From the FDA Drug Label
Acetylcysteine is indicated as adjuvant therapy for patients with abnormal, viscid, or inspissated mucous secretions in such conditions as: Chronic bronchopulmonary disease, Acute bronchopulmonary disease, Pulmonary complications of cystic fibrosis, Tracheostomy care, Pulmonary complications associated with surgery, Use during anesthesia, Post-traumatic chest conditions, Atelectasis due to mucous obstruction, Diagnostic bronchial studies After proper administration of acetylcysteine, an increased volume of liquified bronchial secretions may occur. When cough is inadequate, the open airway must be maintained open by mechanical suction if necessary. When used by direct instillation, 1 to 2 mL of a 10% to 20% solution may be given as often as every hour. When used for the routine nursing care of patients with tracheostomy, 1 to 2 mL of a 10% to 20% solution may be given every 1 to 4 hours by instillation into the tracheostomy
The treatment for heavy tracheal secretions is acetylcysteine. It can be administered through:
- Nebulization: 1 to 10 mL of the 20% solution or 2 to 20 mL of the 10% solution may be given every 2 to 6 hours
- Direct instillation: 1 to 2 mL of a 10% to 20% solution may be given as often as every hour It is essential to maintain an open airway and be prepared for mechanical suction if necessary, as acetylcysteine may increase the volume of liquified bronchial secretions 1, 1, 1.
From the Research
The most effective treatment for heavy tracheal secretions is the use of recombinant human deoxyribonuclease (rhDNase) in conjunction with chest physiotherapy, as it has been shown to improve pulmonary function and reduce respiratory exacerbations in patients with cystic fibrosis 2, 3.
Treatment Approaches
The treatment for heavy tracheal secretions includes several approaches depending on the underlying cause and severity, including:
- Mucolytics like N-acetylcysteine (NAC) at 600-1200mg daily to help thin secretions
- Expectorants such as guaifenesin (400mg every 4 hours) to loosen mucus
- Adequate hydration with a recommended 2-3 liters of fluid daily to maintain thin secretions
- Physical interventions like chest physiotherapy, postural drainage, and airway clearance techniques like huffing and active cycle breathing
- Suctioning using sterile technique for patients unable to clear secretions independently
- Nebulized saline (0.9%) to help mobilize secretions
- Bronchodilators such as albuterol (2.5mg via nebulizer every 4-6 hours) for patients with concurrent bronchoconstriction
Addressing Underlying Conditions
Addressing underlying conditions like infections with appropriate antibiotics, managing GERD, or treating chronic respiratory diseases is crucial for long-term management 4, 5.
Optimal Timing of rhDNase
The optimal timing of rhDNase administration in relation to physiotherapy is also important, with a longer time interval between rhDNase and physiotherapy showing improved clinical outcomes 5.
Safety and Efficacy
rhDNase has been shown to be safe and effective in patients with severe pulmonary disease, with improvements in pulmonary function and reductions in respiratory exacerbations 6.