Topic Thursday | PCDsmiles

Written by PCD Smiles on 17 April 2024. Posted in Topic Thursday.

ACT Series, 13: Other Mechanical ACT Devices, Part 1

Over the next two weeks we will explore other mechanical airway clearance devices in our airway clearance technique (ACT) series. There are many outliers to airway clearance therapies. As the internet has brought the world closer than ever, especially in the dawn of social media, more and more ACTs have come to light. From the simple and inexpensive to more aggressive and expensive. The need for mobile therapies as the patient population who use ACTs grows has forced researchers back to the drawing board. In fact even basic clinics, licensed respiratory therapists, patients, everyday people with 3D printers, and even social media influencers have gotten in the game of inventing ACTs and ACT devices. But what is true and what is helpful? We will spend the next few weeks looking at some of the more notable ones, including the medically sound ACTs rooted in scientific evidence for certain pulmonary diseases. Not all these ACTs will work for specific mucociliary clearance diseases. Please, for your safety, ask your clinic’s licensed respiratory therapist, your clinic’s contracted licensed respiratory therapy provider for more information on these or any ACT device or method you read or hear about on the internet, social media, support group, or one on one from another patient. In “Part 1” we will go over ELTGOL therapy, the Simeox machine, and how they may be used in conjunction with other previously discussed ACTs.

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Written by PCD Smiles on 11 April 2024. Posted in Topic Thursday.

ACT Series, 12: Oscillation & Lung Expansion (OLE)

The next device that we will cover in our airway clearance technique (ACT) series is oscillation & lung expansion (OLE). OLE is touted as the next big advancement in airway clearance. This hospital proven airway clearance therapy has been in use within US medical facilities since 2013. It’s usefulness during the recent 2020 pandemic caught the attention of medical professionals and regulatory authorities when it was granted EUA (emergency use authorization) by the U.S. Food and Drug Administration for the treatment of pandemic patients. OLE delivers three in one therapy; oscillation, expansion, and nebulization. Unlike intrapulmonary percussive ventilation (IPV), OLE can be utilized as a stand alone ACT. There are limited studies to date showing greater improvement in lung clearance index with the use of OLE, compared to the typical ACT methods used during exacerbations in adult cystic fibrosis (CF) patients.

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Written by PCD Smiles on 04 April 2024. Posted in Topic Thursday.

ACT Series, 11: Intrapulmonary Percussive Ventilation (IPV)

The next device that we will cover in our airway clearance technique (ACT) series is intrapulmonary percussive ventilation (IPV). IPV is rarely used outside of the United States. After recent recommendations from the World Health Organization in late 2019, IPV has become the subject of research for the treatment of atelectasis in other countries. Many clinicians within the United States consider IPV as “one of the big guns” in airway clearance. IPV is mainly used as an adjunct therapy with high-frequency chest wall oscillation (HFCWO). Basically IPV is used together with another primary ACT, like vest therapy, to assist the primary ACT and not as a standalone ACT. There is little scientific evidence to support the effectiveness and or the efficacy of IPV therapy.

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Written by PCD Smiles on 27 March 2024. Posted in Topic Thursday.

ACT Series, 10: High-Frequency Chest Wall Oscillation (HFCWO)

The next device that we will cover in our airway clearance technique (ACT) series is high-frequency chest wall oscillation (HFCWO). HFCWO is a commonly prescribed ACT around the world due to it’s ability to be self-administered, it’s less intensive labor requirements, and it being less time consuming than conventional chest physiotherapy. Past research has shown it to be at least as effective as other airway clearance techniques. This however remains hard to prove despite the acceptance of evidence showing that ventilation plays a role in expiratory mobilization of mucus. So outside the United States HFCWO remains an experimental practice. A practice that is reserved for patients with specific medical conditions who are experiencing steep medical declines, and who’s declines have failed to level off or respond to all other forms of airway clearance. HFCWO is usually then granted to these specific patients on compassionate grounds, but not always. Most national health care systems outside the United States follow this line of reasoning, but the patient and their families are often required to pay out of pocket for the more expensive HFCWO devices like the vest airway clearance systems. One such country that allows the vest through this process is the United Kingdom (UK). Although rare, cystic fibrosis (CF) patients who are in step decline and have documentation showing that they have not responded to all other methods of airway clearance can be prescribed the vest airway clearance system in the UK. Whether or not the NHS actually pays for the machine depends on their regional authority who controls expenditures within the region.

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Written by PCD Smiles on 20 March 2024. Posted in Topic Thursday.

ACT Series, 9; Oscillatory Positive Expiratory Pressure (OPEP)

The next device that we will cover in our airway clearance technique (ACT) series is oscillatory positive expiratory pressure (OPEP). OPEP is the most prescribed ACT device for bronchiectasis patients in the United States. In stable bronchiectasis patients twice daily therapy with an OPEP device can improve the patient’s quality of life, improve the subjective symptoms of the patient, and improve airway clearance. However evidence of effectiveness of OPEP therapy is lacking for non-stable patients with bronchiectasis who experience frequent exacerbations. Evidence is also lacking for bronchiectasis patients with higher viscosity secretions or rather thicker mucus. While there is scientific evidence that shows that OPEP devices prevent acute exacerbations in chronic obstructive pulmonary disease (COPD), evidence is lacking that OPEP devices prevent acute exacerbations in patients with bronchiectasis. The main draw back to OPEP devices for any patient is that the device performance is subjective to each particular OPEP device, each chosen device setting, as well as patient effort and cooperation and lastly the patient’s overall health picture.