Atelectasis, the partial or complete collapse of lung tissue, is treated by reopening the affected airways and reinflating the collapsed areas. The approach depends on what caused the collapse and how much lung tissue is involved. Most cases resolve with breathing exercises, physical therapy, and early movement, while severe or persistent cases may require positive pressure devices or a procedure to clear the blockage.
What Causes Lungs to Collapse
Understanding the type of collapse helps explain why different treatments work. Lung tissue stays inflated through a balance of forces: air pressure inside the tiny air sacs (alveoli) pushes outward, while the pressure of surrounding tissues pushes inward. When that balance tips, the air sacs deflate.
There are three main ways this happens. In obstructive atelectasis, something physically blocks the airway, often a mucus plug or retained secretions. The air trapped beyond the blockage gets absorbed into the bloodstream, and with no new air flowing in, the tissue collapses. In compression atelectasis, something outside the lung pushes on it, such as fluid buildup around the lung, abdominal swelling, or a tumor. The external pressure squeezes the air sacs shut. A third type, called absorption atelectasis, can happen when you breathe high concentrations of oxygen. The oxygen gets absorbed into the blood faster than nitrogen would, and the air sacs deflate as a result. This is one reason medical teams avoid giving more oxygen than necessary.
Incentive Spirometry
The most common first-line treatment, especially after surgery, is an incentive spirometer. This handheld device gives you visual feedback as you practice slow, deep breaths. You place the mouthpiece in your mouth, seal your lips around it, exhale normally, then inhale slowly. A piston or indicator rises as you breathe in, showing you how deeply you’re filling your lungs. A small ball or disk inside the device helps you gauge your speed: if it shoots to the top, you’re breathing in too fast; if it stays at the bottom, you need more effort.
The goal is to hold each deep breath for 3 to 5 seconds before slowly exhaling. Most protocols call for 10 to 15 breaths every 1 to 2 hours while you’re awake. This sustained, repeated effort gradually coaxes collapsed air sacs back open by increasing the pressure inside them. It takes consistency to work, so keeping the spirometer within arm’s reach and using it on schedule matters more than any single session.
Chest Physiotherapy
When mucus buildup is contributing to the collapse, chest physiotherapy helps loosen and drain it. The technique combines three elements: percussion, postural drainage, and vibration. During percussion, a therapist (or caregiver) gently claps on your chest wall with cupped hands or a mechanical device. The rhythmic tapping loosens mucus stuck to airway walls.
You’re then positioned at specific angles, sometimes with your head lower than your chest, so gravity can pull the loosened mucus toward the larger airways where you can cough it out. Side-lying and prone positions target different lung segments. After percussion and drainage, you’ll be coached through deep breathing and deliberate coughing to expel whatever has been mobilized. This combination is commonly used for people with conditions like cystic fibrosis or chronic lung disease, but it’s also effective for post-surgical atelectasis when secretions are part of the problem.
Early Movement After Surgery
Getting out of bed soon after surgery is one of the most effective ways to both treat and prevent atelectasis. When you’re lying flat, gravity compresses the lower portions of your lungs, and shallow breathing from pain or sedation compounds the problem. Sitting upright or standing changes the pressure dynamics across your lungs and allows deeper, more even breathing.
A study of patients who had coronary artery bypass surgery found that those who began getting out of bed within the first day after surgery had significantly less atelectasis and fluid buildup around the lungs compared to those who waited until the third day, which was the hospital’s standard protocol. Even sitting on the edge of the bed or standing briefly counts. If you’re recovering from surgery and a nurse encourages you to walk the hallway, this is a big part of why.
Positive Pressure Therapy
For more significant collapse, or when breathing exercises alone aren’t enough, positive pressure devices push air into the lungs to physically reopen collapsed tissue. Continuous positive airway pressure (CPAP) delivers a steady stream of pressurized air through a mask, keeping airways splinted open so air sacs can reinflate. This is the same type of device used for sleep apnea, though the settings and context differ.
In hospital settings, ventilators can deliver what’s called positive end-expiratory pressure (PEEP), which maintains a baseline of air pressure in the lungs even at the end of each breath. For mild cases, pressures of 5 to 10 centimeters of water are typical. More severe cases may require 10 to 15 or even higher. In some situations, clinicians perform recruitment maneuvers, briefly increasing pressure to 30 to 40 centimeters of water for about 30 to 40 seconds to pop open stubborn areas of collapse. These higher-pressure techniques require close monitoring because they can temporarily affect blood pressure and circulation.
Medications That Help
Medications play a supporting role, primarily by making it easier to clear mucus. Inhaled mucolytics thin out thick, sticky secretions so they can be coughed up or suctioned out more easily. These are prescribed as a nebulized solution you breathe in as a mist. If your cough reflex is weak, the loosened mucus may need to be removed by suctioning. People with asthma or reactive airways need to be cautious with mucolytics because they can sometimes trigger airway tightening.
Bronchodilators, medications that relax and widen the airways, are sometimes used alongside mucolytics. By opening up narrowed passages, they make it easier for air to reach collapsed areas and for loosened secretions to travel out. These are also delivered through a nebulizer or inhaler.
Bronchoscopy for Stubborn Blockages
When atelectasis is caused by a mucus plug, foreign body, or tumor that won’t clear with less invasive methods, a bronchoscopy may be needed. During this procedure, a thin, flexible tube with a camera is guided through the nose or mouth into the airways. The doctor can directly see the blockage and remove it using suction or small instruments passed through the scope. Bronchoscopy is also used when atelectasis persists despite aggressive breathing therapy, or when the cause of the collapse isn’t clear and the team needs a direct look.
The procedure is typically done under sedation, and most people recover from it quickly. It’s not a first-line treatment for routine post-surgical atelectasis, but it becomes important when a specific obstruction is identified on imaging or when the collapsed area isn’t responding to standard therapy.
Oxygen Use and Why Less Can Be More
Supplemental oxygen helps maintain adequate blood oxygen levels while the collapsed tissue is being treated, but too much oxygen can actually make atelectasis worse. High oxygen concentrations are absorbed rapidly from the air sacs into the bloodstream. When the oxygen is absorbed faster than it’s replaced, the air sacs deflate, creating the absorption type of atelectasis. This is why medical teams titrate oxygen carefully, aiming for the lowest concentration that keeps oxygen saturation in an acceptable range rather than flooding the lungs with pure oxygen.
What Recovery Looks Like
Small areas of atelectasis, like those that develop routinely after general anesthesia, often resolve within hours to a couple of days with consistent use of an incentive spirometer and early mobility. Larger areas of collapse, or those caused by significant obstruction, can take longer and may require a combination of the therapies described above.
You can generally track progress by how your breathing feels: less shortness of breath, less need for supplemental oxygen, and the ability to take deeper breaths without discomfort. Imaging, usually a chest X-ray, confirms whether the collapsed tissue has reinflated. If atelectasis doesn’t improve within the expected timeframe, it signals the need to investigate further, looking for an underlying cause like a persistent blockage, fluid around the lung, or a problem with the lung’s natural surfactant, the substance that keeps air sacs from sticking shut.