Which statement correctly describes indications and contraindications for airway clearance techniques (ACTs) in patients with respiratory disease?

• A. Indications: mucus retention, atelectasis, ineffective cough; Contraindications: untreated pneumothorax, acute rib fracture or severe osteoporosis, recent thoracic surgery without surgeon clearance, hemorrhage, unstable spine.
• B. ACTs are contraindicated in all patients with COPD.
• C. ACTs should be performed regardless of rib fracture.
• D. ACTs are only used in pediatric patients.

Answer: (A)

Airway clearance techniques are used to help move secretions out of the lungs and improve ventilation. They are indicated when there is mucus retention, when mucus plugging has led to atelectasis, and when a patient has an ineffective cough that cannot clear secretions on their own.

They are contraindicated in conditions where applying ACT could cause harm: an untreated pneumothorax could be worsened by chest wall vibrations or increased intrathoracic pressures; an acute rib fracture or severe osteoporosis raises the risk of further injury from percussion or vibration; recent thoracic surgery without clearance from the surgeon could disrupt healing; active hemorrhage poses a bleeding risk with some maneuvers; and an unstable spine could be injured by certain techniques.

Knowing these distinctions helps avoid unsafe use of ACTs, such as assuming COPD or rib fractures automatically rule them out or applying them universally to all patients. When used appropriately, ACTs can benefit many patients with respiratory disease, including those with COPD, and they’re not limited to any single age group.