Improving mucociliary clearance in chronic obstructive pulmonary disease.
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.
Bhowmik
Angshu
A
Department of Respiratory Medicine, Homerton University Hospital NHS Foundation Trust, London, UK.
Chahal
Kamaljeet
K
Austin
Gillian
G
Chakravorty
Indranil
I
D004234:Diuretics, Osmotic / Q000627:therapeutic use; D005081:Exercise Therapy; D005100:Expectorants / Q000627:therapeutic use; D006612:High-Frequency Ventilation / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008353:Mannitol / Q000627:therapeutic use; D009079:Mucociliary Clearance; D026741:Physical Therapy Modalities / Q000295:instrumentation; D011175:Positive-Pressure Respiration / Q000295:instrumentation / Q000379:methods; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*; D012462:Saline Solution, Hypertonic
D004234:Diuretics, Osmotic; D005100:Expectorants; D012462:Saline Solution, Hypertonic; D008353:Mannitol