Pulmonary clearance – a patient story

MAC & Bronchiectasis – a patient story

Patients with MAC & Bronchiectasis can have difficulty clearing the airways but after nearly two years of experimentation & research, this patient has found an approach that may help you. 

An 84 year old male was diagnosed with Mycobacteria avium Complex in December 2012.   He struggled to produce 3 samples of mucus for analysis.

Due to spinal fusion he has little movement left in the neck and lower spine. The rib cage has been affected. His chest expansion is about one cm.

For the first six months, he tried to clear his airways without any success. With the help of an experienced Respiratory Physiotherapist he started to make some progress. However, after 6 months he still was only removing a small quantity of mucus each day, but the MAC was under control.

Then suddenly, the MAC infection accelerated and for the next seven months, his health had deteriorated noticeably. He felt his inability to clear his airways was possibly the reason for the downturn in his health. He redoubled his efforts to clear his airways using the following technique.

Equipment used

  • A comfortable chair, that allows you to sit and relax with both feet flat comfortably on the floor
  • A table at a comfortable height
  • Sinus Rinse Kit
  • MyAirVo 2 to deliver humidified air at 37 Degrees at a rate of 25 litres per minute
  • Aerobika OPEP Aid
  • Pari Sprint Nebulizer and Pari Boy compressor
  • A tube to connect the Aerobika and Pari Sprint Nebulizer
  • 10 ml of 0.9 % Saline solution. Normal Sterile Eye Wash is OK
  • Some sort of receptacle, like a plastic cup for excess saliva
  • Tissues

Sinus Rinse

Before going to bed, rinse your sinuses, to remove any old mucus in the sinuses.

Using the MyAirVo

Overnight, use the MyAirVo 2 to inhale humidified air at 37 Degrees at a rate of 20 litres per minute. This helps to soften the mucous in the airways. You will need to inhale the warm humid air for at least 6 Hours each night. As soon as possible after getting out of bed in the morning, start using the Aerobika and Nebulizer as follows.

Using the Aerobika and Nebulizer

Tip: Being FULLY RELAXED at ALL times, is the best advice we can give you, when you succeed, you will NOT be exhausted.
Sometimes your chest may feel tight. If this occurs at any time, you are NOT fully relaxed, take a moment to recognise you are not relaxed, pause and let everything go.
  • To start spend 10 minutes getting all your day to day issues out of your mind. Just think about the air moving in and out of your nose. Alternatively, if you have some experience with meditation, spend 10 minutes meditating in a way that works for you.
  • If this is the first time you have used an Aerobika, set the back pressure resistance to the lowest setting (next to the minus sign).
  • Inhaling: Relax your facial muscles, throat and chest. Hold the Aerobika mouthpiece in your mouth and let the compressor fill your lungs with saline air. If you find you need to consciously inhale do so gently and slowly. Inclining your head slightly backwards in a comfortable position will help open up your wind pipe. Use your abdominal muscles to fill the lower lobes of your lung with saline air and expand your diaphragm. Hold your breath for the count of three. You may see the humid saline air escaping from the Aerobika whilst you are holding your breath.
  • Exhaling: Hold the Aerobika mouthpiece firmly with your mouth and tighten your facial muscles so that they are firm but not being strained. Don’t let your cheeks to vibrate excessively when you exhale through the Aerobika.
Comment: This will take some practice to get right. Persevere, and do not give up. The detail matters, otherwise you will lose a lot of the benefit of the Aerobika’s pulsations to reinforce the action of the cilia in the airways to move the mucus towards your throat

You may have been taught how to do a “Pelvic Floor” exercise. We are going to use that technique to push your Thoracic Diaphragm upwards and push the air out of your lungs. At the same time, we want you to keep your upper body, arms, shoulders and throat relaxed, but your facial muscles firm. It is very easy to tighten up your chest when exhaling. This may cause your throat to tighten and the rate of air travelling up your wind pipe, carrying the mucus, will be reduced.

To push your diaphragm upwards, focus your mind on squeezing your buttocks together and tightening your abdomen muscles. You should feel a tightening in your groin region first. Exhale in a firm, but not strained manner until your abdomen muscles are fully contracted and then pause, before inhaling again.

  • Repetitions-Step one: Repeat inhaling and exhaling as above 10 times.

Tip: Use a pencil and paper to mark a count of five, twice. Because your mind is busy whilst you are inhaling and exhaling, it is very easy to lose track of how many times you have breathed in and out.

  • Deep breathing: Take about three deep breaths quietly and exhale through your nose, try and feel the tension in your body disappear.

Tip: Relax as you exhale, from your forehead, your eyes, facial muscles, throat and shoulders. Let your arms just hang loose and twinkle your fingers and toes. Your shoulders are likely to fall as you relax.

  • Huffing: Open your mouth, so it is fully open, but not strained. Let your head incline slightly backward to open up your windpipe. Keep your throat relaxed whilst you squeeze your buttocks together to force your abdomen upwards. Tighten your abdomen muscles to push out the air from deep in your lungs in a short burst. Feel the air moving up through your lung and throat. As you exhale make a sound like “Huff” as if you are fogging up a mirror. You need to firmly exhale the air fairly fast, but never in forced manner, otherwise your windpipe will contract and reduce the volume being exhaled to transport the mucus up and out of your lungs.

Tip: Ask your medical centre for a couple of mouth pieces used for lung function tests. Buy some Rubbing Alcohol and get a small bottle with spray top to spray the alcohol over the mouth piece, when you are finished.

When you “Huff” you might find it helps to put an open hand in front of your mouth and imagine it is the mirror you are fogging up.

  • Deep breathing: You may find it beneficial to take some deep breaths before moving on.
  • Repetitions-Step two: Repeat the above cycle of
    • Inhaling and exhaling 10 times.
    • Deep Breathing, Huffing and Deep Breathing

Until you hear the mucus in your throat crackling strongly and you can feel the mucus collecting in the top of your throat.

Try to avoid coughing, until you get that irresistible urge to cough.

  • Productive Cough:

Comment: This is VERY difficult to do successfully. It may take you many months before you fully succeed.  Try not to give up or get frustrated, continue to persevere. Mucus left in your airways allows the bacteria the opportunity to flourish and reduces the effectiveness of the antibiotics.

Tip: The principles of a successful productive cough are:

  1. Focus your mind on building up from deep in your lungs to cough
  2. Make your cough contain a large rush of air followed by a relaxed cough

If the cough is shallow, forced, vigorous, explosive or uncontrolled, it can cause your airways to collapse and spasm, trapping mucus.

To cough effectively:

  1. Sit on a chair or on the edge of your bed, with both feet on the floor. Alternativley, you may coughing more successfully, standing up. If so, lean slightly forward and relax.
  2. Fold your arms across your abdomen and breathe in slowly through your nose
  3. To exhale: lean forward, pressing your arms against your abdomen. Cough 2-3* times through a slightly open mouth. Coughs should be short and sharp, but not forced. Remember an effective cough comes from deep in your lungs. It is a controlled firm RELAXED movement.

Comment: The first cough loosens the mucus and moves it through the airways. The second and third cough enables you to cough the mucus up and out.

  1. Breathe in again by “sniffing” slowly and gently through your nose. This gentle breath helps prevent mucus from moving back down your airways.
  2. Rest
  3. Perform again if needed.

Comment: There are many ways to cough productively. Use your imagination to adapt the principles outlined above. REMEMBER coughing can be VERY exhausting. When you are fully relaxed and able to control the coughing action, you will NOT be exhausted.  Don’t be concerned if it takes 20 minutes or more, after completing the Breathing and Huffing stages, before you get that irresistible urge to cough

Clean Up

  • The Aerobika can be washed in the dishwasher
  • Once a week, sterilize the Aerobika and Nebulizer

Comment: Over time, you are likely to notice condensation in the connecting tube, particularly when the ambient air is cold. Running the compressor for a short while will dry out the connecting tube.

Tip: A microwave sterilizer is a convenient solution. They are readily available from popular stores.