PT  - JOURNAL ARTICLE
AU  - Maggie McIlwaine
AU  - Judy Bradley
AU  - J. Stuart Elborn
AU  - Fidelma Moran
TI  - Personalising airway clearance in chronic lung disease
AID  - 10.1183/16000617.0086-2016
DP  - 2017 Mar 31
TA  - European Respiratory Review
PG  - 160086
VI  - 26
IP  - 143
4099  - http://err.ersjournals.com/content/26/143/160086.short
4100  - http://err.ersjournals.com/content/26/143/160086.full
SO  - EUROPEAN RESPIRATORY REVIEW2017 Mar 31; 26
AB  - This review describes a framework for providing a personalised approach to selecting the most appropriate airway clearance technique (ACT) for each patient. It is based on a synthesis of the physiological evidence that supports the modulation of ventilation and expiratory airflow as a means of assisting airway clearance. Possession of a strong understanding of the physiological basis for ACTs will enable clinicians to decide which ACT best aligns with the individual patient's pathology in diseases with anatomical bronchiectasis and mucus hypersecretion.The physiological underpinning of postural drainage is that by placing a patient in various positions, gravity enhances mobilisation of secretions. Newer ACTs are based on two other physiological premises: the ability to ventilate behind obstructed regions of the lung and the capacity to achieve the minimum expiratory airflow bias necessary to mobilise secretions. After reviewing each ACT to determine if it utilises both ventilation and expiratory flow, these physiological concepts are assessed against the clinical evidence to provide a mechanism for the effectiveness of each ACT. This article provides the clinical rationale necessary to determine the most appropriate ACT for each patient, thereby improving care.Understanding the basis of airway clearance assists in determining the most appropriate technique for the patient http://ow.ly/uQuz307iCIZ