Non-invasive Approaches to Secretion Clearance in Neuromuscular Disease

In health, normal airway mucus is produced and propelled upwards to the lower oropharynx, where it is unconsciously swallowed. During times of increased mucus production or changes in its nature, active coughing is required to maintain airway clearance and lung health. This involves generating maximal expiratory flows and resulting shear forces to mobilize and propel secretions to the upper airway and oropharynx. Effective airway clearance is fundamental to adequate ventilation and gas exchange. Strong inspiratory muscles, sufficient lung volumes, active closure and opening of the glottis, and strong expiratory muscles are required to achieve this. This chapter reviews interventions and therapies directed toward achieving adequate airway clearance for individuals with impairment of these components due to neuromuscular weakness, including artificial airways.