Airway Clearance Devices for COPD

A Review of the Most Current Techniques and Devices

The excessive production mucus is a common feature of chronic obstructive pulmonary disease (COPD). This accumulation of mucus accounts in large part for the restriction of air into and out of the lungs. This results in the characteristic wheezing, coughing, and shortness of breath that we have come recognize as obstructive lung diseases, including chronic bronchitis and emphysema.

Airway clearance techniques (ACT) are those which aim to remove sputum (the combination of mucus and saliva) from your lungs. Conventional methods of airway clearance include the Huff cough technique, controlled coughing, chest physiotherapy, and postural drainage. These are certainly helpful technique but typically fall short in providing anything more than modest relief.

Airway clearance devices, by contrast, offer greater returns if used when conjunction with traditional ACT. They are widely available, easy to use, and relatively inexpensive. To better facilitate clearance, a bronchodilator inhaler is typically used to widen airway passages while an inhaled mucolytic is used to thin mucus.

1
Positive Expiratory Pressure (PEP) Therapy

Positive expiratory pressure (PEP) therapy was developed in the 1970s as an alternative to standard chest physiotherapy (CPT).

Using a face mask or mouthpiece, patients take in a normal breath and then exhale into a one-way valve against gentle resistance. The device allows more air into the smaller airways thereby creating pressure to gently dislodge the mucus. It is this pressure that ultimately pushes the mucus toward the larger airways, making it easier to expel. 

In clinical studies, the PEP device was shown to:

  • improve mucus clearance
  • increase patient comfort compared to standard CPT
  • reduce lung infections and antibiotic use
  • improve bronchodilation
  • reduce hospital stays

Some of the more popular devices are marketed under the names Astra PEP, Pari PEP, and AeroPEP.

2
High-Frequency Chest Wall Oscillation (HFCWO)

High-frequency chest wall oscillation (HFCWO) is comprised of an inflatable vest which uses air pressure to gently oscillate the chest wall. This action increases airflow to the smaller passages and aids in the clearance of mucus.

HFCWO devices are easy to use and have been shown to mobilize more mucus than standard CPT.

Typically, a person will use the vest for five minutes at a time and then cough and huff to clear the loosened mucus. Sessions last for around 20 to 30 minutes.

Examples of the HFCWO device include the Vest Airway Clearance System and the Medpulse Respiratory Vest System.

3
Flutter Mucus Clearance System

Combining PEP therapy with high-frequency oscillation, the Flutter Mucus Clearance Device offers a controlled vibration system that gently oscillates the large and small airways. This action helps loosen mucus from bronchial walls while accelerating airflow to better stimulate clearance. 

Oscillating devices like this create vibrations when you exhale. After blowing through the device several times, a person is usually able to cough and huff out the accumulated mucus.

Although the Flutter device is inexpensive and relatively easy to use, persons with severe airway obstruction may not be able to generate enough airflow to allow the device to work properly.

Similar devices are marketed under names Acapella, Cornet, and Aerobika OPEP.

4
Lung Flute Acoustic Induction Device

The Lung Flute is a hand-held device that generates low-frequency sound waves into the airways as the person vigorously exhales through a reeded mouthpiece (much like blowing into a clarinet). The waves travel down into the lower airways and stimulate mucus clearance.

The Lung Flute is FDA approved for diagnostic as well as therapeutic use and is regularly used in labs to help collect sputum samples for testing.

In order to achieve the best results, the patient would need to blow into the Lung Flute for up to 20 sets of two blows per set. As with any ACT therapy, the person would need to begin slowly and build up the number of repetitions over time.

In addition to COPD, the Lung Flute is approved for use in treating bronchitis, pneumonia, asthma, emphysema, and other chronic respiratory ailments.

Choosing the Right Airway Clearance Device

Choosing the right air clearance device is ultimately an individual choice. Each has different mechanisms of action, which some people like and others don't. As such, don't hesitate to ask your doctor or respiratory therapist for advice. Alternately, you can post a message on a COPD community board to get insights from others who may have used a device.

Sources:

Holland, A. and Button, M. "Is there a role for airway clearance techniques in chronic obstructive pulmonary disease?" Chron Respir Dis. 2006; 3(2):83-91.

Hristara-Papadopoulou, A.; Tsanakas, J; Diomou, J.; et al. "Current devices of respiratory physiotherapy." Hippokratia Medical Journal 2008 ; 12(4): 211-220.

Osadnik, C., McDonald, C.; Jones, A.; et al. "Airway clearance techniques for chronic obstructive pulmonary disease." Cochrane Database Syst Rev. 2012; (3):CD008328

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