During secretion assessment, we must consider Volume, Consistency and Colour as these indicators tell if there is an issue(s) within the lungs.

Volume: High volume could indicate an infection whilst low volume indicates dehydration or difficulty to expectorate.

Causes of excessive secretions

• Spinal cord and Brain Injuries
• Chronic respiratory conditions: eg COPD
• Neuromuscular: Huntington’s disease and degenerative conditions
• Atrophy- muscle wasting leading breathing difficulty, poor balance/weakness, low levels of alertness and an ineffective cough can cause difficulties to expectorate secretions

Management for high volume secretion

• Regular suctioning: This is the most important technique for removing secretions
• Pharmacological intervention needs for antibiotics if the high volume of secretions is due infection like pneumonia or bronchitis (bronchodilator)
• Cough Assistance: encourage coughing exercises or use mechanical cough assist devices to help expel secretions, especially if the patient has a weak cough
• Assess Underlying Causes: Investigate potential causes of increased secretions such as respiratory infections, aspiration, or allergies, and treat the underlying issue accordingly

Adequate Humidification:

• Ensure proper humidification to keep secretions thin and easier to clear
• Use heated humidifiers or Heat Moisture Exchangers (HMEs) depending on the patient’s condition
• Hydration such as (IV fluids or oral) helps to loosen thick secretion for airway clearance
• Medications: Nebuliser help to break down thick mucus for easy expectoration
• Chest physiotherapy can help mobilize secretions through manual percussion or vibration techniques

Consistency (thick and viscous): Healthy mucus is around 95% water and 3% solids, but the concentration of solids can increase to 15% in some cases.

• Thick secretion could indicate poor hydration, humidification, or oral hygiene
• Sticky airway secretion can be symptom of infection

Management of thick and thin volume secretion

• Some secretions can be difficult to remove due inaccessible anatomy or consistency
• Appropriate hydration, humidification, and nebulisation (salbutamol and normal saline: Osmotic process) can with thick secretions removal
• For thin secretions, think about patient’s ability to swallow is a concern for aspiration. Therefore, Hyoscine and Atropine is used to dry up and make it easier to manage