The Importance of Airway Clearance for Bronchiectasis Patients

Bronchiectasis is a serious, debilitating, and increasingly prevalent disease in the developed and developing world. Due to an overall aging of first world populations as well as widespread tobacco use and the prevalence of airborne pollution in many urban areas there has been a dramatic rise in new cases.

New data and vastly improved diagnostic techniques permit earlier recognition as well as more accurate diagnoses. Through ongoing research, the medical community has a greater understanding of the etiology and pathophysiology of this particular condition.  This has resulted in more timely and effective therapeutic interventions.

In the past, bronchiectasis was viewed as an advanced to late stage of a variety of diseases and conditions.  New data suggests that certain diseases and conditions, such as uncontrolled infection, cystic fibrosis, ciliary dyskinesia, and immunological defects, are risk factors rather than the actual cause.

The single common denominator that diseases and conditions associated with bronchiectasis is that they contribute to susceptibility to the “classic vicious cycle of pulmonary infection” according to Dr. Jane Braverman of the University of Minnesota.

Dr. Braverman argues that patients with these risk factors (cystic fibrosis, ciliary dyskinesia, and immunological defects) predispose patients to the development of bronchiectasis.  Therefore, to stop this progression requires “preventative strategies”.

First, it is vital that the underlying pathological conditions be identified to prevent disease progression.  Although the study of causation of bronchiectasis is rather complex and varies between patients, the actual components of preventative treatments are well established.

Appropriate physical (percussion and using the Hill-Rom The Vest Airway Clearance System) and pharmacologic interventions must be aggressively implemented to control infection and disease progression.  If these strategies are successful, patients can expect relief from bronchial obstructions, improved ventilation and gas exchange.

Airway clearance therapy

Mucus hypersecretion is both a cause and an effect of destructive events such as pneumonia or bronchitis that so often defines bronchiectasis. Uncleared secretions in the patient’s lungs and airway can nurture microorganisms that trigger a destructive cycle of pulmonary infections, chronic inflammation, and cause the patient to retain high concentrations of cytotoxic byproducts.

To make matters worse, it is the patient’s mucus acting as the medium to transport cytotoxic byproducts that damage ciliary apparatus and other components of the lung defense system.  Data from CF patients suggests that traditional airway clearance techniques such as percussion therapy and postural drainage are insufficient.  In addition, excessive use of antibiotics has caused certain organisms to become resistant to most common antibiotics.

Dr. Braverman continues: “Because bronchiectasis is a consequence of a well-defined cascade of pathological events, it is imperative to prevent patients’ initiation into the vicious cycle. If the infectious cycle is already established, therapy should be designed to limit disease progression. With the implementation of aggressive, effective airway clearance therapy, pathogenic microorganisms and inflammatory byproducts are removed. Such therapy mobilizes retained secretions, augments mucociliary transport, and enhances clearance of thick mucus.”

So why is Airway Clearance so important?

“Because bacterial colonization and irreversible damage from mucus plugging occurs most frequently in the peripheral airways, it is important to utilize a modality that treats all regions of the lungs and reliably mobilizes mucus from small as well as large airways.”

This post includes passages from an article entitled “Airway Clearance Indications in Bronchiectasis: An Overview” authored by Jane M. Braverman, Ph.D. published by Hill-Rom.

The entire article is available at http://www.thevest.com/files/CLS175BronchiectasisOverview.pdf

 

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