Pulmonary Toilet

Pulmonary toilet includes exercises that help remove secretions like mucus from your airways. “Pulmonary” refers to your lungs. “Toilet” comes from the French word “toilette,” which means to wash. It’s a common treatment for conditions that make it challenging for you to cough or clear mucus, like:

• Asthma
• Bronchiectasis
• Chronic obstructive pulmonary disease (COPD)
• Cystic fibrosis
• Emphysema
• Muscular dystrophy
• Pneumonia
• Rib fracture

If a lung condition prevents you from clearing mucus, you’re at a greater risk of complications.

Other names for pulmonary toilet include:

• Airway clearance techniques
• Bronchopulmonary hygiene
• Chest physical therapy
• Pulmonary hygiene
• Pulmonary toiletry

What are the exercises for pulmonary toilet?

There are many pulmonary hygiene techniques. You’ll need the help of a respiratory therapist for some. But others you may be able to do at home. These exercises include:

• Huff coughing
• Breathing exercises
• Incentive spirometry
• Chest and back percussion
• Airway clearance vests
• Postural drainage
• Suctioning
• Nebulized sodium chloride (hypertonic saline)

You may have to try several techniques or a combination of techniques to see what works best for you.

Huff coughing

This is different from a typical cough. During huff coughing, your healthcare provider will teach you how to control your breath. The cough comes from deep within your lungs. You use short, forceful breaths to exhale, like how you fog up a pair of glasses before wiping them clean.

Breathing exercises

Your provider teaches you how to take slow, deep breaths while sitting up. The position helps air enter all parts of your lungs and loosen up mucus. You can clear out the mucus by coughing.

Incentive spirometry

An incentive spirometer is a small medical device that helps clear mucus from your lungs. During incentive spirometry, you:

• Take slow, deep breaths in through the device
• Hold your breath as long as you can
• Breathe out slowly through the device

You do this about 10 times every hour that you’re awake. Your provider can teach you how to use an incentive spirometer at home.

Chest and back percussion

Your provider will cup a hand and clap it against your chest and/or back. They can also teach you, a friend or a family member how to do it. The claps help break up mucus, which you cough out.

Airway clearance vests

Airway clearance vests (or high-frequency chest wall oscillation) are inflatable devices that you wear. Some vests plug into a wall outlet. But others use batteries. They vibrate and help loosen mucus, which you cough out.

Postural drainage

Your provider will guide you into certain positions. These positions allow gravity to help drain your lungs. Providers usually combine postural drainage with chest and back percussion.

Suctioning

Your provider inserts a thin, flexible tube with a light and camera on the end into your airway. This tool is a bronchoscope. The bronchoscope sucks secretions out.

Nebulized sodium chloride (hypertonic saline)

This is a type of airway clearance. A nebulizer turns a liquid medication into a mist that you breathe in. It helps get rid of mucus from your lungs.

What are the contraindications for pulmonary toilet?

Contraindications are situations in which healthcare providers shouldn’t use treatments or procedures. They can be harmful. Providers may not perform some pulmonary toilet exercises if you have:

• A blood clot in your lung
• Blood in your mucus when you cough
• Fluid in your lungs
• Heart problems
• Increased intracranial pressure
• Open wounds in your chest or back
• A rib fracture
• A spinal cord injury

How long will I need pulmonary toilet?

It depends on the condition causing mucus or other secretions to build up in your airways. You may only need it a few times. Or you may need a long-term plan for some conditions. Your healthcare provider will let you know what to expect.

What are the potential benefits and risks of pulmonary toilet?

Pulmonary toilet won’t cure lung diseases. But it helps loosen and remove mucus and secretions from your airways. This helps prevent complications like respiratory failure or your alveoli collapsing. Alveoli are the small air sacs in your lungs.

Other pulmonary toilet benefits include:

• Better ability to breathe, do physical activities and perform daily tasks
• Improved quality of life
• Less tiredness
• Reduced risk of requiring mechanical ventilation to breathe for you
• Reduced symptoms

Pulmonary toilet doesn’t have many risks. There’s conflicting research on how effective it is. But many people report that their symptoms improve. You may have some muscle soreness or discomfort when you first start some exercises. You may also have them after some procedures. But it should start to improve once you do them for a little while. There’s also a risk that you may lose some of pulmonary toilet’s benefits over time.

How long will it take for me to feel better?

Clearing mucus from your lungs should help you feel better immediately. As you continue pulmonary toilet, you should start to see some improvements in a few weeks. Your healthcare provider will give you a better idea of what to expect.

When should I call my healthcare provider?

Reach out to your healthcare provider if you have any questions about your condition, medications or how to do pulmonary toilet techniques at home. Contact them right away if your symptoms get worse or you develop any new symptoms.

What is bronchial toileting?

Bronchial toileting is another name for pulmonary toilet. “Bronchial” means it relates to your bronchi. Your bronchi are the large tubes that carry air from your windpipe to your lungs.