Medicines for Airway Clearance
Complete bronchial hygiene routines usually include over-the-counter or prescription medicine to help thin the mucus in the lungs. Individuals with chronic lung conditions such as bronchiectasis and nontuberculous mycobacterial (NTM) lung disease, fight a battle against the collection of mucus in their lungs.1 This mucus pooling is caused by too much mucus being created in the lungs and poorly working cilia. The cilia are the tiny hair-like structures that help to move mucus out of the lungs. Mucolytics are medicines designed to thin or break down the mucus in the lungs, making it easier to cough out.
Guaifenesin – Commonly known as brands like Mucinex and Robitussin, this drug is an oral expectorant used to loosen and thin mucus in the lungs.2 When buying guaifenesin for clearing the lungs, do not purchase the guaifenesin/dextromethorphan hydrobromide combination. Dextromethorphan hydrobromide suppresses cough. The goal for bronchial hygiene is to rid the lungs of excess mucus. The mucus must be coughed out. Suppressing the cough would not allow the mucus to be coughed out.
Normal Saline 0.9% – Nebulizing normal saline is commonly used to hydrate the lungs and thin out mucus.3
Albuterol Sulfate Inhalation Solution 0.083% – Albuterol is a bronchodilator (brawn coe die lay tor). It works quickly to open the airways. It also helps to trigger the cilia to move. This will allow you to cough more forcefully. Albuterol may be prescribed in nebulized form or as a metered-dose inhaler.4
Hypertonic saline (3% or 7% saline solution) – Studies have shown that inhaling hypertonic saline can help with mucus removal and improve the breathing in patients with bronchiectasis and other lung diseases.5 Hypertonic saline is often prescribed by pulmonologists as part of bronchial hygiene therapy. It is inhaled using a nebulizer. Sometimes, the hypertonic saline can cause spasms of the airway and lots of coughing. Talk to your doctor about whether you should use the hypertonic after using an albuterol. This could help open your airways and prevent the airway spasms.
Inhaled Mannitol – Inhaled mannitol has been studied as a possible medicine for bronchiectasis patients. It may help thin out mucus through hydration.6 This medicine is not used often in the United States. Further study may be needed.
Other Non-medical Therapies
Frequently, patients with bronchiectasis and/or NTM lung disease turn to non-medical therapies to ease the symptoms of their diagnosis. How well these practices work, has not been proven with science. However, these practices are very popular.
Hydrate – Drinking plenty of fluids like water can help to thin mucus. This makes it easier to expel. Follow your doctor’s advice on how much water to drink each day.
The COPD Foundation advises that you consult with your doctor before making any changes to your medicine or therapies. Also, it is important that you take medicines that are prescribed to you as directed by your doctor. Report any side effects to your doctor soon after they occur.
1Egan AM, Clain JM, Escalante P. Non-antimicrobial airway management of non-cystic fibrosis bronchiectasis. J Clin Tuberc Other Mycobact Dis. 2017;10:24-28. doi: https://doi.org/10.1016/j.jctube.2017.12.003
2Prescribers Digital Reference. Guaifenesin/Mucinex drug summary. Updated 2021. Accessed March 2021. https://www.pdr.net/drug-summary/Mucinex-guaifenesin-1275.1918
3Nicolson C, Stirling R, Borg B, Button BM, Wilson JW, Holland AE. The long-term effect of inhaled hypertonic saline 6% in non-cystic fibrosis bronchiectasis. Respir Med May;106(5):661-667. doi: https://doi.org/10.1016/j.rmed.2011.12.021
4Rubin BK. Aerosol medications for treatment of mucus clearance disorders. Respir Care. 2015 ;60(6):825-829; discussion 830-32. doi: https://doi.org/10.4187/respcare.04087
5Wark PA, McDonald V, Jones AP. Nebulised hypertonic saline for cystic fibrosis. Cochrane Database Syst Rev. 2005 J;(3):CD001506. doi: https://doi.org/10.1002/14651858.CD001506.pub2
6Daviskas E, Anderson SD, Gomes K, et al. Inhaled mannitol for the treatment of mucociliary dysfunction in patients with bronchiectasis: effect on lung function, health status and sputum. Respirology. 2005 J;10(1):46-56. doi: https://doi.org10.1111/j.1440-1843.2005.00659.x