Aerosol and Airway Clearance Therapies: Challenges and Opportunities. Growth of the Medicare. Aerosol and ACT Therapies Terry L. Forrette, M.H.

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1 Baby Boomers: The Next Patient Population Aerosol and Airway Clearance Therapies: Challenges and Opportunities Terry L. Forrette, M.H.S., RRT The person sitting next to you may be your patient in the next 5 years Pandemic crisis Acute exacerbations related to climate change Increase in hospital admissions for chronic diseases Growth of the Medicare Population Rosen: Leading Causes of Death Age 65+ Medical Diagnoses Heart Disease 32% Cancer 22% Stroke 8% Chronic respiratory 6% Flu/Pneumonia 3% Diabetes 3% Alzheimer s 3% State of Aging and Health CDC/NCHS Health US, 2002 Percent Selected Chronic Conditions Age 65 and over by Sex, Heart disease Hypertension Diabetes Arthritis Data source: National Health Interview Survey Male Female 1

2 What Does This Mean for RCP s? Increased value to your hospital s bottom line COST SAVINGS. Opportunity to become part of the solution and become a change agent A New Era for Aerosol and Airway Clearance Therapies Yes, but doesn t mean that more demands will be put on my time? Not if you can work smarter not harder! The Changing Face of Aerosol Delivery Constant Output The original T piece or updraft neb Breath Enhanced Constant output with an inspiratory boost Dosimetric (breath actuated) Aerosol only released on inspiration Importance of Size and Impaction Rate on Drug Delivery The most important characteristic of nebulizer performance is the respirable dose provided for the patient Nebulizers: Principles and Performance; Respiratory Care, 2000, 45(6) Dean Hess, PhD RRT FAARC Ideal Particle Size Medication Nebulizers optimum airway deposition Respirable Dose 10% Respirable Dose 15% Respirable Dose 30% Higher respirable dose = quicker onset of action! Higher respirable dose = shorter treatment times! 2

3 Conventional Neb BAN Device The problem with continuous flow Waste/environmental concerns Lung Deposition 32% Throat Deposition 68% Lung Deposition 72% Throat Deposition 28% Inspiration Dosimetric Nebulizer (Breath Actuated Nebulizer Conventional T-piece Expiration Inspiration Inspiration Breath Enhanced Expiration Expiration Work Smarter NOT Harder What would you do? minute treatment time! 3

4 Bronchial Hygiene Therapy Key Features of Airway Clearance Therapies (ACT) Humidity Airflow behind the secretions with pressure or vibrations Positive Expiratory Pressure (PEP) What would you do? 48 hour post IPV Intrapulmonary Percussive Ventilation (IPV) Mobilization of Pulmonary Secretions Creation of Bilateral Uniform Alveolar Ventilation Enhancement of Endobronchial Diffusion Providing Convective Tidal Flow FORREST M BIRD, M.D., PhD. ScD. 4

5 Percussive Air Hammer PHASITRON Airways are percussed Airway dilation Gas mixing and hydration Increased expiratory flow Slides courtesy of: Brent D. Kenney BSRT, RRT Educational Coordinator Respiratory Care Services Intrapulmonary Percussive Ventilation: Waveform Des Jardins, T. Cardiopulmonary Anatomy and Physiology: Essentials for Respiratory Care 2 nd Edition. Albany, Delmar Publishers, 1993, pp 21. VENTURI PRINCIPLE CPT From the Inside Out 5

6 IPV Pig Lung Bronch View Retained Secretions IPV in Line Pressure Control Puritan Bennett 840: A/C Pressure Control IPV in-line IPV Pig Lungs.wmv IPV 24 hr Prior to IPV 2 days IPV Q4 6

7 The Problem A Gentle Percussive Force High Frequency Percussive Ventilation: Before 7

8 High Frequency Percussive Ventilation: After Meeting The Challenge of Effective Airway Clearance Promote Secretion Removal Improve Aerosol Delivery Become a Change Agent Questions 8

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