Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients

Publication Date: December 1, 2015
Last Updated: March 14, 2022


Hospitalized Adult and Pediatric Patients Without Cystic Fibrosis

  1. Recombinant human dornase alfa should not be used in adults and children with non-CF bronchiectasis.
  2. Routine use of bronchodilators to aid in secretion clearance is not recommended.
  3. Routine use of aerosolized N-acetylcysteine to improve airway clearance is not recommended.

Adult and Pediatric Patients With Neuromuscular Disease, Respiratory Muscle Weakness, or Impaired Cough

The use of aerosolized agents to change sputum physical properties or improve airway clearance cannot be recommended for patients with NMD or weakness due to insufficient evidence.

Postoperative Adult and Pediatric Patients

  1. Mucolytics cannot be recommended for use in the treatment of atelectasis due to insufficient evidence.
  2. Routine administration of bronchodilators to postoperative patients is not recommended.

Recommendation Grading




Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients

Authoring Organization

Publication Month/Year

December 1, 2015

Last Updated Month/Year

April 13, 2023

Supplemental Implementation Tools

Document Type


External Publication Status


Country of Publication


Document Objectives

The purpose of this guideline is to provide guidance to clinicians in the identification, selection, and delivery of medication for airway clearance. This guideline does not include the use of medication for patients with cystic fibrosis, as this has been addressed.

Target Patient Population

Patients require airway clearance therapy

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Emergency care, Hospital

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D006493 - Heparin, D058109 - Airway Management, D020545 - Respiratory Mucosa


airway restriction, difficult airway, airway management, mucolytics

Source Citation

Respir Care 2015;60(7):1071–1077