How to treat mucous buildup in patients with Parkinson's disease?

Treatment of Mucous Buildup in Parkinson's Disease

Sinonasal irrigation with saline is the first-line treatment for mucous buildup in Parkinson's disease patients, followed by mechanical insufflation-exsufflation for those with ineffective cough. 1

First-Line Treatments

Saline Irrigation

• Saline irrigation is a safe and effective method for clearing mucostasis in the upper airways resulting from impaired mucociliary clearance in Parkinson's disease 1
• Can be performed independently by patients or caregivers
• Should be used regularly as a preventive measure, not just during acute episodes

Assisted Cough Techniques

• Mechanical insufflation-exsufflation (cough assist devices) should be used when:
  • Peak cough flow is less than 270 L/minute
  • Maximal expiratory pressures are less than 60 cm H₂O
  • Clinical history suggests difficulty in airway clearance 1
• These devices simulate a cough by providing positive pressure breath followed by negative pressure exsufflation, generating superior peak cough expiratory flows 1

Second-Line Treatments

Pharmacological Options

• Acetylcysteine (Mucomyst) nebulization can be used for viscid or inspissated mucous secretions
  • Dosage: 3-5 mL of 20% solution or 6-10 mL of 10% solution 3-4 times daily 2
  • Monitor for bronchospasm, especially during initial treatments
  • May be administered via face mask, mouthpiece, or nebulizer 2

Bolus Modification for Dysphagia

• For patients with concurrent dysphagia:
  • Thickened liquids (pudding-thick consistency) result in safer swallowing with lower penetration-aspiration scores 1
  • Honey-thick liquids are more effective than chin-down posture in preventing aspiration 1

Specialized Techniques

Expiratory Muscle Training

• Expiratory muscle strength training improves cough effectiveness and swallow function 3
• Benefits include:
  • Improved penetration/aspiration scores
  • Enhanced hypolaryngeal complex function
  • Increased peak cough expiratory flow 3

Thermal-Tactile Stimulation

• Can be effective for reducing pharyngeal transit time in patients with pharyngeal swallow delay 1
• Applied to the anterior faucial pillars

Monitoring Effectiveness

• Home pulse oximetry is useful to monitor effectiveness of airway clearance during respiratory illnesses 1
• Regular follow-up with otorhinolaryngologist is recommended:
  • Every six months for pediatric patients
  • As needed for adult patients 1

Common Pitfalls and Caveats

1. Delayed Treatment: Mucous buildup can lead to respiratory infections, a leading cause of mortality in Parkinson's disease - early intervention is critical

2. Overlooking Dysphagia: Concurrent dysphagia is common in Parkinson's disease and can worsen mucous management - comprehensive assessment is essential

3. Bronchospasm Risk: When using acetylcysteine, monitor for bronchospasm which may occur unpredictably, especially during initial treatments 2

4. Inadequate Hydration: Poor hydration can worsen mucous viscosity - ensure adequate fluid intake unless contraindicated

5. Equipment Compatibility: When using acetylcysteine, certain materials (particularly iron, copper, and rubber) may react with the solution - use equipment made of glass, plastic, aluminum, or stainless steel 2

By implementing this comprehensive approach to mucous management in Parkinson's disease, respiratory complications can be minimized, potentially improving quality of life and reducing morbidity.