Choosing a technique

Choosing an appropriate airway clearance (AC) routine

Despite lacking a robust evidence base, airway clearance techniques are standard treatment in people with bronchiectasis (TSANZ Bronchiectasis Guidelines). Available studies suggest that airway clearance techniques are beneficial, with improved QOL and exercise capacity and reduced cough and sputum volumes (Lee 2013, Lee 2008).

An appropriate AC program should be prescribed by a physiotherapist trained in airway clearance.

The choice of techniques will depend on:

Cause of bronchiectasis – stability of the airways

Location of the affected bronchi

Time since diagnosis

Quantity and nature of the sputum

Frequency of exacerbations

Co-morbidities eg pelvic floor weakness, gastroesophageal reflux


Age of the patient

Oxygen therapy required

Financial circumstances of the patient

Cognitive ability of the patient

Adherence to treatment

The AC technique should aim to:

Decrease exacerbations

Increase quality of life

Decrease shortness of breath

Minimise stress on the pelvic floor

Minimise energy expenditure

The AC routine should be reviewed every 6 months to check the technique and to assess if the above criteria continue to be met.
Some general guidelines:​

Take time to educate patients about their condition

All patients should be taught the forced expiration technique

It is also beneficial for patients’ to be taught the active cycle of breathing technique as it is a portable technique, not requiring any equipment which can be used in any position

When choosing an appropriate airway clearance technique – think of physiology principles

Oscillating positive expiratory pressure therapy should be considered with tenacious sputum

Tenacious sputum may also benefit from nebulised saline – isotonic or hypertonic

Nebulised saline may also be beneficial in the presence of microbial isolates

Positive expiratory therapy should be considered for patients with unstable airways susceptible to collapse or airway collapse due to mucus plugs

Autogenic drainage should be considered for patients with stress incontinence and patients with large amounts of sputum

Ideally only teach one technique at a time

Patients should be instructed to minimise coughing unless the sputum is in the upper airways

Patients need to be educated that airway clearance is a technique to be done daily

Patients are more likely to adhere to an airway clearance routine if their preference is considered

As cough clearance is important in bronchiectasis, antitussive therapy, such as codeine, is relatively contraindicated.

See Airway Clearance Techniques section and AC videos for a full description of each technique.