Bronchial Hygiene Technique (BHT), Lecture notes of Physiotherapy

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Bronchial Hygiene

Technique(BHT)

By Dr. Hari Narayan Saini (PT) Associate Professor NIMS College of Physiotherapy & Occupational Therapy

• Bronchial hygiene therapy involves the use of non invasive airway clearance techniques designed to help mobilize and remove secretions and improve gas exchange.

CONT.

• PREVENT postural deformities
• Improve exercise tolerance
• Return to optimal function

• Indication or contraindications for or against bronchial hygiene therapy should never be formulated on the basis of diagnostic entities but should rather stem from a detailed analysis of the prevailing individual pathophysiology. Respir J

The second component required for bronchial hygiene therapy is an ineffective cough.

Examples of causes for an ineffective cough are :-

• Weakness
• Pain
• Placement of an artificial airway

• Pre-operative high risk surgical patient
• Post operative patient who is unable to mobilize secretions
• Neurological patient who is unable to cough effectively
• Patient receiving mechanical ventilation who has a tendancy to retain secretions
• patients with pulmonary disease who needs to improve bronchial hygiene

Specific contraindications for bronchial hygiene therapy are:-

• Elevated intracranial pressure
• Acute, unstable head, neck or spine injury
• Increased risk of aspiration
• Cardiac instability

Other medical conditions that would be of concern when considering bronchial hygiene therapy are:-

• Pulmonary embolism and pulmonary oedema associated with congestive heart failure.

• Untreated tension pneumothorax
• Abnormal coagulation profile
• Status epilepticus or status asthmaticus
• Immediately following intra cranial surgery
• Head injury with raised ICP
• osteoporotic bones
• Recent acute myocardial infarction, unstable vitals
• Immediately after tube feedings
• Sutures and ICDs

• Prevent accumulation of secretions
• Improve mobilization and drainage of secretions
• Promote relaxation to improve breathing patterns
• Promote improved respiratory function
• Improve cardio-pulmonary exercise tolerance
• Teach bronchial hygiene programs to patients with chronic respiratory dysfunction.

The three traditional methods of BHT are:-

• Directed cough
• Postural drainage
• External manipulation of the thorax.

Positioning is the use of body position as a specific treatment technique.

Physiological effects of positioning:-

• Optimizes O2 transport by improving V/Q mismatch.
• Increase lung volumes
• Reduces the work of breathing
• Minimize the work of heart
• Enhances mucociliary clearance- postural drainage

• Coughing:- It is a forced expiratory techniques performed with a closed glottis.
• Huffing:- It is a forced expiratory technique performed with a open glottis.
• Sniffing:- Its an respiratory maneuver performed after a full inspiration or expiration.