Physiotherapy for airway clearance in adults

Abstract

Techniques for augmenting, when necessary, the normal mucociliary and cough clearance mechanisms of the lungs are not new, but, in more recent years, techniques have been developed which are effective, comfortable and can be used independent of an assistant in the majority of adolescents and adults.Postural drainage with chest clapping and chest shaking has, in most parts of the world, been replaced by the more effective techniques of the active cycle of breathing, autogenic drainage, R-C Cornet1, Flutter1, positive expiratory pressure mask, highfrequency chest wall oscillation and intrapulmonary percussive ventilation. Glossopharyngeal breathing is being considered again and is often a useful technique for increasing the effectiveness of cough in patients with tetraplegia or neuromuscular disorders.The evidence in support of these techniques is variable, and the literature is confusing and conflicting. There may or may not be significant differences among the techniques in the short or long term. Many of the regimens now include the forced expiratory manoeuvre of a "huff" and this has probably increased the effectiveness of airway clearance. If objective differences are small, individual preferences and cultural influences may be significant in increasing adherence to treatment and in the selection of an appropriate regimen or regimens for an individual patient.

Influência da variação dos decúbitos laterais na deposição pulmonar de aerossol

“…There are few published studies on the effectiveness of PD for such clearance, and evidence about its effectiveness is still inconclusive as a standalone technique [24][25][26][27][28] . Lannefors and Wollmer 30 analyzed mucociliary clearance by means of scintigraphic analysis in nine patients with cystic fibrosis and compared three techniques of respiratory physical therapy: PD, positive expiratory pressure (PEP) and physical exercise.…”

“…Recent studies have linked the benefits of PD to an association with other techniques 24,[26][27][28][29][30] .…”

“…However, it has been replaced by new techniques such as autogenic drainage, active cycle of breathing technique, PEP -mask ® , FLUTTER ® , total slow expiration with the glottis open in a lateral posture (ELTGOL) and exercises with inspiratory controlled flow (EDIC), etc. [24][25][26][27][28] .…”

“…These therapeutic resources are frequently associated with other bronchial hygiene techniques, which has tended to obfuscate their specific role [24][25][26][27][28] .…”

A pilot study comparing two physiotherapy techniques in patietnts with cystic fibrosis

“…The flutter thus combines the techniques of positive expiratory pressure (PEP) with high frequency oscillations. The oscillating PEP prevents airway collapse and mucus clearance is enhanced by the vibrations and intermittent airflow accelerations produced by the movement of the ball (Prasad 1998;Pryor 1999). Pryor et al (1991) renamed the forced expiratory technique (FET) the active cycle of breathing technique.…”