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What is a mucus plug and how do I avoid it?

A mucus plug is a potentially life-threatening incident for people with subglottic stenosis and must be taken very seriously.

What is a mucus plug?

If you have never experienced a mucus plug, the following diagram attempts to explain what is happening.

 

Your stenosis is creating an unnatural obstruction in your airway. Even if you have a dilation, the lining of the airway still does not function properly at the site of scar. Scarring damages the delicate cilia that help whisk mucus out of the airway. This can lead to mucus getting stuck in your airway. You will have to cough to make this shift, and ideally cough it out (or swallow it).

Diagram of mucus plug

Sometimes though, this mucus can get more difficult to cough out.  This can happen when you get dehydrated, or when you get sick. If you have an infection you might find that instead of white or clear mucus being coughed up, it is yellow, green, or orange. This is a sign you are at risk of a mucus plug forming. When infected with bacteria, it can become quite thick, sticky, and hard, and is particularly challenging to cough.

 

When it becomes big enough, there is a risk of this blocking (plugging) your narrow airway. This is quite terrifying when it happens, and usually your survival instinct kicks in and you can manage to somehow cough it out.

 

Should a mucus plug affect you, you will not be able to speak and tell others what is happening, so it is best to forewarn those around you that this is a risk.

 

What if I cannot shift the plug?

If you cannot shift the plug, you will not be able to breathe or speak and will fall unconscious. If you have somehow managed to alert someone that you are struggling, they must immediately call for emergency medical assistance. Speed is of the essence here, and again it is important people around you are prepared with what to tell medical professionals when they call.

 

  • You are not breathing and are now unconscious.

  • Your airway is blocked.

 

At this stage, the name of your disease is not the most important thing, getting air is primary.  Make sure they know what number to dial (e.g. 911/000/999 depending on the country they are in) – it is amazing how many people have a mental block to what the correct emergency services number is when they need to call it.

 

An option those around you can try is the abdominal thrust (also known as the ‘Heimlich manoeuvre’). This is a first aid technique used to move foreign bodies caught in your airway in an emergency. This may dislodge the plug and can be tried while waiting for emergency services.

Heimlich maneuver with help

If you are alone, you can also attempt this on oneself:

Heimlich maneuver without assistance

Mouth to mouth resuscitation can also be attempted by those around you, they can potentially push the plug back down into the airway allowing you to breathe. This can also be tried before you lose consciousness.

 

  1. With the airway open (using the head-tilt, chin-lift manoeuvre), pinch the nostrils shut for mouth-to-mouth breathing and cover the person's mouth with yours, making a seal.

  2. Give two strong rescue breaths...

  3. Proceed with chest compressions to restore circulation. How do I prevent a plug from happening?

 

Vigilance is key to prevention. If you notice the early signs, you need to act. These could be one or more of the following:

  • Coughing more than usual

  • Coughing up small lumps of mucus

  • Mucus, which is yellow, green, or orange

  • Your peak flow dropping 40%+ suddenly when it has usually been stable.

 

If you notice any of these, your first step should be to use your saline nebuliser at least twice a day. Adding moisture to your airway can help you cough up the growing plug before it becomes unmanageable. Staying hydrated with enough water is also extremely helpful.

 

In addition, if you have noticed green, yellow, or orange coloured mucus, then consult with a doctor about using antibiotics to help clear any infection.

 

Finally, keep monitoring your breathing with your peak flow meter – if it remains low despite action, then contact your ENT surgeon, and if you continue to have concerns, go to emergency at your local hospital.

 

A mucus plug is very serious, and subglottic stenosis patients have died from this.

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