen based on patient response and tolerance, and monitor for improvement in breathing and oxygen saturation, and be alert for signs of respiratory distress or infection, as recommended by the guidelines 1. It is also important to note that long-term mucoactive treatment and bronchodilator therapy may be beneficial for some patients, but the evidence is limited and these treatments should be individualized based on patient response and tolerance 1. Additionally, pulmonary rehabilitation programs have been shown to improve exercise capacity and quality of life in patients with bronchiectasis, and should be considered for patients with impaired exercise capacity 1.

From the FDA Drug Label

The viscosity of pulmonary mucous secretions depends on the concentrations of mucoprotein and, to a lesser extent, deoxyribonucleic acid (DNA). The mucolytic action of acetylcysteine is related to the sulfhydryl group in the molecule This group probably “opens” disulfide linkages in mucous thereby lowering the viscosity. After proper administration of acetylcysteine, an increased volume of liquefied bronchial secretions may occur. When cough is inadequate, the airway must be maintained open by mechanical suction if necessary. When there is a mechanical block due to foreign body or local accumulation, the airway should be cleared by endotracheal aspiration, with or without bronchoscopy

The management of bronchial mucous plugging in the lungs involves the use of mucolytic agents such as acetylcysteine to lower the viscosity of mucous secretions.

• Mechanical suction may be necessary to maintain an open airway when cough is inadequate.
• Endotracheal aspiration, with or without bronchoscopy, may be required to clear mechanical blocks due to foreign bodies or local accumulation. 2

From the Research

Management of Bronchial Mucus Plugging

The management of bronchial mucus plugging in the lungs can be approached through various methods, including:

• Bronchoscopic intervention, which may not be readily available in all centers 3
• Chest physiotherapy, such as bedside chest percussion, which has been shown to improve clinical status in patients with acute mucus plugging 3
• Preventive nebulization of mucolytic agents and bronchodilating drugs, which aims to prevent sputum plugging and associated complications in intubated and ventilated ICU patients 4
• Use of a mucus clearance device, which can enhance the bronchodilator response in patients with stable COPD 5
• Inhaled hypertonic saline, which has been shown to acutely enhance mucociliary clearance in adult asthma 6

Treatment Options

Treatment options for bronchial mucus plugging may include:

• Dual long-acting muscarinic antagonist/long-acting β2-agonist bronchodilators, which are recommended as initial maintenance therapy for many patients with COPD 7
• Combination therapy with long-acting bronchodilator agents and inhaled corticosteroids, which may be used as initial or follow-up therapy in patients with more severe symptoms or at risk of COPD exacerbations 7
• Acetylcysteine and salbutamol, which are being studied in a randomized controlled trial for their effectiveness in preventing sputum plugging and associated complications in intubated and ventilated ICU patients 4

Considerations

When managing bronchial mucus plugging, considerations should be given to:

• The patient's underlying condition, such as COPD or asthma, and the severity of their symptoms 7, 5, 6
• The availability of bronchoscopic intervention and the potential need for alternative treatments 3
• The potential benefits and risks of different treatment options, including the use of mucolytic agents and bronchodilating drugs 4