The last subject in our our sixteen part series on airway clearance techniques (ACTs) is a little known but critical aspect of daily ACT therapy, the “Outside the Box” technique. Doing life with primary ciliary dyskinesia (PCD) takes a whole lot of compromise, innovation, compassion, empathy, and plain thinking outside of the box especially when it comes to airway clearance therapy compliance. When the body’s natural filter for germs, bacteria, and debris is compromised that leaves the PCD patient to have to manually clear and remove those secretions that can be removed on a daily basis. That daily effort can become mundane, boring, and tiring. Frankly the patient ends up dreading the daily process and then avoidance begins to set in. Airway clearance therapy avoidance in PCD care can lead to bacterial infections that become increasingly difficult to treat, leading to permanent airway destruction otherwise known as bronchiectasis. Bronchiectasis (BE) is a clinical consequence of having PCD, and by adulthood BE is almost universal among adult PCD patients. The goal of airway clearance therapy in PCD care is to get the patient to cough and to delay the onset of BE for as long as possible.

As we near the end of our airway clearance technique (ACT) series there are a few other mechanical ACT device outliers left to discuss. In a social media age the resurgence of holistic practices have come full circle once again, as has the age of invention. Then add in recent awareness campaigns for rare diseases and there is a ton of focus helping those who have no help or treatments. The awareness campaigns for diseases like primary ciliary dyskinesia (PCD) have succeeded in bringing together not only the patient population, but clinicians and researchers a like. While there still needs to be a ton of research into PCD, one thing is clear, as a mucociliary clearance disorder airway hygiene is of particular importance in the treatment and management of PCD. Once the pathophysiology of PCD in regard to delayed airway clearance is completely understood, then we can begin to understand which airway clearance techniques will actually work for a particular PCD patient. It’s important to note that whatever works for one PCD patient may or may not work for another PCD patient, even if they have the exact same genetic defect. In “Part 2” we will look at the Lung Flute, the Vibralung Acoustical Percussor, the Revitive Aerosure, & cough assist devices.

Over the next two weeks we will explore other mechanical airway clearance devices in our airway clearance technique (ACT) series. There are many outliers to airway clearance therapies. As the internet has brought the world closer than ever, especially in the dawn of social media, more and more ACTs have come to light. From the simple and inexpensive to more aggressive and expensive. The need for mobile therapies as the patient population who use ACTs grows has forced researchers back to the drawing board. In fact even basic clinics, licensed respiratory therapists, patients, everyday people with 3D printers, and even social media influencers have gotten in the game of inventing ACTs and ACT devices. But what is true and what is helpful? We will spend the next few weeks looking at some of the more notable ones, including the medically sound ACTs rooted in scientific evidence for certain pulmonary diseases. Not all these ACTs will work for specific mucociliary clearance diseases. Please, for your safety, ask your clinic’s licensed respiratory therapist, your clinic’s contracted licensed respiratory therapy provider for more information on these or any ACT device or method you read or hear about on the internet, social media, support group, or one on one from another patient. In “Part 1” we will go over ELTGOL therapy, the Simeox machine, and how they may be used in conjunction with other previously discussed ACTs.

The next device that we will cover in our airway clearance technique (ACT) series is oscillation & lung expansion (OLE). OLE is touted as the next big advancement in airway clearance. This hospital proven airway clearance therapy has been in use within US medical facilities since 2013. It’s usefulness during the recent 2020 pandemic caught the attention of medical professionals and regulatory authorities when it was granted EUA (emergency use authorization) by the U.S. Food and Drug Administration for the treatment of pandemic patients. OLE delivers three in one therapy; oscillation, expansion, and nebulization. Unlike intrapulmonary percussive ventilation (IPV), OLE can be utilized as a stand alone ACT. There are limited studies to date showing greater improvement in lung clearance index with the use of OLE, compared to the typical ACT methods used during exacerbations in adult cystic fibrosis (CF) patients.