I can t cough it up! Airway Clearance Therapy Heather Murgatroyd, RRT, RPSGT Field Clinical Specialist 1 Disclaimer Name of presenter: Heather Murgatroyd, BA, RRT, RPSGT Name of employer: RespirTech I recognize that I must follow all guidelines and criteria regarding vested interest. [ ] No, I have no real or perceived conflicts of interests that relate to this presentation. (If the response is no, stop here.) [ x ] Yes, I have the following real or perceived conflicts of interest that relate to this presentation: 2 Objectives Why might I need Airway Clearance Therapy (ACT)? Overview of respiratory system Normal and abnormal airway clearance Airway clearance devices 3
Airway Clearance Therapy Summary THE PREMISE Excess/retained secretions are harmful Effective removal of mucus can prevent exacerbations and delay lung deterioration THE GOAL Airway clearance is intended to impede mucus retention and to prevent or break the cycle of recurrent infection Successful treatment should help or sustain health and reduce medical and ancillary care costs associated with lung disease 4 Pulmonary Defense The respiratory system is lined with mucus-secreting goblet cells Airway mucus is a complex substance that forms a protective barrier lining the respiratory tract Bacteria and other airborne particles become trapped in this sticky mucus and then are swept upwards and out by tiny hair-like structures called cilia 5 Mucociliar Clearance (MCC) Cilia beat at 15 times per second Sol layer: 95% water, The gel nature is very important When this dries out, the cilia cannot sweep 6
Physiology of Normal Clearance The Four Stages of a Cough IRRITATION INSPIRATION COMPRESSION EXPULSION 7 Abnormal Airway Clearance Retention of secretions Internal obstruction - obstructive diseases External compression - scoliosis Mucociliary dysfunction - cystic fibrosis Dry secretions - medication side effect 8 The Vicious Cycle Defense System Overwhelmed Mucus Production, Inflammation & Infection Intensified Lung Defense Activated Mucus Accumulates Lung Damage Occurs Airways Obstructed with Mucus 9
Self-Directed ACT Incentive Spirometer The basic maneuver is sustained maximal inspiration Forced Exhalation Techniques Directed open-glottis cough technique; also called huff coughing Active Cycle Breathing Technique (ACBT) Alternate periods of breathing control, huff-coughing, diaphragmatic breathing and thoracic expansion exercises 10 Manual Chest Physiotherapy (CPT) Autogenic/postural drainage uses gravitation flow and controlled coughing to mobilize secretions Manual Chest Physiotherapy (CPT) aids in secretion clearance by percussion of the chest 11 Positive Expiratory Pressure (PEP) Devices & Oscillating Positive Expiratory Pressure (OPEP) Devices DEVICE EXAMPLES a. Aptalis FLUTTER mucus clearance device a b b. Monaghan Medical AerobiKa OPEP Therapy c c. Smiths Medical Acapella Vibratory PEP Therapy System 12
Intrapulmonary Percussive Ventilation IPV delivers mini bursts of positive pressure to the airways through a mouthpiece, this is a variant of PEP DEVICE EXAMPLES Percussionaire Impulsator IPV TravelAir (home use) VDR-4 Bronchotron IPV-IC (hospital use) Dima Italia Pegaso A-Cough Perc 13 Continuous Positive Expiratory Pressure (CPEP) / Continuous High Frequency Oscillation (CHFO) Device Therapy alternates time in CPEP mode (to improve lung expansion) with CHFO mode (a pneumatic form of chest physiotherapy) with aerosolized medication DEVICE EXAMPLES Hill-Rom MetaNeb System* * Hospital device only. 14 High Frequency Chest Compression The Vest System Model 205 incourage Airway Clearance Therapy The SmartVest System 15
Sine and Triangular Waveform - Different Approaches The airflow patterns created by vest help dislodge mucus that adheres to the bronchial walls. The percussive waveforms are a fundamental component of this therapy 1 16 Self - Advocate Be pro-active about your health Research about your condition Follow a healthy lifestyle Have all your medical information in the same place Foster a strong doctor-patient relationship Time with doctor is limited be prepared! Have a list of questions Be honest 17 Self - Advocate Advocate for yourself and your family Read policies Ask about tests, medications, therapies Have someone attend appointments with you Research and learn seek out multiple trusted sources for medical information Online resources Local support groups (Better Breathers Club, pulmonary rehab support groups) 18
Expected Outcomes of Airway Clearance Therapy (ACT) Clear secretions Preserve lung function Delay disease progression Reduce infectious exacerbations Reduce dependence on antibiotic therapy and other medications Reduce the need for hospitalizations Enhance quality of life 19 Questions? Thank you! 20