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Pulmonary Hygiene after Spinal Cord Injury


Pulmonary hygiene is also called respiratory care. Pulmonary hygiene is a group of exercises and treatments to help you breathe better and to keep your lungs healthy. Although many people need pulmonary hygiene, it is very important for people with spinal cord injuries (SCI). Caregivers will work very closely with you to help your lungs work as well as possible and to prevent problems. The amount of trouble you have breathing depends on where your spinal cord is injured. Pulmonary hygiene consists of breathing exercises and treatments, postural drainage, chest physiotherapy (fiz-ee-oh-THER-ah-pee), quad assist coughing, and suctioning.


Take your medicine as directed.

Call your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

  • Anti-Anxiety Medicine: Having trouble breathing can make you very anxious. Caregivers may give you anti-anxiety medicine to help you feel less nervous and more relaxed.
  • Steroids: This medicine may be given to decrease inflammation.
  • Bronchodilators: You may need bronchodilators to help open the air passages in your lungs, and help you breathe more easily.
  • Pain medicine: You may need medicine to take away or decrease pain.
    • Learn how to take your medicine. Ask what medicine and how much you should take. Be sure you know how, when, and how often to take it.
    • Do not wait until the pain is severe before you take your medicine. Tell caregivers if your pain does not decrease.
    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling someone when you get out of bed or if you need help.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

What is pulmonary hygiene?

  • Breathing Exercises: Breathing exercises help to keep you from getting a lung infection (in-FEK-shun). You should do these exercises three to four times a day. Do them at about the same time each day. This will help you remember to do them.
    • Deep breathing opens the tubes going to your lungs. Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs forcefully. Do this 10 times in a row.
    • You may be asked to use an incentive (in-SEN-tiv) spirometer (spi-ROM-e-ter). This helps you take deeper breaths. Exhale (breathe out) as much air as possible. Put the plastic piece into your mouth and inhale (breath in) deeply. Hold your breath as long as you can. Then let out your breath. Do this 10 times in a row. This helps bring up the extra mucous at the bottom of your lungs.
  • Breathing treatments: You may need breathing treatments to help open your airways so you can breathe easier. A machine is used to change liquid medicine into a mist. You will breathe the mist into your lungs through tubing and a mouthpiece. Inhaled mist medicines act quickly on your airways and lungs to relieve your symptoms.
  • Postural Drainage and Chest Physiotherapy: Postural drainage or "PD" and chest physiotherapy (fiz-ee-oh-THER-ah-pee) or "CPT" help loosen the mucous in your lungs. PD is done while lying or sitting for at least five minutes, in each of several positions. This allows gravity to help bring up the mucous. CPT is when a caregiver lightly claps on your back and chest with his hands. This breaks up the sputum in your lungs making it easier to cough up. Your caregiver may use a machine to lightly clap on your chest and back. Doing PD and CPT at the same time works even better. Do not do PD or CPT right before or after a meal because it may upset your stomach.
  • Quad Assist Coughing: If your rib muscles and diaphragm do not work correctly, it may be hard to cough and bring up mucous. Doing quad assist coughing is a way to make a weak cough strong enough. A caregiver places one hand over the other on your abdomen between your ribs and belly button. At the same time that you try to cough, your caregiver thrusts his hands up. This should be repeated at least three times, or until you cough up the mucous.
  • Suctioning: Breathing exercises and treatments, PD, and CPT may not be enough to bring up the mucous in your lungs. You may need to use a cofflater machine or do tracheal suctioning.
    • Cofflater Machine: A machine like a vacuum is put over your mouth and nose or tracheotomy tube for a few seconds. Positive air pressure is put into your lungs to inflate them and then the positive pressure changes quickly to negative pressure. This causes the air sacs to let go of their mucous and makes a cough which brings up the mucous. Ask your caregiver if a cofflater machine is right for you.
    • Tracheal Suctioning: A sterile thin tube hooked to suction is put down into your trachea. The suction pulls up the mucous from your lungs. It is best to use other methods to clear mucous before using tracheal suctioning.

What is a pulmonary embolism?

  • A pulmonary embolism (EM-boh-lizm) happens when a thrombus (blood clot) blocks a pulmonary (lung) artery. Pulmonary embolisms are also called PE's. PE's are common problems after an SCI, and can be life-threatening. Caregivers may give you medicine to slow your blood from clotting. You may have a bed that rotates to keep your blood moving well through your body. The bed also helps prevent pressure from being placed on any part of your body for too long.
  • The symptoms of a PE include very bad and sudden chest pain and difficulty breathing. Blood in your sputum (spit) is another sign. Tell your caregivers if you feel or see any of these problems. You may have one or more of the following treatments:
    • Pressure Stockings: These tight elastic stockings keep blood from staying in the legs and causing clots. The stockings are also called Ted Hose® or Jobst Stockings®. These stockings can keep you from getting blood clots.
    • Pneumatic (noo-MAT-ik) Boots: These are plastic boots or leggings put on your feet or legs over pressure stockings or ace wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the boot or legging. This helps push the blood back up to the heart to keep clots from forming.
    • Vena Cava Filter: Caregivers may suggest that you need a special filter called a vena cava filter put into a blood vessel to collect clots. You may need this surgery if medicines and other treatments are not enough to prevent blood clots.

What if I cannot breathe well enough on my own?

You may need assisted ventilation (ven-ti-LAY-shun). Ventilation assistance may include a phrenic (FREN-ik) pacer, or a mechanical ventilator (ven-ti-LAY-ter).

  • Electrophrenic (ee-lek-troh-FREN-ik) Nerve Pacer: This electronic device stimulates the phrenic nerve that tells the diaphragm what to do, which causes you to inhale. Not all people can use a phrenic nerve pacer especially if their phrenic nerve does not respond to stimulation. Many people with phrenic nerve pacers may also have their trach tubes capped, allowing for better speech. Phrenic nerve pacing is very costly and requires a surgical procedure. It often takes a long "conditioning" process to learn how to do it. Ask your caregiver if a phrenic nerve pacer would work for you.
  • Ventilator: This is a special machine that can breathe for you. Caregivers may put an endotracheal or "ET" tube in your throat, or a tracheostomy "trach" tube in your neck. Caregivers hook the tube to a mechanical ventilator (ven-ti-LAY-ter). The ventilator is set to give you a certain number of breaths each minute. The machine can tell if you try to take a breath on your own, and helps by adding extra oxygen if needed. The amount of extra oxygen added depends on the results of blood tests that measure how much oxygen is in your blood. The ventilator has an alarm to tell caregivers if there is any problem with the machine and how much oxygen you are getting.

Can I go home if I need a ventilator?

You may be sent home with a portable, movable ventilator that gets it power from a wall outlet or a battery. A manual resuscitator (re-SUS-ih-tay-tor) is a balloon-like, hand operated tool to give you air if you are not on your ventilator. The person attaches the resuscitator to your trach and gently squeezes the bag, which puts air into your lungs. This manual resuscitator should remain with you at all times. Make sure that all family members and caregivers know how to use the resuscitator.

If I need a ventilator now, will I always need one?

Whether you need a ventilator depends on how high on the spinal cord your injury occurred. It also depends on how much improvement you have during rehabilitation (ree-hah-bil-ih-TAY-shun). If your injury is low on the spinal cord, you may only need a ventilator until your breathing muscles are stronger. You also may only need it until you recover from breathing problems such as pneumonia (noo-MOH-yuh). Caregivers may then slowly take you off the ventilator.

What does it mean to be taken off the ventilator?

  • Caregivers usually plan to take you off the ventilator in a series of steps. This allows your breathing muscles to get stronger and also helps you not to be afraid to be without the ventilator.
  • There are different ways to wean a person off a ventilator. One method is called the work-rest method. The ventilator is set so that you are allowed to breathe all or partially on your own. This is followed by a rest period where the ventilator does all the work of breathing so your muscles can rest. The work phase slowly is lengthened until you can do all the breathing on your own. How long it takes to be taken off the ventilator depends on how long you have been using the ventilator, and other factors.

What can I do to prevent breathing problems?

The following are things you can do to help prevent respiratory problems:

  • Stay active: Staying as active as possible is very important. The lungs normally have some thin mucous in the form of sputum. With an SCI, the lungs can make too much mucous and it may be too thick to move freely in your lungs. Moving as much as possible helps keep the mucous thin and prevents it from staying in one place.
  • Eat a healthy diet: Eat a variety of healthy foods. Eating healthy foods may help you feel better and have more energy. It may also help you heal faster. Ask your caregiver if you should follow a special diet. If you are not on a special diet, eat different foods from the following groups every day:
    • Bread, cereal, rice and pasta.
    • Vegetables.
    • Fruits.
    • Milk, yogurt, and cheese.
    • Meat, poultry (chicken), fish, dry beans, eggs and nuts.
    • Ask your caregiver how many servings of fats, oils and sweets should be included in your diet.
  • Drink plenty of liquids: Liquids help keep the mucous in your lungs thin. You must follow your caregiver's advice about the amount of liquids to drink for your bladder management program. Drink six to eight (8 ounce) cups of liquid each day if this follows your program. Good liquids to drink are water, juices, and milk. Limit the amount of caffeine you drink, such as coffee, tea, soda and sports drinks. You will know you are drinking enough liquids if your urine is clear or pale yellow.
  • Use a humidifier: Using a humidifier moistens the air in your home. The moist air makes it easier to cough up your sputum (mucus from the lungs). Wash the humidifier each day with soap and warm water to keep it germ free.
  • Quit smoking: It is never too late to quit smoking. Smoking harms the heart, lungs, and the blood. You are more likely to have a heart attack, lung disease, and cancer if you smoke. Smoking is especially dangerous when you have an SCI and breathing problems. You will help yourself and those around you by not smoking. Ask your caregiver for more information on how to stop smoking if you are having trouble quitting.

Where can I go for support?

  • Having a spinal cord injury is life changing for you and your family. Accepting that you have a spinal cord injury is hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Let them help you. Encourage those close to you to talk to your caregiver about how things are at home. Your caregiver can help your family better understand how to support a person with a spinal cord injury.
  • You may want to join a support group. This is a group of people who also have spinal cord injuries. Ask your caregiver for the names and numbers of support groups in your town. You can contact one of the following national organizations for more information.
    • Paralyzed Veterans of America
      801 Eighteenth Street NW
      Washington, DC , 20006
      Phone: 1- 800 - 424-8200
      Web Address:
    • National Spinal Cord Injury Association
      1 Church Street, Suite 600
      Rockville , MD 20850
      Phone: 1- 800 - 962-9629
      Web Address:
    • American Spinal Cord Association
      2020 Peachtree Road, NW
      Atlanta, Georgia , 30309-1402
      Phone: 1- 404 - 355-9772
      Web Address:


  • You think the ventilator is not giving you enough oxygen.
  • You suddenly feel lightheaded and have trouble breathing.
  • You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.