![]() Make sure a health care provider, often a Respiratory Therapist, experienced in the use of the device shows you how to use it. Correct technique using these devices is very important. Postural drainage and clapping use gravity to promote drainage of mucus from the lungs.Įach technique can be prescribed by your health care provider. Once the mucus is dislodged, the device can help clear the mucus. ![]() Sometimes the Aerobika® or Acapella® is used after the inflatable vest. The vest shakes your chest to help dislodge the mucus from the airway walls. High-frequency chest wall oscillation vests: These include The Vest® and the SmartVest® and AffloVest ® and are inflatable vests that you put on. These are small devices you inhale and/or exhale into. Oscillating positive expiratory pressure devices (OPEPD): These include devices such as the Aerobika ®, Acapella ® or the Flutter Valve ® that help clear mucus from your lungs. Common strengths of hypertonic saline are 3% and 7% and are generally used once or twice daily and are administered with a nebulizer.Īirway clearance measures are treatments designed to clear trapped mucus from the airways. Inhaled hypertonic saline may be used to loosen airway mucus for easier clearance. Inhaled Steroid and Long-Acting Bronchodilator CombinationsĬommon combinations of inhaled steroid and long-acting bronchodilator include: Inhaled steroids reduce and prevent swelling inside the airways. Utibron ® (indacaterol and glycopyrolate) LABA and LAMA are types of bronchodilators. Long-acting bronchodilators can be either LABAs (long-acting beta2 agonists) or LAMAs (long-acting muscarinic antogonists). Inhaled long-acting bronchodilators may also be used. ProAir RespiClick or HFA ®, Proventil ® HFA, Ventolin ® HFA (albuterol) Commonly used inhaled short-acting bronchodilators include: This type of medication is available in a number of inhaled forms. Inhaled Bronchodilators - An inhaled bronchodilator medication opens the airways by relaxing the smooth muscles around the airways. Your healthcare provider may recommend one or more of them depending on your individual needs. Inhaled medication (bronchodilator and/or inhaled steroid, saline) and/orĪirway clearance measures (oscillating positive expiratory pressure device, high-frequency chest wall oscillation vest). Improved clearance of mucus is the cornerstone of the management of bronchiectasis and includes several components. Your healthcare provider will evaluate your history and recommend the best management plan for you. Identifying the need for surgical resection of affected segments or lobes of the lung. Improving muscle strength and endurance through pulmonary rehabilitation and Treatment of associated conditions (such as GERD or sinusitis), Improving the clearance of sputum, also called airway clearance or bronchopulmonary hygiene, The ATS addresses smoking cessation ( ) in a separate guideline.-Michael J.The management of bronchiectasis is long-term and is directed at: Only the ATS discusses the use of opioid therapy for refractory dyspnea. All three organizations recommend long-term oxygen therapy in COPD when associated with severe resting hypoxia, and the ATS alone suggests consideration of ambulatory oxygen with severe exertional hypoxia. All three organizations note that exacerbation risk is further reduced by adding an ICS at the cost of increased pneumonia risk. Based on cost, ease of use, and clinical equivalence, LAMA monotherapy recommended by the VA/DoD may be the best starting point. The GOLD does not recommend any treatment order. The ATS recommendation is based on a comparison of combination LABA/LAMA therapy with either monotherapy, which overstates the benefits because LABA monotherapy, but not LAMA monotherapy, is inferior to the combination. Although all three note that combination LABA/LAMA therapy is superior to monotherapy, the ATS recommends combination LABA/LAMA use by all symptomatic patients with COPD, whereas the VA/DoD recommend starting with LAMA monotherapy. Department of Defense (VA/DoD) recommendations and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations that were included in the most recent AFP COPD review ( ). Department of Veterans Affairs and the U.S. The recommendations by the ATS are similar to those of the U.S.
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