Humid NaCl inhalation (may need to be highly concentrated), or with salbutamol (improves the mucociliary clearance)

Respiratory therapy using Modified Autogenic Drainage (MAD). This method was developed in Belgium for secretion management in Cystic fibrosis patients. The method had been modified in Germany by Rita Kieselmann in order to apply this method to all diseases with secretion retention. The patient is supposed to continue with therapy after instruction by a physiotherapist. If necessary the treatment is combined with inhalation by a PEP (Positive-expiratory Pressure) system. The main principle is based on fluctuation in caliber of the bronchi during inhalation and expiration. See also PEP-systems.

Positive-expiratory Pressure (PEP) systems (with and without oscillation) can optimizie the utilization of low end pressure in the bronchial system. Simplified: The more peripheral the secretions are located, the deeper the patient has to inhale to bring air behind the secretion. The pause at the end of inspiration is supposed to open blood vessel collaterals minimizing mismatches in perfusion. Expiration is used for further secretion transportation towards the centrally located airways. As secretions are moved more centrally, the shorter the inspiration needed and the longer the expiration required to further transport the secretions towards the throat (Fig. 11.2).