What is the rehabilitation approach for a patient with excessive sputum production?

From the Guidelines

The most effective rehabilitation approach for a patient with excessive sputum production is regular respiratory physiotherapy, which includes bronchopulmonary hygiene therapy and airway clearance techniques.

Key Components of Rehabilitation

• Respiratory physiotherapy: Regular twice daily sessions increase sputum expectoration, improve cough-related health status, quality of life, and exercise capacity in individuals with stable bronchiectasis and chronic sputum expectoration 1.
• Bronchopulmonary hygiene therapy: Includes education and instruction on appropriate airway clearance techniques, which lead to improvement in cough symptoms and cough-related health status in stable outpatients with bronchiectasis 1.
• Airway clearance techniques: Such as postural drainage, chest wall percussion, and vibration, which increase airway clearance as assessed by sputum characteristics and clearance of radioaerosol from the lung 1.

Additional Considerations

• Collaborative self-management: Promotes self-efficacy and adaptive behavior change, including goal setting, problem solving, and decision-making, which can be implemented through pulmonary rehabilitation 1.
• Patient education: Essential for effective airway clearance and self-management, particularly for younger patients or those with decreased understanding of the necessity of airway clearance 1.
• Interdisciplinary team: A team of healthcare professionals, including physicians, nurses, respiratory therapists, and exercise specialists, is necessary for comprehensive pulmonary rehabilitation 1.

From the Research

Rehabilitation Approach for Excessive Sputum Production

The rehabilitation approach for a patient with excessive sputum production involves various techniques to improve mucociliary clearance and reduce sputum production.

• Postural drainage, percussion, and vibration can enhance mucociliary clearance and produce larger sputum volumes in patients with excessive tracheobronchial secretions 2.
• Breathing exercises, such as active cycle of breathing techniques (ACBT), can improve sputum production and cough efficiency in patients with chronic obstructive pulmonary disease (COPD) 3.
• The use of devices like the FLUTTER device, which provides oscillating positive expiratory pressure, can be effective in removing secretions and improving sputum production 4.
• Techniques like expiration with the glottis open in the lateral posture (ELTGOL) can also be effective in removing secretions and improving sputum production 4.
• Pulmonary rehabilitation programs, including treadmill walking, cycle ergometry, breathing exercises, and postural drainage with clapping percussion-vibratory-shaking, can improve exercise tolerance and quality of life in patients with bronchiectasis 5.

Components of Chest Physiotherapy

Chest physiotherapy (CP) is effective in clearing secretions from the lungs of patients with copious secretions.

• The administration of a beta 2-agonist via a nebulizer prior to CP can help promote bronchodilation and alter the physical properties of secretions, making them more amenable for clearance 6.
• Postural drainage (PD) is successful in helping to drain secretions in the lungs 6.
• The forced expiration technique (FET) is effective in clearing secretions, and its effect is greater than that achieved with instructed cough 6.
• Intermittent positive pressure breathing (IPPB) may have a role to play in those patients where conventional CP is not possible 6.