Which nursing interventions are important for the patient who is unable to cough up thick secretions?

What should I know about controlled coughing?

COPD can cause your lungs to produce excess mucus, leading to frequent coughing. Not all coughs are effective in clearing excess mucus from the lungs. Explosive or uncontrolled coughing causes airways to collapse and spasm, trapping mucus.

The effective, or controlled, cough comes from deep within the lungs and has just enough force to loosen and carry mucus through the airways without causing them to narrow and collapse. Controlled coughing saves energy and therefore, oxygen.

Controlled coughing technique

To cough effectively:

1. Sit on a chair or on the edge of your bed, with both feet on the floor. Lean slightly forward. Relax.
2. Fold your arms across your abdomen and breathe in slowly through your nose. (The power of the cough comes from moving air.)
3. To exhale: lean forward, pressing your arms against your abdomen. Cough 2-3* times through a slightly open mouth. Coughs should be short and sharp. The first cough loosens the mucus and moves it through the airways. The second and third cough enables you to cough the mucus up and out.
4. Breathe in again by "sniffing" slowly and gently through your nose. This gentle breath helps prevent mucus from moving back down your airways.
5. Rest
6. Perform again if needed.

Tips

• Avoid breathing in quickly and deeply through your mouth after coughing. Quick breaths can interfere with the movement of mucus up and out of the lungs, and can cause uncontrolled coughing.
• Drink 6 to 8 glasses of fluid per day unless your doctor has told you to limit your fluid intake. When mucus is thin, coughing is easier.
• Use the controlled coughing technique after you use your bronchodilator medication or any time you feel mucus (congestion) in the airways.

Mucus clearing devices

If you have trouble coughing up secretions, your physician may prescribe a hand-held mucus clearing device. These devices include the Flutter device, the Acapella® (known as the ‘pickle’), the RC Cornet®, Lung Flute (lungflute®), and the Aerobika®.

To use these devices, place a mouthpiece in your mouth, seal your lips around it, and take a deep breath using your diaphragm. Breathe out slowly with a moderate force through the device for as long as you can. The increased pressure in the airways and the oscillations created by the device will give you the feeling to cough. When you feel the urge to cough, take a deep breath in, hold for 1-3 seconds and cough to loosen the mucus.

Get useful, helpful and relevant health + wellness information

enews