Presentation on theme: "National Jewish Medical and Research Center 1 “Airway Clearance Devices” Why we use them with Bronchiectasis."— Presentation transcript:
National Jewish Medical and Research Center 1 “Airway Clearance Devices” Why we use them with Bronchiectasis
National Jewish Medical and Research Center 2 What Else Can I do to feel Better? Airway Clearance
Impaired Airway Clearance – What Happens? inflammation pulmonary infection increased mucus production airway obstruction (mucus plugging) lung damage (lung scarring and remodelling of airways) Dyspnea (shortness of breath) And the risk factors rise for recurrent, ever-worsening episodes of:
Impaired Airway Clearance – What Happens? Infectious bronchitis, bronchiolitis, and pneumonia Air trapping, uneven ventilation, and increased work of breathing Increased risk of recurrent infections and acute exacerbations Increased risk of hospitalization Increased risk of mortality Increased cost of care Acceleration of the vicious cycle promotes: GOAL
What Should Be Done? Routine administration of aggressive, effective airway clearance therapy. Airway clearance therapy is the most reliable means stopping or delaying the progression of mucus retaining lung disease. Airway clearance therapy is the most reliable means stopping or delaying the progression of mucus retaining lung disease. In cases of impaired airway clearance it is necessary to provide: GOAL
What Should Be Done? minutes per day Divided up into a few sessions per day Divided up into a few sessions per day Rx examples: Rx examples: 10 minutes – TID10 minutes – TID 15 minutes – BID15 minutes – BID Adjust as needed or toleratedAdjust as needed or tolerated For patients at risk for retained secretions provide them with the means to do bronchial hygiene therapy (BHT):
Airway Clearance Devices PEP (Positive Expiratory Pressure) devices Vibratory PEP Acapella ®, Flutter Valve™, Quake® Acapella ®, Flutter Valve™, Quake® HFCWO (High Frequency Chest Wall Oscillation) Vest Systems Vest Systems Cough Assist® IPV® (Intrapulmonary Percussive Ventilation) Aerosol therapy to loosen thick secretions or to treat infections Mucolytics, Hypertonic Saline, Inhaled Antibiotics Mucolytics, Hypertonic Saline, Inhaled Antibiotics Palm Cups®, percussive vibrators Palm Cups®, percussive vibrators positioning beds, tables, wedges or pillows positioning beds, tables, wedges or pillows
Web Sources: dhd.com, thevest.com, axcan.com8 Devices Often used at NJC OPEP devices: Acapella ® DM Acapella ® DH Flutter Valve® (used mainly in (used mainly in the past) the past) OPEP for 15 minutes, two times per day. HFCWO system: The Smart Vest HFCWO 10 to 20 minutes, two or three times per day.
National Jewish Medical and Research Center 9 Important Mechanisms of Normal Airway Clearance Physiology It takes two: 1. A functional mucociliary clearance system (MCC), also called the mucociliary escalator 2. The ability to cough
Source: NJMRC & 10 When normal airway clearance becomes impaired the following can occur: Dyspnea (shortness of breath)Dyspnea (shortness of breath) And the risk factors rise for recurrent, ever-worsening episodes of: inflammation inflammation pulmonary infection pulmonary infection increased production of excess mucus increased production of excess mucus airway obstruction (mucus plugging) airway obstruction (mucus plugging) lung damage (lung scaring & remodeling of airways) lung damage (lung scaring & remodeling of airways)
National Jewish Medical and Research Center 11
12 Take Bronchiectasis for example Source: THE MERCK MANUAL--SECOND HOME EDITION Online, Ch. 47, Bronchiectasis
13 Examples of some Chest PT positions & equipment to treat a disease like Bronchiectasis or CF
Equipment examples tools to help treat chronic phlegm-retaining diseases the traditional way Traditional Therapy Percussive vibrators Flimm Fighter ® Vibracare ® Neocussor ® Source: Manual percussion assistive devices Palm Cups ® Source: Images used by permission from the manufacturers
National Jewish Medical and Research Center15 Other Airway Clearance Techniques: Coughing and breathing techniques Directed Coughing Directed Coughing Huff coughing Huff coughing “Quad cough” “Quad cough” Autogenic Drainage (AD) Autogenic Drainage (AD) Active Cycle Breathing Technique (ACBT) Active Cycle Breathing Technique (ACBT) Best used in combination with each other or with hand held airway clearance devices
Resources: smiths-medical.com, pari.com, axcan.com, thayermedical.com16 PEP & OPEP hand held devices PEP (Positive Expiratory Pressure) Cost, usually less than $100 Cost, usually less than $100 TheraPEP® TheraPEP® PARI PEP™ PARI PEP™ various other brands various other brands Vibratory PEP (Oscillatory PEP) Cost, usually < $150 Cost, usually < $150 Flutter Valve® Flutter Valve® Acepella® Acepella® Quake® Quake®
National Jewish Medical and Research Center17 Vibratory PEP via an acapella Choice®
National Jewish Medical and Research Center18 Huff Cough “Huff Cough” or Force Expiration Technique (FET)– is an alternative to deep coughing Huff coughing involves taking a deeper breath than normal. Then use the diaphragm and stomach muscles to make a series of rapid exhalations, with the airway open, making a, “ha, ha, ha,” or “H” sound. This is then followed diaphragmatic breathing, and then a deep cough if mucus is felt moving within the larger airways or trachea.
19 High Frequency Chest Wall Vibration (Oscillation) – HFCWO therapy SmartVest™, Electromed, New Prague, Minnesota The Vest™ Airway Clearance System, Hill-Rom, St. Paul, Minnesota InCourage™, RespirTech, St. Paul, Minnesota Images used by permission from the manufacturers Hill-Rom, Inc., ElectroMed, Inc., RespirTech, Inc.,
Resource: Cough Assist Device™ “coughalator” Also known as the insufflator/exsufflator is a cough simulator for people incapable of generating their own cough effort It gives positive pressure during inhalation to expand the lungs Then negative pressure is applied to simulate a cough & clear secretions
Percussionaire & Vortran Medical - Corporations 21 IntraPulmonary Percussive Ventilation Percussive PEP (IPV types of nebulizer): Percussive PEP (IPV types of nebulizer): o Impulsator® (IPV®) by PERCUSSIONAIRE® Corp. o PercussiveNEB™(P-NEB), by Vortan Medical Corp. o These are aggressive aerosol devices with an air jack hammer like effect that may be appropriate for some patients, however, disadvantages can include: availability, cost, cleaning, and complexity of use.
Sound Wave Airway Clearance Devices / Emerging Technologies Products not fully approved or adopted yet as mainstream airway clearance devices that use sound or acoustic waves to help loosen mucus in the chest. Possible methods: (1) Externally applied to the chest wall. (2) Internally applied to the airways at the mouth. The Frequencer™ The Frequencer™ The Lung Flute™ The Lung Flute™ VibraLung™ VibraLung™ Images used by permission from the manufacturers
National Jewish Medical and Research Center23 Thank you Questions