As we move into the devices used as airway clearance techniques (ACTs) it is important to understand that as the patient population with mucociliary clearance disorders ages, due to advances in research and treatment of those disorders, it has become apparent that airway clearance techniques that patients could do on their own actually increases treatment compliance. One of the first devices we will talk about are PEP devices, or rather positive expiratory pressure devices. A PEP device comes in many forms from handy devices that are inexpensive and portable, to more complex processes that use common household or facility components. These devices operate under the premise of stenting the airways open to allow ventilation to get in behind mucus to relieve gas trapping and help shear mucus away from the airway walls. Positive expiratory pressure temporarily improves pulmonary volume by recruiting peripheral airway ventilation, this aids in the mobilization of mucus in the peripheral airways towards the central airways.

As we continue our deep dive into airway clearance when percussion is added to postural drainage it is known as postural drainage and percussion or PD&P in the United States. PD&P is also known by percussion and drainage and chest physiotherapy or rather CPT in most countries worldwide. Percussion and drainage was the traditional method of moving mucus manually within the airways. But the many contraindications and risks of percussion and drainage and the burden of treatment lead to poor patient treatment compliance which has given way to the development of less burdensome airway clearance techniques. There is research that supports the use of percussion and drainage in patients with cystic fibrosis (CF), and those parents with similar mucus viscosity seen in CF, who can tolerate it. Proper percussion and drainage is caregiver dependent, meaning the patient can not effectively perform this airway clearance technique by themselves; they must have a caregiver’s help.