Patients with different lung disease and health issues tend to have atelectasis either by breathing lower tidal volume (passive atelectasis) or by mucus plugging (Resorption atelectasis). Different devices are used as a prevention technique to decrease the incidence of atelectasis, which is known as lung expansion therapy. On the other hand, some other devices such as bronchial hygiene therapy devices are used to mobilize the secretions and help the patient to expel these secretions that could be a source of infection.

Lung expansion therapy works under the mechanism of increasing the transpulmonary pressure, which results in increasing lung volumes. An incentive spirometer (IS) is an example of a lung expansion device that is widely used in different situations. It is mostly used with patients who undergo surgery or patients with restrictive lung diseases, who do not breath deeply enough. Special consideration should be given if incentive spirometer is suggested as a therapy because it is not recommended for use with confused or sedated patients since it will not be an effective therapy. Flow or volume oriented devices are different types of IS, but actually, it requires the same maneuver to preform it. Incentive spirometry procedure requires the patient to take a maximal inspiration followed by breath hold to maximize it’s effect. In some situations IS is not effective or it may be contraindicated; in this case, other devices are suggested such as intermittent positive pressure breathing (IPPB). Even though IPPB is not widely used as before it still has a role in lung expansion therapy for carefully selected patients when other lung expansion therapy is not effective. During IPPB therapy, pressure, sensitivity to the patient’s effort to initiate a breath, flow and oxygen percentage are controls that the respiratory therapist would adjust according to the patient’s need. Other lung expansion modalities such as continuous positive pressure (CPAP) or bi-level continuous positive pressure depend on various ways of establishing a positive pressure during exhalation to recruit collapsed alveoli.1

 

Patients with copious secretions due to diseases that affect the normal cough mechanism, or mucociliary transport system abnormalities are indications for bronchial hygiene therapy. The goal of bronchial hygiene therapy is to remove retained secretions, improve gas exchange and decrease work of breathing. Choosing the appropriate device for the patient depends on the patient’s condition, age and the ability to follow directions. Bronchial hygiene therapy varies between advanced devices that are used in the hospital to simple devices that could be portable or designed for home care use. Cystic fibrosis patients tend to have a large amount of secretions that result in frequent infections. To prevent secretions from blocking their airways, as I mentioned before, it is ideal to use bronchial hygiene therapy. Different modalities are suggested such as chest physiotherapy that is implemented by either percussion or vibration; it also could be combined with postural drainage. Flutter valves or PEP therapy that depend on creating back pressure or vibration to the lungs could be other recommended devices with the advantages of being portable as well as being delivered in conjunction with aerosol therapy. If long periods of therapy were needed, high frequency chest oscillation that has the effect of applying vibration externally to the chest would be a great suggestion for bronchial hygiene therapy. 2

 

To prevent a patient’s condition from worsening due to breathing at low lung volumes, and to maintain maximal lung function, various kinds of therapy can be used according to the underlying cause to reach therapeutic goals.

 

 

Reference:

1-Mosby’s Respiratory care Equipment book

2-Egan’s Fundamentals of Respiratory Care book