From the Guidelines
Treatment of excessive bronchial secretions should prioritize nonpharmacologic airway clearance therapies, including physical therapy procedures and devices, as they have been shown to enhance secretion clearance in patients with copious secretions. When considering the management of excessive bronchial secretions, it's crucial to focus on techniques that improve airway clearance. According to the study by 1, nonpharmacologic airway clearance therapies such as postural drainage, forced exhalation, and positive expiratory pressure (PEP) therapy can be beneficial in enhancing secretion clearance. Key points to consider in the treatment approach include:
- The use of physical therapy procedures and devices to aid in secretion clearance
- The potential benefits of manually and mechanically assisted coughing for patients with severe neuromuscular disease and impaired cough
- The importance of considering the individual patient's condition, such as those with cystic fibrosis (CF), when selecting the most appropriate airway clearance technique
- The need for further research on the long-term outcomes of nonpharmacologic airway clearance techniques, including their impact on health-related quality of life and rates of exacerbations, hospitalizations, and mortality, as noted in the study by 1. In clinical practice, a combination of these nonpharmacologic approaches, tailored to the individual patient's needs, is likely to provide the most effective management of excessive bronchial secretions, although the study by 1 highlights the need for more research in this area to fully understand the effects on long-term outcomes.
From the FDA Drug Label
Acetylcysteine solution, USP is indicated as adjuvant therapy for patients with abnormal, viscid, or inspissated mucous secretions in such conditions as: Chronic bronchopulmonary disease (chronic emphysema, emphysema with bronchitis, chronic asthmatic bronchitis, tuberculosis, bronchiectasis and primary amyloidosis of the lung) 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.
The treatment for excessive bronchial (Bronchiolar) secretions is acetylcysteine as an adjuvant therapy to help liquify mucous secretions. Key points to consider:
- Mechanical suction may be necessary if cough is inadequate to clear the airway.
- Endotracheal aspiration with or without bronchoscopy may be required to clear the airway in cases of mechanical blockage.
- Bronchodilators may be used to relieve bronchospasm in asthmatic patients 2, 2.
From the Research
Treatment for Excessive Bronchial Secretions
The treatment for excessive bronchial secretions involves various medications and therapies. Some of the key options include:
- Mucoactive medications to reduce hypersecretion, make secretions easier to transport, or increase the efficiency of cough or mucus clearance 3
- Nebulized mucolytics, such as hypertonic saline or n-acetylcysteine, to help loosen and clear mucus 4
- Bronchodilators, including β(2)-adrenoceptor agonists, muscarinic receptor antagonists, and xanthines, to relax airway smooth muscle cells and improve airflow 5
- High-frequency chest wall oscillation (HFCWO) therapy to help clear mucus from the airways 4
Medications for Airway Clearance
Some medications that can enhance airway clearance include:
- Pulmonary clearance medications, such as those used in cystic fibrosis patients, which have shown beneficial effects in pulmonary function 6
- Aerosol medications, such as those used to augment secretion clearance, which can be used to reduce hypersecretion and improve mucus clearance 3
Treatment Algorithms
Treatment algorithms for bronchiectasis, such as the one described in 4, may include a combination of therapies, including:
- Nebulized bronchodilators and mucolytics
- High-frequency chest wall oscillation (HFCWO) therapy
- Macrolide therapy
- Long-acting antimuscarinic agents
These algorithms can help reduce hospitalizations and improve lung function in patients with bronchiectasis 4.