What Are the Benefits of Pulmonary Hygiene for COPD?

How May Pulmonary Hygiene or Toilet Help with Lung Disease?

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What is pulmonary hygiene and how may it help people with lung disease?. Lumi Images/Romulic-Stojcic / Getty Images

What are the benefits of pulmonary hygiene for people with COPD?

What is Pulmonary Hygiene or Bronchopulmonary Hygiene? - Definition

Pulmonary hygiene is a technique designed to help clear mucus and secretions from your lungs. It can be used for people who have chronic obstructive pulmonary disease (COPD), pneumonia, cystic fibrosis, or bronchiectasis.

Pulmonary hygiene, or bronchopulmonary hygiene is usually performed by physical therapists or respiratory therapists, and uses a combination of deep breathing, lung exercises, different positions and vibration to help break up and remove mucus.

Pulmonary hygiene, which formerly was called "pulmonary toilet," may help to prevent what's called atelectasis, which is when the tiny air sacs in your lungs, the alveoli, collapse. Studies, however indicate that benefits of pulmonary hygiene in people who have COPD may be small, and other methods to help clear mucus—methods that don't involve a caregiver's help—may be just as effective as pulmonary hygiene. Medications also can help to clear mucus.

Pulmonary Hygiene Basics

Here's a rundown of the various methods that may be used to clear mucus during pulmonary hygiene:

  • Deep breathing. Deep breathing is as simple as it sounds—you breathe in deeply and then attempt to cough up mucus and secretions. A physical therapist should be able to instruct you in the most effective breathing techniques for someone with COPD or another medical condition involving the lungs.
  • Incentive spirometry. Incentive spirometry involves a medical device that helps you to exercise your lungs. When you blow into an incentive spirometer, you also exercise your lungs, which can help to keep them clearer.
  • Postural drainage. Simply put, postural drainage uses your posture—your body's position, with an assist from gravity—to help drain mucus out of your lungs. Your physical therapist or respiratory therapist will tell you exactly how to position yourself for this procedure. Postural drainage is often used together with devices that create a vibration in the lungs to break up mucus.

During a pulmonary hygiene session, you and your therapist may use any combination of these techniques.

How Well Does Pulmonary Hygiene Work?

It's not clear how effective pulmonary hygiene is in reducing and thinning mucous in the lungs, and ultimately, how helpful it is in reducing the symptoms of lung disease. There have been various studies conducted on pulmonary hygiene and on the individual techniques and procedures involved, and while pulmonary hygiene does appear to be safe, the available evidence indicates only a small benefit in people with COPD. Some of the techniques are uncomfortable as well.

If you've been hospitalized with COPD, it's possible that pulmonary hygiene can help lessen the need for a mechanical respirator, and it may also reduce the length of your hospital stay.

However, it doesn't appear to reduce the number of COPD exacerbations, nor does it reduce the number of COPD-related hospitalizations.

Alternatives to Pulmonary Hygiene

In addition to, or instead of pulmonary hygiene, there are other methods which can be used to decrease or thin respiratory mucus.

  • Controlled coughing - Controlled coughing is one of the most effective means of airway clearance for people with COPD.
  • Expectorants - Expectorant medications may help to thin and loosen airway mucus. People may actually cough more when using an expectorant as the purpose is to make coughing more productive.
  • Mucolytics - Mucolytic medications are used to thin thick secretions. Though not used as often as in the past for COPD, these medications have been found to reduce the frequency of COPD exacerbations.

Bottom Line on Pulmonary Hygiene for COPD

Though studies haven't found pulmonary hygiene to reduce COPD exacerbations, it is encouraging that it may decrease the length of hospitalization. It is also uncertain how helpful it may be in reducing the symptoms of the disease. It's likely that it probably helps some people but not others, as with many of the treatments we currently have available.

Overall, the most effective management of COPD includes a wide range of approaches ranging from medications to lifestyle changes. Since each person is different, it's important to talk to your doctor about what seems to help and what doesn't seem to make a difference for you specifically. We do, however, know that pulmonary rehabilitation can make a tremendous difference in both the severity of symptoms and exacerbations for those coping with the disease.

Sources:

Spapen, H., De Regt, J., and P. Honore. Chest Physiotherapy in Mechanically Ventilated Patients without Pneumonia – A Narrative Review. Journal of Thoracic Diseases. 2017. 9(1):E44-E49.

Lee, A., Burge, A., and A. Holland. Airway Clearance Techniques for Bronchiectasis. Cochrane Database of Systematic Reviews. 2015. (11):CD008351.

Osadnik, C., McDonald, C., Jones, A., and A. Holland. Airway Clearance Techniques for Chronic Obstructive Pulmonary Disease. Cochrane Database of Systematic Reviews. 2012. (3):CD008328.

Puhan, M., Gimeno-Santos, E., Cates, C., and T. Troosters. Pulmonary Rehabilitation Following Exacerbations of Chronic Obstructive Pulmonary Disease. Cochrane Database of Systematic Reviews. 2016. 12:CD005305.

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