What is the treatment for air space mucous plugging (also known as bronchial mucous plugging)?

From the Guidelines

Airspace mucous plugging is most effectively treated with chest physiotherapy, including postural drainage, percussion, and vibration techniques, as it has been shown to enhance the removal of tracheobronchial secretions in patients with various pulmonary conditions, including cystic fibrosis 1. The treatment of airspace mucous plugging involves a multifaceted approach that includes hydration, mucolytics, bronchodilators, and airway clearance techniques.

• Hydration is essential to thin secretions, and this can be achieved through oral or intravenous fluids.
• Mucolytic agents like N-acetylcysteine (NAC) can break down mucus, but their effectiveness in treating airspace mucous plugging is not well-established in the provided evidence.
• Bronchodilators such as albuterol can help open airways to facilitate mucus clearance, but the provided evidence does not specifically address their use in treating airspace mucous plugging 1.
• Chest physiotherapy, including postural drainage, percussion, and vibration techniques, has been shown to be effective in enhancing the removal of tracheobronchial secretions in patients with cystic fibrosis and other pulmonary conditions 1.
• The evidence suggests that chest physiotherapy can be beneficial in patients who produce > 20 to 30 mL of mucus daily, and it can increase the amount of expectorated sputum 1.
• While the evidence is limited, chest physiotherapy is considered the standard of care for patients with cystic fibrosis, and it is recommended to be performed 2-3 times daily for 20-30 minutes.
• Other treatments, such as hypertonic saline nebulization and mechanical devices like oscillatory positive expiratory pressure devices, may also be beneficial in treating airspace mucous plugging, but the provided evidence does not specifically address their use 1.

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: Acute bronchopulmonary disease (pneumonia, bronchitis, tracheobronchitis) 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 (bronchograms, bronchospirometry, and bronchial wedge catheterization)

The treatment for airspace mucous plugging is acetylcysteine (INH), which can be administered through various methods, including:

• Nebulization: 1 to 10 mL of the solution may be given every 2 to 6 hours
• Direct Instillation: 1 to 2 mL of solution may be given as often as every hour
• Diagnostic Bronchograms: two or three administrations of 1 to 2 mL of the solution should be given by nebulization or by instillation intratracheally, prior to the procedure 2 The indications for acetylcysteine solution include adjuvant therapy for patients with abnormal, viscid, or inspissated mucous secretions in conditions such as chronic bronchopulmonary disease, acute bronchopulmonary disease, and pulmonary complications of cystic fibrosis 2

From the Research

Treatment Options for Airspace Mucous Plugging

• Mechanical insufflation-exsufflation can be used to prevent acute respiratory failure in patients with amyotrophic lateral sclerosis, as seen in a study from 1997 3.
• Manually assisted coughing can also be effective in eliminating airway secretions, provided that bulbar muscle function is sufficient to permit assisted peak cough flows of 160 l/min or greater 3.
• Bronchoscopic inspection and airway lavage may be necessary to identify and clear central-airway mucus plugging in mechanically ventilated patients 4.
• Biologic therapies may help decrease mucus plugging in asthma, as they have been shown to reduce airflow obstruction and markers of eosinophilic airway inflammation 5.

Identifying Mucus Plugging

• High-resolution computed tomography imaging can be used to identify mucus plugs in patients with moderate to severe asthma 6.
• A mucus plug score can be calculated to assess the severity of mucus plugging, with higher scores indicating more severe plugging 6.
• Airway pressure and flow tracings can be used to identify occult central airway mucus plugging in ventilated asthmatic patients 4.
• Bronchoscopic findings, such as the presence of thick, inspissated mucus, can also be used to diagnose mucus plugging 7.

Associated Conditions

• Mucus plugging is commonly associated with asthma, particularly in patients with severe asthma 6, 5.
• Other conditions that may involve mucus plugging include allergic bronchopulmonary aspergillosis, plastic bronchitis, and chronic eosinophilic pneumonia 7.
• Mucus plugging can also be associated with impaired spirometry, frequent exacerbations, and raised blood eosinophils and IgE levels 6.