Improving mucociliary clearance in chronic obstructive pulmonary disease

Abstract

Patients with COPD usually experience mucus hypersecretion as a result of airway inflammation and response to noxious stimuli. These in turn lead to worsening airway resistance, impaired airflow, increased work of breathing, dyspnoea and exercise intolerance. Mucus hypersecretion may also lead to increased exacerbations and poor health related quality of life (HRQL). Institution based pulmonary rehabilitation programs incorporating airway clearance techniques have been shown to improve HRQL, reduce dyspnoea and improve exercise tolerance but are often difficult to provide due to restricted accessibility and resource implications. This review examines the current evidence base and best clinical practice in the area of airway clearance. Mechanical devices such as the flutter valves, positive end expiratory pressure and high frequency chest wall oscillation (HFCWO) may be able to provide the benefits of improved airway clearance in the patient's home potentially with reduced demands on healthcare resources.

Utility of vest high frequency chest wall oscillation device versus flutter device in acute exacerbation of chronic obstructive pulmonary disease

“…The total CAT score was calculated by summing the points of each variable, the higher scores represent worse health. [8][9][10][11][12] It was classified into four categorizes; low (< 10), medium (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), high (21)(22)(23)(24)(25)(26)(27)(28)(29)(30) and very high (> 30). (FEV1% pred = predicted amount as a percentage of the forced expiratory lung volume in one second; 6MWD = six minute walking distance; MMRC = modified medical research council dyspnea scale; BMI = body mass index.…”

“…During expiration through the Flutter, the expiratory flow move the steel ball up and down, creating PEP and oscillations with a back transmission to the patient, to facilitate mucus expectoration. 24,25 The patients placed in erect positions; in a well-supported chair with a neutral lumbar spine to enhances the function of the diaphragm and the pelvic floor, minimizes musculoskeletal stress and to ensure the best transmission of vibration to chest wall. 26 They were instructed to inhale deeply and hold his/her breathe for 2-3 second, then expire slowly through the Flutter valve, which cause oscillations of the steel ball inside the cone of the Flutter.…”

Nasal Mucociliary Clearance in Subjects With COPD After Smoking Cessation

“…The STT of smokers with COPD (16.5 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] [6 -16] min) (P Ͻ .001). There was no difference in STT values between smokers with COPD and current smokers, and these values in ex-smokers with COPD were similar to those for the control group (Fig.…”

“…12 Studies have shown that the impairment of MCC in smokers was related to the intensity of the smoking habit 13 and that smoking cessation improved nasal MCC by 15 d after quitting smoking and that the improvement persisted over 6 months. 14 Some studies found modified mucociliary function in subjects with COPD, 15,16 and ciliary beat frequency was markedly lower in these subjects. 17 It is known that smoking cessation reduces the decline in FEV 1 , respiratory symptoms, and airway inflammation and that it improves longterm prognosis.…”

Dinámica y patología del barrido mucociliar como mecanismo defensivo del pulmón y alternativas farmacológicas de tratamiento

“…EPOC se caracteriza por obstrucción crónica del flujo espiratorio manifestada clínicamente como bronquitis crónica con o sin enfisema, fibrosis, daño de tejido e inflamación de la vía aérea pequeña 39 . Su principal causa es el tabaquismo 40 .…”