Pulmonary Hygiene

Pulmonary toilet is what is now commonly called bronchopulmonary hygiene or pulmonary hygiene. The term refers to any number of exercises and processes that would help clear your nasal passage and airways of mucus, phlegm, and other secretions. Clearing your airways ensures that enough oxygen reaches your lungs and helps your respiratory system work optimally.

Aggressive pulmonary toilet techniques and strategies are used as part of the treatment for chronic conditions that promote mucus build-up and could potentially cause blockage in the lungs and impair the patients breathing. These chronic conditions include asthma, cystic fibrosis, chronic obstructive pulmonary disease (COPD), pneumonia, emphysema, muscular dystrophy, bronchitis, and bronchiectasis. 

Some of the techniques that fall under the umbrella of the pulmonary toilet or pulmonary hygiene are tapping on the chest, deep breathing, and lung exercises. Of the many methods and approaches of the pulmonary toilet, some should only be performed by a physical therapist or a respiratory therapist, whereas others can be learnt and practised at home. Additionally, some of the at-home techniques can be performed independently, while other pulmonary hygiene methods may require assistance from family members or other caregivers.

Pulmonary Toilet Methods

There are many techniques for pulmonary hygiene, but what is common throughout them all is that all these methods employ some sort of physical manipulation to help you expel sticky mucus. During a pulmonary toilet or pulmonary hygiene session, your therapist may employ any combination of the following techniques for optimal results.

1. Controlled Coughing

One of the most effective methods to clear the airways in lung disease instances is controlled coughing. Coughing is basically your body’s natural response in an attempt to get rid of mucus. But involuntary, uncontrolled coughing makes things worse by trapping mucus in your lungs causing your airways to close. On the other hand, controlled coughing loosens mucus and helps expel it. Follow these steps for controlled coughing:

• Sit on the edge of a chair with both feet flat on the floor.
• Lean forward a bit, and relax.
• Inhale slowly and gently through your nose, folding your arms over your stomach. Do not breathe quickly or take deep breaths through your mouth.
• As you breathe out, lean forward more, pushing your arms against your stomach.
• Cough twice with your mouth slightly open as you exhale. The coughs should be short and sharp. Push in on your stomach as you cough. The first cough loosens the mucus through your lung airways. The next cough brings it up and out.
• Repeat as needed.

2. Deep Breathing

As the name suggests, deep breathing is a simple technique where you breathe in deeply and then make a conscious effort to cough up mucus, phlegm, and other secretions. Your physical therapist or nurse should be able to recommend effective breathing techniques depending on your specific condition, or you may choose to consult a respiratory therapist. Deep breathing techniques include relaxed breathing, huffing by breathing hard out of your mouth, and other diaphragmatic breathing exercises.   

3. Incentive Spirometry

An incentive spirometer is a medical tool that helps by expanding the lungs and thus helping the patient to breathe deeply. The incentive spirometer is often employed during deep breathing and coughing exercises to keep the lungs active and prevent complications like pneumonia. However, patients with active respiratory infections (like COVID-19, pneumonia, or bronchitis) are advised not to use the device around other people.

4. Chest Percussion

Chest percussions are done to break up the mucus in your lungs and airways for easier expulsion. A mechanical device is often used by therapists to repeatedly tap a patient’s chest creating a vibratory effect. These vibrations help dislodge and break up thick sticky mucus trapped in the lungs so it can be expelled more easily. Follow these steps for chest percussion:

• Lightly but firmly tap your chest and back with slightly cupped hands.
• Avoid hitting the spine and breastbone. Your doctor or therapist will identify the best spots for you to tap.
• It is recommended that you acquire assistance from someone else who could do the tapping for you.

5. Postural Drainage

This technique makes use of gravity and involves positioning your body a certain way to facilitate the draining of mucus out of your lungs. Respiratory therapists often couple postural draining with percussions to achieve the best results. Different positions help drain the mucus from different parts of your lungs. Follow these steps for postural drainage:

Clearing the front of the lungs

• Lie on your back with your arms at your sides making sure that your hips are higher than your chest. You can achieve this by putting two cushions under your hips.
• Inhale long and deep with one hand on your stomach and the other on your chest. You should feel the hand on your stomach move up, while the hand on your chest stays in place. As you exhale, you should be able to feel the hand on your belly move back down. This is called diaphragmatic breathing or belly breathing.

Clearing the sides of your lungs

• Lie on your side, with one arm under your head and the other on your belly.
• Make sure your chest is lower than your hips.
• Use belly breathing as explained earlier for 5 to 10 minutes.
• Switch sides and repeat while lying on other side.

Clearing the back of your lungs

• Lie on your stomach with your arms by your head.
• Use belly breathing as explained earlier for 5 to 10 minutes.

6. Suction

In more severe cases, your doctor or therapist might use a suction catheter to suck out the mucus from your lungs. The suction catheter is a thin, flexible tube that is attached to a pumping device that sucks through your airway to remove secretions. It is an uncomfortable process, but thankfully only lasts about 20 seconds.

Benefits of Pulmonary Toilet

There are many benefits associated with this therapy, even though scientists have yet to definitively verify the long-term benefits of pulmonary hygiene. However, here are just some of the purported benefits of pulmonary toilet:

• Helps prevent atelectasis, a detrimental effect of lung disease where the alveoli or air sacs in the lungs collapse.
• Pulmonary hygiene can help reduce your need for a mechanical respirator, thereby reduce the duration of your stay at the hospital.
• Provides relief in the symptoms of chronic conditions like asthma, cystic fibrosis, chronic obstructive pulmonary disease (COPD), pneumonia, emphysema, muscular dystrophy, bronchitis, and bronchiectasis.

While the research on the benefits of pulmonary toilet or hygiene is inconclusive, it is largely agreed by patients and practitioners alike that this treatment shows an improvement in symptoms. Aggressive pulmonary toilet or hygiene is especially beneficial when the illness is compounded and complicated by infections, such as pneumonia where mucous secretions are increased.

As with all medical approaches, it is difficult to predict with 100% accuracy whether this approach is right for you. Your best bet is to try it. However, if you are contemplating trying out a pulmonary hygiene method at home, consult your therapist and learn exactly how to do it beforehand. Pulmonary toilet or hygiene can benefit and alleviate your condition, but it is not intended to replace other necessary treatments prescribed by your doctor.

FAQs

1. Why is it called pulmonary toilet?
   The word pulmonary refers to the lungs. The word toilet, related to the French toilette, refers to body care and hygiene; this root is used in words such as toiletry that also relate to cleansing. Respiratory health (pulmonary hygiene) depends on consistent clearance of airway secretions.(Wikipedia)
2. What manoeuvres would promote the clearance of pulmonary secretions?
   Chest physiotherapy refers to a variety of respiratory manoeuvres performed to aid in the clearance of airway secretions and promoting lung expansion. These are (1) postural drainage, (2) chest percussion and chest vibration, and (3) deep breathing exercises. (Sciencedirect.com)
3. What is tracheobronchial toilet?
   The practice known as "Tracheobronchial Toilet" is the result of applying the anesthetist's acquired facility in intubating the trachea to the treatment of respiratory complications. "Tracheobronchial Toilet" is only used to describe the procedure where intubation enables foreign matter to be removed from the respiratory tree by suction. (Sciencedirect.com)
4. What is a spirometer used for?
   The spirometer is a device used to help you keep your lungs healthy. Using the incentive spirometer teaches you how to take slow deep breaths. (medlineplus.gov)
5. What is the fastest way to get mucus out of your lungs?

A combination of controlled coughing and deep breathing exercises coupled with expectorant medication as prescribed by the doctor is considered the quickest way to get mucus out of your lungs.