Mucus Clearance Device - Indications, Contraindications, and Benefits

Overview

Mucus clearance devices are the flutters that remove the excess mucus from the lungs. They are lightweight and can be used anywhere, as they do not require any electrical supply. It is a device with a mouthpiece and a ball that rolls around to form vibrations or oscillations. It is used along with exhaling the breath. It is used in lung conditions where mucus accumulates, like cystic fibrosis, bronchitis, bronchiectasis, and atelectasis.

What Is a Mucus Clearance Device?

Mucus clearance devices are portable devices that are used to clear the mucus from the lungs of patients with hypersecretory lung disorders. It is a device that can be used anywhere, as it is not powered. When the patient exhales through the device, it causes the loosening of the muscles by collapsing the airway and accelerating the airflow, followed by upgrading the mucus in the airways. Further, a gentle cough can also remove mucus.

What Are the Indications of Mucus Clearance Devices?

Indications of mucus clearance devices are involved in the mucus-producing a few respiratory conditions that include the following:

• Atelectasis - It is the complete collapse of the lung, it can be a partial collapse too.

• Bronchitis - It is an inflammation of bronchial tubules and their lining.

• Bronchiectasis - It is a condition with the widening of the lungs and the formation of mucus.

• Cystic Fibrosis - It is an inherited disorder that affects the digestive tract and lungs.

• Chronic Obstructive Pulmonary Disease (COPD) - A lung disease that is associated with obstructed airflow.

• Asthma - It is a condition in which the airway becomes narrowed and swollen.

What Are the Contraindications of Mucus Clearance Devices?

The contraindications of mucus clearance devices are:

• Pneumothorax - It occurs when the air leaks into the chest wall and lungs.

• Right heart failure.

What Are the Limitations of Using Mucus Clearance Devices?

The limitations of using mucus clearance devices are:

• This device is dependent on gravity.

• These need to be cleaned after every usage.

• They are limited to one patient only.

• These require adequate cognitive functionings like motivation and concentration.

• These also require adequate control over the motor movements, like sitting in the right position to hold the device properly and generating expiratory pressure.

Warning:

• Pneumothorax: If the patient is suffering from pneumothorax, then avoid its usage.

• Right-Sided Heart Failure: If any patient already has right-sided heart failure, then they should avoid the use of a mucus clearance device.

• Severe Tuberculosis: If the patient has severe tuberculosis, then the patient should avoid the usage of this device.

• Hemoptysis: If the patient is coughing up blood, then also the patient is inhibited from using a mucus clearance device.

What Are the Benefits of a Mucus-Clearance Device?

The benefits of mucus-clearance devices are:

• They are an effective alternative to physiotherapy treatment.

• They are small and portable devices.

• They are easy-to-use devices.

• They are also easy to clean by simple washing.

• They are low-cost and better for mucus clearance.

• They relieve the trapped mucus in the lungs.

• They keep the airways open by relieving mucus.

For Patients:

What Is the Use of a Mucus Clearance Device?

A mucus clearance device is used to clear the secretions from the chest. It is used in conjunction with other respiratory medicines. It is a handy and portable device that is used by the patient themselves.

Why Is a Mucus Clearance Device Used?

Mucus clearance devices are used when the patient is suffering from chronic lung conditions in which sputum or mucus is also present in the chest but is difficult to remove from the chest. Other than that, there are many benefits to using the mucus clearance device. They are:

• They are low-cost devices.

• They are portable.

• They are an effective alternative to physiotherapy.

• They keep the airways open and relieve the trapped mucus.

What Happens on Using the Mucus Clearance Device Regularly?

If the mucus clearance devices are used regularly, then,

• They decrease the cough of the patient throughout the day.

• They decrease the feeling of breathlessness.

• They help in decreasing the chances of infections.

• They decrease hospital visits.

• They decrease the chances of damage to the lungs.

How Does the Mucus Clearance Device Work?

The mucus clearance device provides resistance as the patient breathes out through it. They try to create some back pressure in the patient's airways that helps the airways of the chest remain fully open instead of collapsing. It basically uses a ball and cone mechanism, which is present in the device, to cause the air traveling from the lungs to vibrate, which helps to remove the secretions from the walls of the airways. They also help to make the airways clear in easy and effective ways.

How to Use the Mucus Clearance Device?

The steps to using a mucus clearance device involve the following:

• Treatment starts by sitting in a postural drainage position.

• Before using the mucus clearance device, try to relax the stomach muscles by taking a few normal breaths.

• Forming a good seal with the lips around the mouthpiece with the mucus clearance device.

• Try to take a bigger breath than the normal breath through the nostrils and then breathe through a mucus clearance device.

• Soon vibrations are felt over the chest.

• Repeating the same eight to ten times.

• After this process, go for coughing and huffing to clear the chest and remove sputum. Then have a break of relaxed breathing before starting again.

• It should be continued for 15 to 20 minutes or until the patient feels the sputum is cleared.

• The patient can also change the angle of the mucus clearance device and go for a huff to mobilize the present sticky secretions.

What Is the Prevention Taken While Using a Mucus Clearance Device?

The precautions taken while using mucus clearance devices are:

• The mucus clearance devices are needed to clean properly after every use to prevent infection.

• It is not used in tuberculosis, hemoptysis, and pneumothorax patients.

How to Clean the Mucus Clearance Device?

The mucus clearance device needs to be cleaned properly after every use to prevent infections. The device is taken apart and cleaned properly in hot, soapy water, and then dried thoroughly every day after each usage. Take care of the mucus clearance device while operating them or putting them together, as it can easily get cracked if it gets dropped on the hard structure.

How to Sterilize the Mucus Clearance Device?

The mucus clearance device is required to be sterilized at least once a week, either with the help of a steam sterilizer or by putting it in a bowl of boiling water. Avoid using a microwave sterilizer.

How Is the Mucus Clearance Device Stored?

The storage of the mucus clearance device is also an important task. It is not stored in direct sunlight. Instead, it is placed in lint-free cloth by wrapping it around or placing it in an envelope that is usually provided along with it. Or it can also be placed in a clean plastic container, which should have a lid on it. But try to keep it in a dust-free environment.

For Doctors:

Mucus Clearance Devices:

It is a small portable device that has a hardened plastic end at the mouthpiece, an opening with a plastic cover at the other ends, and a small valve present inside that creates a high-density steel ball that rests in a plastic circular cone. It is actually an expiratory resistance device that provides vibrations to the airways associated with mucus. The ball present in it is moveable and opposes the exhaled air, which creates a resistance to expiration due to the weight of the ball (steel ball). These vibrations have oscillation effects in the small airways present in the lungs. With continuous and repeated effects of vibrations, the mucus present in the deep roots of the airways gets mobilized to the throat and then huffed and expectorated.

Usage of Mucus Clearance Devices:

It is used to remove the excess mucus from the lungs of patients who are suffering from cystic fibrosis, bronchitis, and bronchiectasis. It is also used along with other medical requirements for positive expiratory pressure (PEP) therapy.

Mechanism of Mucus Clearance Devices:

• When the patient exhales through the mucus device mouthpiece, the ball present inside it rolls and moves up and down, which creates an opening with a closing cycle that can repeat many times through exhalation.

• The position of the ball while the exhaling process is the equilibrium position between the pressure of exhaled air and the force of gravity on that ball. The opening and closing process of the cycles provides oscillations to endobronchial pressure with expiratory airflow.

• The highest endobronchial pressure that is generated is near 20 to 25 cm of H2O. However, the expiratory pressure provides variation between 0.8 and 2.5 cm H20 with an opening and closing cycle. The oscillations in the airflow have resulted from successive acceleration and deceleration, producing the flutter effect.

• The frequency of oscillation can be altered by providing the inclination of the mucus clearance device as a slight up or down position from its horizontal location.

• The patient can also choose its maximum fluttering position to provide oscillation.

• The vibrations produce the loss of mucus from the airway walls, accelerating expiratory airflow and facilities the mobility of the mucus up into the airways, and increasing the endo-bronchial pressure, decreasing the collapse of the airways during exhalation, which increases the mucus clearance automatically from the tracheobronchial tracts.

• The patient should also try to achieve maximum oscillation by slightly moving the device up or down.

• The patient should try to remove and expectorate more mucus from the chest.

• The patient takes five to 15 minutes every day to remove the mucus.

How Is the Mucus Clearance Device Used?

1. Positioning the Mucus Clearance Device: The position of the device and the angle at which the patient holds the device is a crucial step. The device is used along with the stem in a slight up or downward, horizontal position. Such a position causes the cone to tilt and allow the ball to roll in the device and which also causes vibrations as the patient breathes or exhales. There are the following steps to use the device tilting it until the patient gets the desired effects from the device.

• The patient has to be relaxed and in a comfortable position. And the device can be used while sitting, lying down, or in a specific position as guided by the doctor or physiotherapist.

• The patient should breathe in slowly through the nose and breathe out through the mouth but at normal speed.

• The patient should avoid letting the shoulder rise with the breath.

• The patient should softly feel the tummy moving in and out.

• The patient should maintain a relaxed breathing position for one to two minutes.

• Then place the device mouthpiece in the mouth and then ensure the tight seal with the lips.

• Then breathe in slowly but deeper than before through the nose.

• Then take a pause for two to five seconds so that the lungs fill properly.

• Then breathe out with the help of the device but at a steady rate as the patient can feel the vibrations in the chest.

• Further, breathe out to normal comfort levels.

• Ensure the cheeks have stayed still as the patient breathes out.

• Repeat the process of breathing in and out through the device at least five to ten times.

• And possibly try to control the cough during these periods of breathing.

• And repeat the relaxed breathing for one to two minutes.

• And if the sputum is readily trying to come out, then go for one or two huffs or coughs.

• And repeat the whole process for 20 to 30 minutes.

2. Huffing: It is a followed step to move the mucus secretions from the airways of the chest to the upper tract of the throat to remove the mucus. It is a process that provides respiratory physiotherapists to check that the device is effectively working for the patient. It is not required to huff after every set of breathing; instead, go for huffing at the end of sessions to clear the secretions. The steps for huffing are:

• Take a slow breath, which is a bit deeper than normal.

• Opening the mouth to an 'O' shape and then huffing out the air, but the patient should feel the stomach muscles working to exhale the air out.

• Soon, the mucus secretions are moved to the throat to cough out this mucus and perform a short huffing to clear them.

• Huffing is not performed too hard.

• If the process goes right, then the patient has a louder and more coarse sound for removing the secretion.

• Do not try to huff more than two so that the patient does not get any coughing fit or wheezing.

3. Putting the Device Together: Airway clearance is most effective when used along with a combination of inhalers and nebulizers. It is advised to use it with a bronchodilator such as Salbutamol or Ventolin for 15 minutes before going for mucus clearance. The process before the device usage will help the patient open the airways and air passages to move the secretions more easily and prevent the feeling of wheezing. If the nebulizer is used with antibiotics, then the patient has a better and more effective treatment.

4. Keeping the Device Clean: It is also an important step to clean the mucus clearance device to avoid any accumulation of bacteria on it. The patient should read the manufacturer's information, which includes the recommendations and use. It is important to wash it with warm, soapy water, followed by rinsing and drying it. The device also needs to be sterilized once a week by boiling in distilled, deionized, or even de-mineralized water for nearly five minutes. or by keeping it in a steam sterilizer but not in the microwave.

Clinical Studies:

There have been no clinical studies performed with respect to mucus-clearance devices. However, the model has a slight variation in the design and material for example the Flutter and its various modification, which has not impacted the results of the oscillations generated or the airflow. But it has a good effect on removing or dislodging the mucus from the walls of the airways and allowing mucus clearance with medical requirements for positive expiratory pressure (PEP) therapy.