Effectiveness of Nonpharmacologic Airway Clearance Therapies in Hospitalized Patients

Publication Date: June 1, 2014
Last Updated: March 14, 2022


Hospitalized Adult and Pediatric Patients Without Cystic Fibrosis

  1. CPT is not recommended for the routine treatment of uncomplicated pneumonia.
  2. ACT is not recommended for routine use in patients with COPD.
  3. ACT may be considered in patients with COPD with symptomatic secretion retention, guided by patient preference, toleration, and effectiveness of therapy.
  4. ACT is not recommended if the patient is able to mobilize secretions with cough, but instruction in effective cough technique (eg, FET) may be useful.

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

  1. Cough assist techniques should be used in patients with NMD, particularly when peak cough flow is <70 L/ min.
  2. CPT, PEP, IPV, and HFCWC cannot be recommended, due to insufficient evidence.

Postoperative Adult and Pediatric Patients

  1. Incentive spirometry is not recommended for routine, prophylactic use in postoperative patients.
  2. Early mobility and ambulation is recommended to reduce postoperative complications and promote airway clearance.
  3. ACT is not recommended for routine postoperative care.

* All recommendations are supported by low-level evidence
ACT, airway clearance therapy; CPT, chest physiotherapy; CF, cystic fibrosis; CPD, FET, forced exhalation technique; HFCWC, high-frequency chest wall compression; IPV, intrapulmonary percussive ventilation; PEP, positive expiratory pressure

Recommendation Grading




Effectiveness of Nonpharmacologic Airway Clearance Therapies in Hospitalized Patients

Authoring Organization

Publication Month/Year

June 1, 2014

Last Updated Month/Year

May 30, 2023

Document Type


External Publication Status


Country of Publication


Document Objectives

The purpose of this guideline, developed in conjunction with the systematic review by Andrews et al, is to provide guidance to clinicians in the identification, selection, and application of ACT techniques. These guidelines do not include the use of ACT in patients with cystic fibrosis (CF), as this has already been addressed.

Target Patient Population

Patients requiring airway clearance therapy

Inclusion Criteria

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

Health Care Settings

Emergency care, Hospital, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D058109 - Airway Management, D001261 - Pulmonary Atelectasis, D005441 - Fluids and Secretions


nonpharmacological treatment, nonpharmacologic, airway management, airway clearance therapy, ACT

Source Citation

Respir Care 2013;58(12):2187–2193.