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Airway Clearance in Chronic Respiratory Disorders: Obstructive CF, COPD, and Asthma

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Humidification in the Intensive Care Unit

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Abstract

Several chronic lung diseases that affect the airways, including chronic obstructive pulmonary disease, obstructive cystic fibrosis, and bronchial asthma, can be defined from a pathophysiological point of view as muco-obstructive diseases. These diseases are characterized by exacerbations that when severe needed hospitalization and intensive care unit admission. The management of bronchial secretions is one of the main problems encountered during the intensive care management of patients with muco-obstructive diseases. The early start of airway clearance techniques is a fundamental part of the management to reduce the negative impact on patients’ prognosis. A wide range of therapeutic options as techniques and devices are present for managing bronchial encumbrance during intensive care unit stay, but up to now, for all airway clearance techniques, there is an insufficient evidence to affirm the superiority of one technique over another. Moreover, data on their use in conjunction with NIV is lacking. A personalized tailored approach for a single patient is mandatory. Rarely is just one single technique used for a given pathological condition. The best approach is to combine the best effect on the clearance of the airways with the lowest possible incidence of side effects. A trained experienced staff is fundamental to achieving successful treatment. Multicenter randomized controlled trials should be well designed and conducted in this setting to try to resolve the many controversies that exist in this area.

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Abbreviations

ACTs:

Airway clearance techniques

AECOPD:

Acute exacerbations of chronic obstructive pulmonary disease

BiPAP:

Biphasic positive airway pressure

CF:

Cystic fibrosis

CFTR:

Cystic fibrosis transmembrane conductance regulator

COPD:

Chronic obstructive pulmonary disease

CPAP:

Continuous positive airway pressure

HFCWO:

High-frequency chest wall oscillation

HFNC:

High-flow nasal cannula

ICU:

Intensive care unit

iPEEP:

Intrinsic positive end-expiratory pressure

IPV:

Intrapulmonary percussive ventilation

LTAE:

Life-threatening asthma exacerbation

MCC:

Mucociliary clearance

MI-E:

Mechanical in-exsufflator

MODs:

Muco-obstructive diseases

NIV:

Noninvasive mechanical ventilation

oCF:

Obstructive cystic fibrosis

PECF:

Peak expiratory cough flow

PEF:

Peak expiratory flow

PEP:

Positive expiratory pressure

PIF:

Peak inspiratory flow

PD:

Postural drainage

VC:

Vital capacity

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    Authors and Affiliations

    1. Pneumology Unit, Pneumologia, Department BIOMORF, University of Messina, Messina, Italy

      Paolo Ruggeri & Francesco Nucera

    2. Pneumology Unit, Hospital “Papardo”, Messina, Italy

      Claudia Profazio

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    1. Paolo Ruggeri
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    2. Claudia Profazio
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    3. Francesco Nucera
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    Correspondence to Paolo Ruggeri .

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    Editors and Affiliations

    1. Intensive Care Unit, Hospital General Universitario Morales Meseguer, Murcia, Spain

      Antonio M. Esquinas

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    Ruggeri, P., Profazio, C., Nucera, F. (2023). Airway Clearance in Chronic Respiratory Disorders: Obstructive CF, COPD, and Asthma. In: Esquinas, A.M. (eds) Humidification in the Intensive Care Unit. Springer, Cham. https://doi.org/10.1007/978-3-031-23953-3_23

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    • DOI: https://doi.org/10.1007/978-3-031-23953-3_23

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