scholarly journals Physiologic Evidence for the Efficacy of Positive Expiratory Pressure as an Airway Clearance Technique in Patients With Cystic Fibrosis

2004 ◽  
Vol 84 (6) ◽  
pp. 524-537 ◽  
Author(s):  
Joan C Darbee ◽  
Patricia J Ohtake ◽  
Brydon JB Grant ◽  
Frank J Cerny
Keyword(s):  
Cystic Fibrosis ◽  
Lung Function ◽  
Vital Capacity ◽  
Preliminary Investigation ◽  
Therapeutic Modality ◽  
Gas Mixing ◽  
Ventilation Distribution ◽  
Single Breath ◽  
Arterial Blood ◽  
Positive Expiratory Pressure

Abstract Background and Purpose. Individuals with cystic fibrosis (CF) have large amounts of infected mucus in their lungs, which causes irreversible lung tissue damage. Although patient-administered positive expiratory pressure (PEP) breathing has been promoted as an effective therapeutic modality for removing mucus and improving ventilation distribution in these patients, the effects of PEP on ventilation distribution and gas mixing have not been documented. Therefore, this preliminary investigation described responses in distribution of ventilation and gas mixing to PEP breathing for patients with moderate to severe CF lung disease. Subjects and Methods. The effects of PEP breathing on ventilation distribution, gas mixing, lung volumes, expiratory airflow, percentage of arterial blood oxyhemoglobin saturation (Spo2), and sputum volume were studied in 5 patients with CF (mean age=18 years, SD=4, range=13–22) after no-PEP, low-PEP (10–20 cm H2O), and high-PEP (>20 cm H2O) breathing conditions. Single-breath inert gas studies and lung function tests were performed before, immediately after, and 45 minutes after intervention. Single-breath tests assess ventilation distribution homogeneity and gas mixing by observing the extent to which an inspired test gas mixes with gas already residing in the lung. Results. Improvements in gas mixing were observed in all PEP conditions. By 45 minutes after intervention, the no-PEP group improved by 5%, the low-PEP group improved by 15%, and the high-PEP group improved by 23%. Slow vital capacity increased by 1% for no PEP, by 9% for low PEP, and by 13% for high PEP 45 minutes after intervention. Residual volume decreased by 13% after no PEP, by 20% after low PEP, and by 30% after high PEP. Immediate improvements in forced expiratory flow during the middle half of the forced vital capacity maneuver (FEF25%–75%) were sustained following high PEP but not following low PEP. Discussion and Conclusion. This study demonstrated the physiologic basis for the efficacy of PEP therapy. The results confirm that low PEP and high PEP improve gas mixing in individuals with CF, and these improvements were associated with increased lung function, sputum expectoration, and SpO2. The authors propose that improvements in gas mixing may lead to increases in oxygenation and thus functional exercise capacity.

scholarly journals Physiologic Evidence for High-Frequency Chest Wall Oscillation and Positive Expiratory Pressure Breathing in Hospitalized Subjects With Cystic Fibrosis

2005 ◽  
Vol 85 (12) ◽  
pp. 1278-1289 ◽  
Author(s):  
Joan C Darbee ◽  
Jamshed F Kanga ◽  
Patricia J Ohtake
Keyword(s):  
Cystic Fibrosis ◽  
Lung Function ◽  
Chest Wall ◽  
High Frequency ◽  
Gas Mixing ◽  
Ventilation Distribution ◽  
Oxyhemoglobin Saturation ◽  
Arterial Blood ◽  
Wall Oscillation ◽  
Positive Expiratory Pressure

Abstract Background and Purpose. This investigation identified ventilation distribution, gas mixing, lung function, and arterial blood oxyhemoglobin saturation (Spo2) physiologic responses to 2 independent airway clearance treatments, high-frequency chest wall oscillation (HFCWO) and low positive expiratory pressure (PEP) breathing, for subjects who had cystic fibrosis (CF) and who were hospitalized during acute and subacute phases of a pulmonary exacerbation. Subjects. Fifteen subjects with moderate to severe CF were included in this study. Methods. Subjects performed single-breath inert gas tests and spirometry before and immediately after HFCWO and PEP breathing at admission and discharge. Arterial blood oxyhemoglobin saturation was monitored throughout each treatment. Results. At admission and discharge, PEP breathing increased Spo2 during treatment, whereas HFCWO decreased Spo2 during treatment. Ventilation distribution, gas mixing, and lung function improved after HFCWO or PEP breathing. Discussion and Conclusion. High-frequency chest wall oscillation and PEP breathing are similarly efficacious in improving ventilation distribution, gas mixing, and pulmonary function in hospitalized people with CF. Because Spo2 decreases during HFCWO, people who have moderate to severe CF and who use HFCWO should have Spo2 monitored during an acute exacerbation.

scholarly journals A short-term evaluation of a prototype disposable Oscillating Positive Expiratory Pressure (OPEP) device in a cohort of children with cystic fibrosis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kevin J. O’Sullivan ◽  
Valerie Power ◽  
Barry Linnane ◽  
Deirdre McGrath ◽  
Magdalena Mulligan ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Lung Function ◽  
Clinical Investigation ◽  
Mean Difference ◽  
Short Term ◽  
Intervention Participant ◽  
Post Intervention ◽  
Convenience Sample ◽  
Disposable Device ◽  
Positive Expiratory Pressure

Abstract Background Oscillating Positive Expiratory Pressure (OPEP) devices are important adjuncts to airway clearance therapy in patients with cystic fibrosis (CF). Current devices are typically reusable and require daily, or often more frequent, cleaning to prevent risk of infection by acting as reservoirs of potentially pathogenic organisms. In response, a daily disposable OPEP device, the UL-OPEP, was developed to mitigate the risk of contamination and eliminate the burdensome need for cleaning devices. Methods A convenience sample of 36 participants, all current OPEP device users, was recruited from a paediatric CF service. For one month, participants replaced their current OPEP device with a novel daily disposable device. Assessment included pre- and post-intervention lung function by spirometry, as well as Lung Clearance Index. Quality of life was assessed using the Cystic Fibrosis Questionnaire – Revised, while user experience was evaluated with a post-study survey. Results 31 participants completed the study: 18 males; median age 10 years, range 4–16 years. Lung function (mean difference ± SD, %FEV1 = 1.69 ± 11.93; %FVC = 0.58 ± 10.04; FEV1: FVC = 0.01 ± 0.09), LCI (mean difference ± SD, 0.08 ± 1.13), six-minute walk test, and CFQ-R were unchanged post-intervention. Participant-reported experiences of the device were predominantly positive. Conclusions The disposable OPEP device maintained patients’ lung function during short term use (≤ 1 month), and was the subject of positive feedback regarding functionality while reducing the risk of airway contamination associated with ineffective cleaning. Registration The study was approved as a Clinical Investigation by the Irish Health Products Regulatory Authority (CRN-2209025-CI0085).

scholarly journals Effects of Side Lying on Lung Function in Older Individuals

1999 ◽  
Vol 79 (5) ◽  
pp. 456-466 ◽  
Author(s):  
Fiona Manning ◽  
Elizabeth Dean ◽  
Jocelyn Ross ◽  
Raja T Abboud
Keyword(s):  
Lung Function ◽  
Vital Capacity ◽  
Forced Expiratory Volume ◽  
Phase Iii ◽  
Diffusing Capacity ◽  
Older Individuals ◽  
Transport Pathway ◽  
Single Breath ◽  
History Of ◽  
Body Positioning

Abstract Background and Purpose. Body positioning exerts a strong effect on pulmonary function, but its effect on other components of the oxygen transport pathway are less well understood, especially the effects of side-lying positions. This study investigated the interrelationships between side-lying positions and indexes of lung function such as spirometry, alveolar diffusing capacity, and inhomogeneity of ventilation in older individuals. Subjects and Methods. Nineteen nonsmoking subjects (mean age=62.8 years, SD=6.8, range=50–74) with no history of cardiac or pulmonary disease were tested over 2 sessions. The test positions were sitting and left side lying in one session and sitting and right side lying in the other session. In each of the positions, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), single-breath pulmonary diffusing capacity (DLCO/VA), and the slope of phase III (DN2%/L) of the single-breath nitrogen washout test to determine inhomogeneity of ventilation were measured. Results. Compared with measurements obtained in the sitting position, FVC and FEV1 were decreased equally in the side-lying positions, but no change was observed in DLCO/VA or DN2%/L. Conclusion and Discussion. Side-lying positions resulted in decreases in FVC and FEV1, which is consistent with the well-documented effects of the supine position. These findings further support the need for prescriptive rather than routine body positioning of patients with risks of cardiopulmonary compromise and the need to use upright positions in which lung volumes and capacities are maximized.

Sleep quality and nocturnal hypoxaemia and hypercapnia in children and young adults with cystic fibrosis

2012 ◽  
Vol 97 (11) ◽  
pp. 960-966 ◽  
Author(s):  
Brigitte Fauroux ◽  
Jean-Louis Pepin ◽  
Pierre-Yves Boelle ◽  
Claire Cracowski ◽  
Marlène Murris-Espin ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Young Adults ◽  
Lung Function ◽  
Gas Exchange ◽  
Sleep Quality ◽  
Function Parameter ◽  
Night Time ◽  
Arterial Blood ◽  
A Value ◽  
Nocturnal Hypoxaemia

ObjectivesThe aim of the study was to evaluate sleep quality and nocturnal gas exchange in patients with cystic fibrosis (CF) and to assess if sleep quality and daytime lung function could predict nocturnal hypoxaemia or hypercapnia.Study designDaytime sleepiness and objective sleep quality were evaluated by the Pittsburgh Sleep Quality Index (PSQI) and actigraphy in 25 children and 55 young adults (mean age 24±10 years, forced expiratory volume in 1 s (FEV1) 41±11% predicted). Nocturnal gas exchange was assessed by pulse oximetry (SpO2) and transcutaneous carbon dioxide (PtcCO2) recordings. Eleven patients underwent simultaneous polysomnography (PSG).ResultsPSQI was 6.3±3.4 with 51% of the patients having a score >5 corresponding to significant sleep complaints. On actigraphy, sleep efficiency was impaired at 79±11% with a fragmentation index at 41±18. Mean nocturnal SpO2 was 93±3% with 18% of the patients exhibiting >10% of night time spent with a value below 90%. Mean PtcCO2 was 44±6 mm Hg with 47% of the patients exhibiting >10% of night time with a value >45 mm Hg. Daytime arterial blood gases correlated with nocturnal gas exchange. FEV1 was the only lung function parameter that correlated with nocturnal SpO2 (p<0.01). Compared with PSG, SpO2 and PtcCO2 accurately identified rapid eye movement sleep hypoventilation.ConclusionsPatients with CF exhibit poor sleep quality that does not predict nocturnal gas exchange. Nocturnal hypoxaemia and hypercapnia can be identified by simple tools.

Effects of hypergravity and anti-G suit pressure on intraregional ventilation distribution during VC breaths

2001 ◽  
Vol 91 (2) ◽  
pp. 637-644 ◽  
Author(s):  
Per M. Gustafsson ◽  
Ola Eiken ◽  
Mikael Grönkvist
Keyword(s):  
Vital Capacity ◽  
Phase Iii ◽  
Healthy Male ◽  
Ventilation Distribution ◽  
Pulmonary Vessel ◽  
Ventilation Inhomogeneity ◽  
Single Breath ◽  
Male Subjects

The effects of increased gravity in the head-to-foot direction (+Gz) and pressurization of an anti-G suit (AGS) on total and intraregional intra-acinar ventilation inhomogeneity were explored in 10 healthy male subjects. They performed vital capacity (VC) single-breath washin/washouts of SF6 and He in +1, +2, or +3 Gz in a human centrifuge, with an AGS pressurized to 0, 6, or 12 kPa. The phase III slopes for SF6 and He over 25–75% of the expired VC were used as markers of total ventilation inhomogeneity, and the (SF6 − He) slopes were used as indicators of intraregional intra-acinar inhomogeneity. SF6 and He phase III slopes increased proportionally with increasing gravity, but the (SF6 − He) slopes remained unchanged. AGS pressurization did not change SF6 or He slopes significantly but resulted in increased (SF6 − He) slope differences at 12 kPa. In conclusion, hypergravity increases overall but not intraregional intra-acinar inhomogeneity during VC breaths. AGS pressurization provokes increased intraregional intra-acinar ventilation inhomogeneity, presumably reflecting the consequences of basilar pulmonary vessel engorgement in combination with compression of the basilar lung regions.

scholarly journals An Overview of Noninvasive Ventilation in Cystic Fibrosis

2021 ◽  
Author(s):  
AESHA JOBANPUTRA ◽  
Sugeet Jagpal ◽  
Paula Marulanda ◽  
MAYA RAMAGOPAL ◽  
TEODORO SANTIAGO ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Lung Function ◽  
Gas Exchange ◽  
Noninvasive Ventilation ◽  
Exercise Tolerance ◽  
Sleep Medicine ◽  
Therapeutic Modality ◽  
Quality Of Sleep ◽  
Airway Clearance

Noninvasive ventilation (NIV) use was initially reported in cystic fibrosis (CF) in 1991 as a bridge to lung transplantation, and over the decades the use of NIV has increased in the CF population. Individuals with CF are prone to various physiologic changes as lung function worsens, and they may benefit from NIV for advanced lung disease. As life expectancy in CF has been increasing due to advances such as highly effective modulator therapy, people with CF are now subject to the same co-morbidities that may benefit from NIV as their age matched cohorts. NIV can improve gas exchange, quality of sleep, exercise tolerance and augment airway clearance in CF, and it is important that CF providers are comfortable with this therapeutic modality. In this review, we will summarize the physiologic basis for NIV use in CF, describe indications for initiation of NIV, and postulate a practical approach for CF clinicians to take fin monitoring patients on NIV. We will discuss aspects unique to people with CF and the use of NIV. We hope that this serves as a resource for CF providers, especially those of us who do not have dedicated training in sleep medicine, as we continue to care for our patient population.

scholarly journals Impact of Hemodialysis on Dyspnea and Lung Function in End Stage Kidney Disease Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Anastasios F. Palamidas ◽  
Sofia-Antiopi Gennimata ◽  
Foteini Karakontaki ◽  
Georgios Kaltsakas ◽  
Ioannis Papantoniou ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Lung Function ◽  
Blood Gases ◽  
Maintenance Hemodialysis ◽  
Moderate Degree ◽  
Single Breath ◽  
Arterial Blood ◽  
Before And After ◽  
Mouth Occlusion Pressure ◽  
End Stage

Background. Respiratory symptoms are usually underestimated in patients with chronic kidney disease undergoing maintenance hemodialysis. Therefore, we set out to investigate the prevalence of patients chronic dyspnea and the relationship of the symptom to lung function indices.Methods. Twenty-five clinically stable hemodialysis patients were included. The mMRC dyspnea scale was applied before and after hemodialysis. Spirometry, single breath nitrogen test, arterial blood gases, static maximum inspiratory (Pimax⁡) and expiratory (Pemax⁡) muscle pressures, and mouth occlusion pressure (P0.1) were also measured.Results. Despite normal spirometry, all patients (100%) reported mild to moderate degree of chronic dyspnea pre which was reduced after hemodialysis. The sole predictor of (Δ) mMRC was the (Δ)P0.1(r=0.71,  P<0.001). ThePimax⁡was reduced before and correlated with the duration of hemodialysis (r=0.614,  P<0.001), whilst after the session it was significantly increased (P<0.001). Finally (Δ) weight was correlated with the (Δ)Pimax⁡  %pred(r=0.533,  P=0,006) and with the (Δ) CV(%pred)(r=0.65,  P<0.001).Conclusion. We conclude that dyspnea is the major symptom among the CKD patients that improves after hemodialysis. The neuromechanical dissociation observed probably is one of the major pathophysiologic mechanisms of dyspnea.

No effect of artificial gravity on lung function with exercise training during head-down bed rest

2015 ◽  
pp. 1-7
Author(s):  
Longxiang Su ◽  
Yinghua Guo ◽  
Yajuan Wang ◽  
Delong Wang ◽  
Changting Liu
Keyword(s):  
Lung Function ◽  
Pulse Rate ◽  
Vital Capacity ◽  
Pulmonary Ventilation ◽  
Bed Rest ◽  
Forced Expiratory Volume ◽  
Observation Time ◽  
Artificial Gravity ◽  
Postural Changes ◽  
Expiratory Flow

AbstractTo explore the effectiveness of microgravity simulated by head-down bed rest (HDBR) and artificial gravity (AG) with exercise on lung function. Twenty-four volunteers were randomly divided into control and exercise countermeasure (CM) groups for 96 h of 6° HDBR. Comparisons of pulse rate, pulse oxygen saturation (SpO2) and lung function were made between these two groups at 0, 24, 48, 72, 96 h. Compared with the sitting position, inspiratory capacity and respiratory reserve volume were significantly higher than before HDBR (0° position) (P&lt; 0.05). Vital capacity, expiratory reserve volume, forced vital capacity, forced expiratory volume in 1 s, forced inspiratory vital capacity, forced inspiratory volume in 1 s, forced expiratory flow at 25, 50 and 75%, maximal mid-expiratory flow and peak expiratory flow were all significantly lower than those before HDBR (P&lt; 0.05). Neither control nor CM groups showed significant differences in the pulse rate, SpO2, pulmonary volume and pulmonary ventilation function over the HDBR observation time. Postural changes can lead to variation in lung volume and ventilation function, but a HDBR model induced no changes in pulmonary function and therefore should not be used to study AG CMs.

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