![]() NMD, post coma, ABI (with attention to glottic functionality)įrom Good (in synchrony with device) to Absent Mobilize secretions from the periphery of the lung the swing facilitates the detachment of secretions, increasing lung volume (FRC and VT), reduction of hyperinflation Excellent for managing the early stages of disease. Low cost, easy to use and transportable, the vibration allows a better action on the denser secretions. OPEP Systems (Aerobika, Acapella, Flutter, Cornet, etc.) Mobilize secretions from the periphery of the lung, increasing lung volume (FRC and VT), reduction of hyperinflation Patients with reduced flows, patients with cognitive impairment, highly deconditioned patients, Pneumothorax, active haemoptysis Excellent for managing the early stages of COPD. PEP Systems (PEP mask, PEP Bottle, thera PEP. Mobilize secretions from the periphery of the lung Patients too young, patients with cognitive impairment, highly deconditioned patients, patients with reduced cough reflex, difficult to teach It combines lung re-expansion and PEP effect. Mobilize secretions from the periphery of the lung. Patients with reduced flows, patients with cognitive impairment, agitated or confused, patients not spontaneously breathing It combines lung re-expansion and PEP effect.Self-management Facilitate expectorationĬOPD hypersecretive Bronchiectasis Cystic fibrosis Pre/post-surgeryįree. Mobilize secretions from periphery of the lung. Patients with reduced flows, patients with cognitive impairment, highly deconditioned patients, patients with reduced cough reflex Low cost, detach secretions from the bronchial wall, Combine with other techniques Mobilize secretions from periphery of the lung Patients with reduced flows, patients with cognitive impairment, highly deconditioned patients, patients with reduced cough reflex, thoracic trauma ![]() Low cost, studied for a long time, combine with other techniques Underlying these numerous techniques, however, are a series of different physiological mechanisms used for “unblocking” the obstruction:ĬOPD, cystic fibrosis, post-surgery (precaution) Therefore, it is essential always to take into account the patient's preferences, and base one's choices about which technique to use not only on the relief of symptoms, but also on the adaptability of the technique to the patient's lifestyle. Adherence to treatment is fundamental and it depends very much on the patient's satisfaction, motivation and perceived effectiveness. According to Lapin ( 11), the overall effectiveness of any technique is influenced by several factors closely related to the patient. In addition, for many patients and/or categories of patients the goal might be to combine the best effect on clearance of the airways with the lowest possible incidence of side effects and of adverse events, such as exacerbation of the underlying pathophysiology ( 10). Looking at the issue from the other side, i.e., from the patient's perspective, rarely is just one single technique used for a given pathological condition. Obviously, there is a need for more studies to increase the body of scientific evidence on this topic ( 9). ![]() This absence of evidence, however, does not necessarily mean an absence of efficacy. Their aim is to reduce airway obstruction caused by secretions occupying the airway lumen and so prevent respiratory tract infections, re-expand the collapsed areas of the lung, thus improving gas exchanges and decreasing the inflammatory response ( 1– 4).Ī wide range of treatments, techniques and devices are present in the scientific literature for managing bronchial encumbrance in respiratory physiotherapy but their very multiplicity begs the question in daily clinical practice: “which of these treatments is it better to use to obtain the better result in my patient?.” Up to now, for all ACTs there is insufficient evidence to prove their efficacy and effectiveness in different clinical scenarios or to affirm the superiority of one technique over another ( 5– 8). ![]() The term airway clearance techniques (ACTs) refers to a variety of different strategies used to eliminate excess secretions. The management of bronchial secretions is one of the main problems encountered in a wide spectrum of medical conditions ranging from respiratory disorders (e.g., COPD, bronchiectasis, cystic fibrosis) to neuromuscular disorders (e.g., ALS) to patients undergoing either thoracic or abdominal surgery.
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