“Airway Clearance Devices”
Why we use them with Bronchiectasis
National Jewish Medical and
Research Center
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What Else Can I do to
feel Better?
Airway Clearance
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Research Center
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Impaired Airway Clearance – What
Happens?
Dyspnea (shortness of breath)
And the risk factors rise for recurrent,
ever-worsening episodes of:
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inflammation
pulmonary infection
increased mucus production
airway obstruction (mucus plugging)
lung damage (lung scarring and remodelling
of airways)
Impaired Airway Clearance –
What Happens?
Acceleration of the vicious cycle promotes:
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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
GOAL 
What Should Be Done?
In cases of impaired airway clearance it is
necessary to provide:
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Routine administration of aggressive,
effective airway clearance therapy.
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Airway clearance therapy is the most reliable
means stopping or delaying the progression of
mucus retaining lung disease.
GOAL 
What Should Be Done?
For patients at risk for retained secretions
provide them with the means to do
bronchial hygiene therapy (BHT):
20 - 40 minutes per day
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Divided up into a few sessions per day
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Rx examples:
• 10 minutes – TID
• 15 minutes – BID
• Adjust as needed or tolerated
Airway Clearance Devices
PEP
(Positive Expiratory Pressure) devices
Vibratory PEP
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Acapella®, Flutter Valve™, Quake®
HFCWO
(High Frequency Chest Wall
Oscillation)
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Vest Systems
Cough
Assist®
IPV® (Intrapulmonary Percussive Ventilation)
Aerosol therapy to loosen thick secretions or
to treat infections
Mucolytics, Hypertonic Saline, Inhaled Antibiotics
Palm Cups®, percussive vibrators
positioning beds, tables, wedges or pillows
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Devices Often used at NJC
OPEP devices:
Acapella ® DM
HFCWO system:
The Smart Vest
Acapella ® DH
Flutter Valve®
(used mainly in
the past)
OPEP for 15 minutes,
two times per day.
HFCWO 10 to 20 minutes, two or
three times per day.
Web Sources: dhd.com,
thevest.com, axcan.com
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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
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Research Center
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When normal airway clearance
becomes impaired the following
can occur:
•Dyspnea (shortness of breath)
And the risk factors rise for recurrent, ever-worsening
episodes of:
• inflammation
• pulmonary infection
• increased production of excess mucus
• airway obstruction (mucus plugging)
• lung damage (lung scaring & remodeling of
airways)
Source: NJMRC &
www.thevest.com
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Research Center
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Take Bronchiectasis for
example
Source: THE MERCK MANUAL--SECOND HOME EDITION Online, Ch. 47, Bronchiectasis
http://www.mercksource.com
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positions & equipment to treat a
disease like Bronchiectasis or CF
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Traditional Therapy
Equipment examples  tools to help treat chronic phlegm-retaining
diseases the traditional way
Manual percussion assistive devices
Palm Cups ®
Source: www.smiths-medical.com
Percussive vibrators
Flimm Fighter ®
Vibracare ®
Neocussor ®
Source: www.g5.com
Images used by permission from the manufacturers
Other Airway Clearance
Techniques:
Best used in combination with each other or with
hand held airway clearance devices
 Coughing
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and breathing techniques
Directed Coughing
Huff coughing
“Quad cough”
Autogenic Drainage (AD)
Active Cycle Breathing Technique (ACBT)
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Research Center
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PEP & OPEP hand held devices
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PEP (Positive Expiratory Pressure)
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Cost, usually less than $100
TheraPEP®
PARI PEP™
various other brands
Vibratory PEP (Oscillatory PEP)
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Cost, usually < $150
Flutter Valve®
Acepella®
Quake®
Resources: smiths-medical.com,
pari.com, axcan.com,
thayermedical.com
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Vibratory PEP via an acapella
Choice®
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Research Center
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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.
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Research Center
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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
•Hill-Rom, Inc., www.thevest.com
•ElectroMed, Inc., www.electromed-usa.com
•RespirTech, Inc., www.respirtech.com
Images used by permission from the manufacturers
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Cough Assist Device™
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
“coughalator”
Resource: www.coughassist.com
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IntraPulmonary Percussive
Ventilation
Percussive PEP (IPV types of nebulizer):
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Impulsator® (IPV®) by PERCUSSIONAIRE® Corp.
PercussiveNEB™(P-NEB), by Vortan Medical Corp.
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.
www14.inetba.com/percussionaire
www.vortran.com
Percussionaire & Vortran
Medical - Corporations
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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.
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The Frequencer™
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The Lung Flute™
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VibraLung™
Images used by permission from the manufacturers
Thank you
Questions
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Research Center
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