Humidification as an adjunct to chest physiotherapy in aiding tracheo-bronchial clearance in patients with bronchiectasis

Conway, Joy; Fleming, John; Perring, S.; Holgate, S. T.

doi:10.1016/s0954-6111(06)80225-8

Cited by 51 publications

(26 citation statements)

References 14 publications

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“…Humidification has been shown to increase the clearance of sputum when used as an adjunct to physiotherapy in patients with bronchiectasis [86] and this is supported by a review of the literature [87].…”

Section: Humidification Hypertonic Saline and Dornase Alfamentioning

confidence: 87%

Physiotherapy for airway clearance in adults

1999

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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of adolescents and adults.Postural drainage with chest clapping and chest shaking has, in most parts of the world, been replaced by the more effective techniques of the active cycle of breathing, autogenic drainage, R-C Cornet1, Flutter1, positive expiratory pressure mask, highfrequency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.

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Section: Humidification Hypertonic Saline and Dornase Alfamentioning

confidence: 87%

Physiotherapy for airway clearance in adults

1999

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“…Moreover, all infants studied have a sufficient production of pharyngeal secretion with isotonic saline. On the other hand, humidification of the airways using isotonic saline significantly increases tracheobronchial clearance in patients with bronchial hypersecretion [20]. Nebulization of isotonic saline is a common supportive treatment for viral acute wheezing episodes [1].…”

Section: Discussionmentioning

confidence: 99%

Cells and mediators from pharyngeal secretions in infants with acute wheezing episodes

Counil

Lebel²,

Segondy³

et al. 1997

Eur Respir J

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An acute wheezing episode is the most common feature of severe lower respiratory tract infection during infancy. Respiratory syncytial virus (RSV) is the major causative agent.In order to study inflammation during acute wheezing episodes in infants, we wanted to assess the feasibility and contribution of induction of pharyngeal secretions.We therefore compared inflammatory markers in the pharyngeal secretions of 27 infants suffering from acute wheezing episodes with an RSV infection (RSV+) and 18 infants suffering with acute wheezing episodes without RSV infection (RSV-). Pharyngeal secretions were recovered by physiotherapy using isotonic saline. The safety of the procedure was carefully checked. Pharyngeal secretions were homogenized with dithiothreitol. Total cells and eosinophils were counted and levels of eosinophil cationic protein (ECP) and histamine were measured.Induction of pharyngeal secretion was always well tolerated. Eosinophils were present in five RSV+ and seven RSV-patients. ECP levels were not significantly different between the groups. Histamine levels after protein adjustment were significantly increased in RSV+ patients (p<0.01) in comparison to RSV-patients.In this study, we have shown, that pharyngeal secretion can be safely recovered from infants suffering from acute wheezing episodes, and that it can be analysed for enumeration of inflammatory cells and measurement of inflammatory mediators. Eur Respir J 1997; 10: 2591-2595 An acute wheezing episode is the most common severe lower respiratory tract infection in infancy. During epidemics, over 80% of cases may be caused by a respiratory syncytial viral (RSV) infection [1]. Although symptoms may become severe, most infections are selflimited, and improvement usually occurs within several days [2,3]. Approximately 2% of infants under 2 yrs of age require hospitalization [4]. In severe acute wheezing episodes, necrosis of the respiratory epithelium, excessive production of mucus, and lymphocytic infiltration result in oedema, dense plugs of debris and subsequent bronchiolar obstruction. The role of eosinophil activation in RSV infection needs to be clarified. It has been observed that nasal or pharyngeal secretions recovered from infants suffering from RSV infection have increased eosinophil cationic protein (ECP) levels. A correlation between ECP levels and severity was noted in one study [5], but ECP levels were found to be similar to those of healthy infants in two other studies [6,7]. However, no study has yet examined inflammatory markers in the pharyngeal secretions of infants.A study was carried out during a viral infection episode in 45 infants suffering from acute wheezing episodes requiring hospitalization, and pharyngeal secretions were recovered by physiotherapy. The safety of the procedure was carefully monitored. Inflammatory cells were counted and inflammatory markers were measured in order to differentiate inflammation in infants suffering from acute wheezing episodes with RSV infection (RSV+) or without RSV infecti...

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“…One study on the use of nebulized water in bronchiectasis, as an adjunct to postural drainage, suggested that clearance was improved, but no attempt was made to distinguish ciliary from cough clearance [15]. Water inhalation, like hypertonic saline, is an irritant and could increase clearance by provoking cough.…”

Section: Discussionmentioning

confidence: 99%

Mucus transportability: the bovine trachea and frog palate models compared

Wills

Pritchard²,

Cole³

1998

Eur Respir J

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The mammalian airway surface forms a major interface between the individual and the environment. The mucociliary escalator is an important defence against unwanted airborne substances. Mucus with entrapped material is conveyed by the cilia towards the pharynx, where it is normally eliminated by swallowing.In conditions characterized by sputum production, such as acute respiratory infections, chronic bronchitis and bronchiectasis, including cystic fibrosis (CF), mucociliary clearance is delayed [1]. The abnormally prolonged retention of infected mucus in the airways is arguably a major cause of the chronic inflammatory damage seen in these chronic conditions [2].Efficient mucociliary clearance requires that both the cilia and the mucus function optimally. Ciliary damage accounts in part for the mucus retention in these diseases [2], but the continuing efforts to discover effective mucoactive drugs testify to the hope that it may be possible to alter the mucus so that it is expelled more easily.The ability of mucus to be cleared efficiently by cilia can be measured ex vivo using explants of ciliated tissue depleted of endogenous mucus. Traditionally, the frog palate has been used for this purpose in numerous studies of respiratory mucus and other gels [3]. The authors have recently developed a model with the same scope, but using the bovine trachea. With this system two interesting observations were made that had not been reported with the frog palate model. Firstly, sputum from patients with bronchiectasis, CF and chronic bronchitis was transported more slowly than mucus obtained from healthy human and animal lungs [4,5]. Secondly, increasing the hydration of sputum markedly impaired its transportability, whereas increasing its osmolality by adding sodium chloride or removing water by evaporation caused its ciliary transportability to increase [6]. These observations may have particular relevance in the pathogenesis of CF, because in this illness an epithelial defect in sodium and chloride transport results in life-shortening chronic bronchial infection [7].It might be expected that if the bovine trachea model yielded results different from the frog palate, it would better reflect the properties of respiratory mucus that lead to its efficient expulsion from the human lung. It is a mammalian respiratory system, faced with the same task as the human airway. In contrast, the frog palate is an amphibian digestive system, which functions mainly to trap and help to ingest flies and other particles of food. Mucociliary transport in the frog palate is in a caudal direction, whereas it is cranial in the mammalian trachea. Therefore, a comparison of these models was undertaken, examining the transportability of samples of sputum and healthy lung mucus on both systems. An investigation was made of the effect on ciliary transportability of inspissating sputum by evaporation of water and of directly altering its salinity. The effect of altered salinity on the beat frequency of frog palate cilia was measured, as it had been pr...

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Humidification as an adjunct to chest physiotherapy in aiding tracheo-bronchial clearance in patients with bronchiectasis

Cited by 51 publications

References 14 publications

Physiotherapy for airway clearance in adults

Physiotherapy for airway clearance in adults

Cells and mediators from pharyngeal secretions in infants with acute wheezing episodes

Mucus transportability: the bovine trachea and frog palate models compared

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