We can’t talk about physiotherapy for bronchiectasis without talking about phlegm (sputum/mucus). For some people that will be met with an “eww gross” response, but for people with bronchiectasis, cough and phlegm can be a daily reality.
Everyone’s airways have a mucous lining. It is part of our body’s defense mechanism, to trap irritants or microorganisms that we breathe in, then get rid of them. Cilia, little hair-like structures which also line the airways, help to push the mucus along and usually it is swallowed away without us even noticing.
Bronchiectasis is a chronic lung condition where damage/ scarring of the airways causes them to become enlarged. Inflammation causes increased mucus production and damaged cilia have difficulty moving the mucus. So mucus can build up in the enlarged areas and become a more obvious plug of phlegm to cough up. Trouble arises if the phlegm isn’t regularly cleared, as it creates a nice place in your lungs for bugs to grow which in turn can cause further damage to airways.
Daily physiotherapy - specifically techniques to clear phlegm - is a cornerstone of bronchiectasis management and helps reduce infections. One of the simplest techniques to try is the active cycle of breathing technique. This uses a combination of deep breaths (to get air in behind phlegm) and “huffing” (forced out breaths) to pull phlegm along the airways and make it easier to cough out.
This technique is great because it doesn’t require any equipment and can be done anywhere, anytime. There are also other strategies that can be used to help clear phlegm. A respiratory physiotherapist can work with you to establish an optimal chest clearance regime.
The “Bronchiectasis Toolbox” is a useful website to check out (www.bronchiectasis.com.au). It has video clips demonstrating a range of different chest clearance techniques. Keeping physically active is also beneficial, not just for your general health, but it can also help clear phlegm.
The most important thing is finding something that works for you, so you can clear your phlegm effectively every day to reduce the risk of infection and further airway damage.
Zöe Manderson is a respiratory physiotherapist in Taranaki for Te Whatu Ora and a member of the Asthma and Respiratory Foundation NZ's Scientific Advisory Board.
