Respiratory Therapy for Managing Moist Cough

First-Line Therapies

The American Thoracic Society recommends chest physiotherapy as an effective technique to increase mucus clearance in patients with bronchiectasis or other conditions causing moist cough, though the long-term benefits remain to be fully documented 1
The American College of Chest Physicians suggests that huffing should be taught as an adjunct to other methods of sputum clearance, particularly in patients with COPD and cystic fibrosis 2
Positive expiratory pressure techniques are recommended over conventional chest physiotherapy as they are approximately as effective, inexpensive, safe, and can be self-administered 2
Hypertonic saline solution is recommended on a short-term basis to increase cough clearance in patients with bronchitis 2

Autogenic drainage should be taught as an adjunct to postural drainage for sputum clearance, especially in cystic fibrosis, as it can be performed without assistance and in one position 2
Devices designed to oscillate gas in the airway, either directly or by compressing the chest wall, can be considered as alternatives to chest physiotherapy 2
For patients with neuromuscular disease and impaired cough, mechanical cough assist devices are recommended to prevent respiratory complications 2
Erdosteine may be used on a short-term basis to increase cough clearance in patients with bronchitis 2
In patients with cystic fibrosis, amiloride is recommended to increase cough clearance 2

In persons with airflow obstruction caused by COPD, manually assisted cough may be detrimental and should not be used 2
Recombinant DNase, while improving spirometry in cystic fibrosis, is not recommended to increase cough clearance 2
Patients with neuromuscular weakness benefit from expiratory muscle training to improve peak expiratory pressure, which may have a beneficial effect on cough 2
For patients with chronic wet cough persisting beyond three weeks, referral to a specialist cough clinic should be considered 4

Medical attention should be sought if the patient experiences coughing up blood, breathlessness, prolonged fever, or if symptoms persist for more than three weeks 3
Smoking cessation should be encouraged as it is accompanied by significant remission in cough symptoms 4