NASHVILLE, Tennessee—Pulmonary hygiene is essential to prevent illness and reduce hospitalizations rates in patients with neuromuscular disorders including Duchenne muscular dystrophy (DMD), according to Andrea Fritsch-Eddleman, a respiratory care practitioner at Loma Linda University Medical Center in California. 

Coughing and airway clearance are also needed to maintain healthy lungs, Fritsch-Eddleman said during a session on best practices in respiratory care at the 2022 Muscular Dystrophy Association Clinical & Scientific Conference.

“Proactive care is better than reactive care,” Fritsch-Eddleman said. “Be open to what is available and identify the right treatments for your patients.”

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Patients with DMD require pulmonary hygiene as the disease progresses. These include cough assisting devices, ventilators, and nebulizers. Pulmonary hygiene is defined as noninvasive and invasive airway clearance techniques that help expand the lungs, mobilize secretions, and improve gas exchange.

Fritsch-Eddleman underscored the importance of pulmonary hygiene in avoiding secondary illnesses, reducing hospitalizations, and improving quality of life. She also described ways in which hyperinflation can be avoided, including breath stacking, breathing exercises, incentive spirometry, and massaging accessory muscles. 

Read more about respiratory therapy and other treatments for DMD.

She described 3 main steps used by cough assisting devices: delivering positive pressure to the lungs, providing pressure in between breaths, and exhaling with negative pressure. “Sometimes your patient will say that it’s not working,” Fritsch-Eddleman said, “but it will take a few days for it to work.”

She also talked about chest physiotherapies and the “power of the nebulizer.” According to Fritsch-Eddleman, the main advantage of nebulized drugs is that they are directly deposited into the respiratory tract. This, she said, allows higher drug concentrations to be achieved in the bronchial tree and pulmonary bed with fewer side effects, compared to systemic drugs. 

She added that the appropriate bronchial hygiene therapy for each patient depends on their compliance, age, access to equipment, and ongoing technical assistance.


Fritsch-Eddleman A. Best practices in respiratory care. Oral presentation at: 2022 Muscular Dystrophy Association Clinical & Scientific Conference; March 14, 2022; Nashville, TN.