Pemenuhan Kebutuhan Oksigenasi Pasien Asthma Bronchiale dengan Teknik Relaksasi Batuk Efektif

Bronchial asthma is a disease of respiratory tract obstruction caused by muscle contraction, inflammation, and accumulation of secretions around the bronchi. Meeting the need for oxygenation is part of the management of asthmatic bronchial patients. This case study aims to describe the fulfillment of oxygenation needs. The case study method uses a descriptive design with a nursing care approach in the same two cases, namely respondents with bronchial asthma. The case study was conducted at the Putri Hijau Kindergarten II Hospital from October to December 2018. The data collection method was through interviews, physical examinations, supporting examinations, using the assessment format as an instrument in data collection. After intervention with effective cough relaxation techniques as well as collaboration in the administration of drug and oxygen therapy, during four days of treatment, both respondents were able to meet their oxygenation needs optimally. It was concluded that the intervention had an effect on the effectiveness of airway clearance so as to eliminate shortness of breath, based on this study, it is hoped that it can be applied by health workforce.

Respiratory physiotherapy in patients with Cystic Fibrosis and upper limb deep vein thrombosis

We report physiotherapy management of two patients with severe cystic fibrosis (CF) lung disease and upper limb deep vein thrombosis (DVT). These patients were admitted due to a pulmonary exacerbation. Following peripherally inserted central catheters they were diagnosed with an upper limb DVT. Due to their underlying lung disease, physiotherapy was mandatory for improvement. However, the DVT and anticoagulation treatment raised concerns for pulmonary emboli and hemoptysis. A framework for physiotherapy management in these patients, using a set of precautions and restrictions to maintain airway clearance while minimizing risk for pulmonary emboli and hemoptysis, was established. Using these set of instructions, the patients experienced no major adverse event while maintaining sufficient airway clearance to allow respiratory improvement. These precautions were continued until the upper limb DVTs resolved. To our knowledge there are currently no guidelines nor expert opinions available. Therefore, this framework can help guide physiotherapy management.

HIGH-FREQUENCY CHEST WALL OSCILLATION: AIRWAY CLEARANCE MANAGEMENT FOR OBSTRUCTIVE PULMONARY DISEASE PATIENTS

<p>Ineffective mucous airway clearance is identified as the main concern in obstructive pulmonary disease. An impaired mucociliary mechanism and hyper secretive are leading to mucous retention. High-frequency chest wall oscillation (HFCWO) offers a great practical advantage for obstructive pulmonary disease treatment. A literature review was conducted to summarize the existing research evidence assessing the effectiveness and benefits of HFCWO as an airway clearance management among people with obstructive pulmonary disease. Literature was limited to accessible articles in the English language and sourced from electronic databases, PubMed and EBSCO, from their published date through 2010. Seven studies that fulfilled the inclusion criteria were included in the analysis. Two themes were identified from the summary of included studies, namely respiratory function improvement and quality of life outcomes. The overall results of the studies indicate that HFCWO positively affects health status and wellbeing in patients with excessive mucous production and impaired airway clearance mechanism. It also can be performed independently and enhances self-satisfaction. Thus, it will be advantageous to include the HFCWO in pulmonary rehabilitation. Further studies are needed to validate the effectiveness of HFCWO in obstructive pulmonary disease patients and develop better treatments in this field.</p>

Penerapan Fisioterapi Dada dan Batuk Efektif Terhadap Ketidakefektifan Bersihan Jalan Nafas Pada Pasien Tuberculosis Paru

Pulmonary tuberculosis is a chronic bacterial infection by the bacillus Myobacterium tuberculosis. This disease causes the patient to cough with phlegm or coghing up blood, shortness of breath, chest pain, night sweats and decreased appetite. The purpose of this scientific paper is ti describe nursing care for pulmonary tuberculosis patients with ineffective airway clearance problems. This research uses a descriptive case study method with the subject of two pulmonary tuberculosis patients who experience ineffective airway clearance problems in Pelutan Pemalang Village. The chest physiotherapy and effetive coughing actions were carried out for three days, twice a day, morning and evening. The results showed that the effective chest physiotherapy and coughing were able to overcome the ineffectiveness of airway clearance. Therefore, it can be concluded that the effective chest and cough physiotherapy is considered effective against ineffective airway clearance in pulmonary tuberculosis patients. For this reason, nurses are expected to be able to provide effective chest and cough physiotherapy therapy to help overcome the ineffectiveness of airway clearance in pulmonary tuberculosis patients.Keywords: Effective Cough and Chest Physiotherapy, Ineffective Airway Clearing AbstrakTuberculosis paru merupakan penyakit infeksi bakteri menahun yang disebabkan oleh basil myobacterium tuberculosis. Penyakit ini menyebabkan pasien batuk disertai dahak atau batuk berdarah, sesak nafas, nyeri pada daerah dada, keringat pada malam hari dan penurunan nafsu makan. Tujuan dari Karya Tulis Ilmiah ini untuk menggambarkan asuhan keperawatan pada pasien tuberculosis paru dengan masalah ketidakefektifan bersihan jalan nafas. Rancangan Karya Tulis Ilmiah ini menggunakan metode studi kasus deskriptif dengan subjek dua pasien tuberculosis paru yang mengalami masalah ketidakefektifan bersihan jalan nafas di Kelurahan Pelutan Pemalang, dilakukan tindakan fisioterapi dada dan batuk efektif dilakukan selama tiga hari dikerjakan dua kali sehari pagi dan sore. Hasil pemberian fisioterapi dada dan batuk efektif berhasil mampu mengatasi ketidakefektifan bersihan jalan nafas. Kesimpulan : fisioterapi dada dan batuk efektif dinilai efektif terhadap ketidakefektifan bersihan jalan nafas pada pasien tuberculosis paru. Untuk itu diharapkan perawat dapat memberikan terapi fisioterapi dada dan batuk efektif untuk membantu mengatasi ketidakefektifan bersihan jalan nafas pada pasien tuberculosis paru.Kata kunci: Fisioterapi Dada dan Batuk Efektif, Ketidakefektifan Bersihan Jalan Nafas

A PHASE IIA OPEN LABEL STUDY TO EVALUATE THE SAFETY, TOLERABILITY AND EFFICACY OF S-1226 ADMINISTERED BY NEBULIZATION IN SUBJECTS WITH CYSTIC FIBROSIS LUNG DISEASE

Rationale: There are approximately 35,000 people with Cystic Fibrosis (CF) in North America. This condition is characterized by impaired airway clearance resulting in chronic infection and bronchiectasis. Current airway clearance treatments include nebulized hypertonic saline and Recombinant Human DNase, which may be limited by bronchospasm and cost, respectively. S-1226, a novel biophysical therapeutic agent combines carbon dioxide (CO2) enriched air (a bronchodilator) with nebulized perflubron (PFOB), (a synthetic surfactant). They act synergistically to open airways, enhance mucus clearance, and increase blood oxygenation. We report preliminary results from a Phase II clinical trial. Methods: An open label, single-center, Phase IIa study of subjects (≥14 years) with mild-moderate (FEV1 40-80%) CF lung disease treated with multiple ascending doses of S-1226 (week one), followed by the highest tolerated dose for 5 consecutive days (week two). Each dose of S-1226 comprised three successive treatments of 3mL of perflubron nebulized (Circulaire II) for two-minutes with CO2 concentrations ranging from 4 to 12%. The oxygen concentration was maintained at ambient levels. Treatments were administered twice daily. Efficacy measurements included spirometry, lung clearance index (LCI), lung volumes, blood oxygenation (SPO2), sputum weight and the respiratory domain of quality of life (QOL) questionnaire (CFQ-R). Safety included adverse event (AE) and tolerance monitoring, vital signs, and assessment of end-tidal CO2. Results: We report preliminary data on safety and efficacy for six CF subjects. All subjects tolerated all doses of S-1226. There were 5 reported AEs in 3 subjects. All were mild and resolved spontaneously. End-tidal CO2 immediately after treatment was comparable to baseline. SpO2 (baseline 91-95%) rapidly improved in all subjects with treatment. Five of six subjects had improvements in their LCI. Three subjects that were compliant in collecting mucus showed increases of 14%, 29% and 64% over baseline. Percent predicted FEV1 response was variable, decreasing initially with return to baseline values at two weeks. Four of the six subjects reported improvements in CFQ-R scores, three of which showed a clinically important difference (> 4 points). An important observation was that S-1226 controlled irritant (but not productive) cough in all five subjects and at all concentrations of S-1226. Conclusions: All doses of S-1226 were safe and well tolerated. Treatments with up to 12% extrinsic CO2 over short periods of time did not result in an elevation of end-tidal CO2. The preliminary efficacy results, including overall improved oxygen saturation, CFQ-R scores, increased expectorated mucus and LCI values provide evidence for potential beneficial effects of S-1226 for CF lung disease but require larger trials and longer-term treatments to fully assess efficacy in CF.