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How Does Mucociliary Clearance Work – Mucus Clearance and Removal

How Does Mucociliary Clearance Work (Mucus Clearance and Removal through Cilia movement)

The respiratory tract is exposed daily to viral and bacterial pathogens, particulates and gaseous material with constant threat of airway inflammation and infection (Bustamante-Marin & Ostrowski, 2017). The respiratory system uses several defense mechanisms against inhaled pathogens and particulates including cough clearance, anatomical barriers, aerodynamic changes and immune mechanisms, but the first line of defense of the lungs is the mucociliary clearance (MCC; Bustamante-Marin & Ostrowski, 2017). The MCC is composed of airway surface layer (ASL) and hair-like structures called cilia. The ASL has two components—a layer of mucus that traps inhaled foreign particulates and pathogens and a low viscosity periciliary layer (PCL) that maintains moisture of the airway surfaces and promotes rhythmic ciliary beating for efficient mucus clearance (Bustamante-Marin & Ostrowski, 2017). In health, the synchronized rhythmic beating of cilia continuously transports the mucus with the foreign particulates and/or pathogen towards the pharynx where it is either swallowed or expectorated (Jing et al., 2017). Abnormal function of the cilia may lead to poor MCC, which is associated with various respiratory diseases, such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, sinusitis and chronic respiratory infections (Jing et al., 2017).

 

 

The Anatomy and Physiology Related to Mucociliary Clearance (Mucus Clearance and Removal through Cilia movement)

 

 

The respiratory system is divided into the upper respiratory tract or upper airway

Schematic representation of the airway epithelium
Schematic representation of the airway epithelium (Bustamante-Marin & Ostrowski, 2017).

and the lower respiratory tract or lower airway. The upper airway includes the nose and nasal passages, paranasal sinuses, the oral cavity, the pharynx, and the portion of the larynx above the vocal cords, while the lower airway is further divided into conducting zone and respiratory zone. The conducting zone is formed by the portion of the larynx below the vocal cords, trachea, and within the lungs, the bronchi, bronchioles, and the respiratory zone is formed by the respiratory bronchioles, alveolar ducts, and alveoli. The percentage of airway ciliated cells increases from about 47% in trachea to 73% in the small airway epithelium (respiratory bronchioles) (Tilley et al., 2015).

 

Cilia are present on epithelial cells lining the respiratory tract (Munkholm & Mortensen, 2014). Cilia are motile hair-like projections that are approximately 6µm long and 250 nm in diameter (Munkholm & Mortensen, 2014). The airway cilia beat in a coordinated fashion at low frequency (10-20 Hz) that results in metachronal waves (Bustamante-Marin & Ostrowski, 2017; Tilley et al., 2015). The waves travel across the epithelium pushing the overlying mucus upward towards the pharynx to be swallowed (Bustamante-Marin & Ostrowski, 2017).

 

Aside from the ciliated cells, secretory cells are present in the airways that generate a deformable gel, known as mucus (Munkholm & Mortensen, 2014). In healthy airways, the mucus is lifted away from the cilia by the PCL, which is a low-viscosity periciliary liquid layer that prevents the mucus from adhering to the epithelial apical membrane, allowing the cilia to beat rapidly (Munkholm & Mortensen, 2014).

 

The respiratory system starts to form around the fourth week of gestation wherein the endoderm forms the epithelium and glands of the larynx, trachea, bronchi, and pulmonary lining epithelium (Bustamante-Marin & Ostrowski, 2017). After birth, the alveoli increase in number to reach the adult range of 300 million by 2 years of age (Bustamante-Marin & Ostrowski, 2017). The airway, on the other hand, does not increase in number, and the airway ciliated cells are incapable of self-renewal (Bustamante-Marin & Ostrowski, 2017; Tilley et al., 2015).

 

 

Adverse Effects of Smoking on Mucociliary Clearance (Mucus Clearance and Removal through Cilia movement)

 

Smokers are at increased risk of respiratory diseases, such as respiratory tract

Adverse Effects of Smoking on Mucociliary Clearance (Mucus Clearance and Removal through Cilia)
Adverse Effects of Smoking on Mucociliary Clearance (Mucus Clearance and Removal via Cilia)

infections and COPD. Several studies demonstrated that cigarette smoke causes inefficient MCC mechanism secondary to the following:

  1. Reduced cilia beat frequency
  2. Disruption of metachronal waves
  3. Decreased number of ciliated cells
  4. Changes in cilia structure, such as fused cilia and shorter cilia length (Leopold et al., 2009).

 

Decreased in numbers of ciliated cells, reduced cilia beat frequency and changes in intercellular coordination of the metachronal waves are associated with the smoking-related decrease in MCC efficiency (Leopold et al., 2009). The cilia height of smokers is found to be 10% shorter than nonsmokers (Leopold et al., 2009). The ASL height is constant, but the cilia height in smokers is reduced, decreasing the interaction between cilia and mucus on the forward stroke (Leopold et al., 2009). These mechanisms contribute to the smoking-induced MCC dysfunction.

 

 

Adverse Effects of Air Pollution on Mucociliary Clearance (Mucus Clearance and Removal through Cilia movement)

 

 

Several studies have shown a strong link between air pollutants and chronic

Relative fraction of multiciliated cells in embryonic trachea (Crotta et al., 2016)
Relative fraction of multiciliated cells in embryonic trachea (Crotta et al., 2016)

respiratory diseases. Exposure to air pollutants impair formation of new cilia. A recent study showed that air pollutants, such as vehicle exhaust and occupational dusts, contain toxicological agonists that bind with aryl hydrocarbon receptor (AhR; Crotta et al., 2016). AhR functions as a transcription factor that is required for formation of multiciliated cells and detoxification (Crotta et al., 2016). The presence of air pollutants in the airways triggers AhR to divert its focus away from forming new cilia to initiate a detoxification process (Crotta et al., 2016). The diversion of AhR impairs the formation of new cilia, leading to a reduction of the number of cilia in the airway epithelium (Crotta et al., 2016). Lesser number of cilia leads to inefficient mucociliary clearance of pathogens and particles from the airways, resulting in respiratory diseases (Crotta et al., 2016). It is most likely that young infants are subjected to the effects of impaired AhR-mediated ciliogenesis, as this dysregulation predominantly occurs during the early phase of development (Crotta et al., 2016).

 

Cilia Dysfunction in Primary Ciliary Dyskinesia

 

Primary Ciliary Dyskinesia (PCD) is an autosomal recessive disorder of motile cilia. Patients with PCD have ciliary motility but ineffective MCC (Tilley et al., 2015). PCD is associated with reduced cilia beat frequency and dyskinetic cilia wave form, contributing to ineffective MCC (Tilley et al., 2015). The clinical manifestations of PCD include nasal congestion, chronic sinusitis, recurrent lower respiratory tract infection, bronchiectasis, neonatal respiratory disorders in newborns, chronic otitis media, transient hearing loss/speech delays, male infertility, and defects in organ laterality (50% of cases) (Tilley et al., 2015). Respiratory diseases in PCD are caused by defective MCC and worsen over time secondary to repeated respiratory tract infections (Tilley et al., 2015).

 

 

OPEP Assisted Mucociliary Clearance (Mucus Clearance and Removal through Cilia movement)

 

Any deficiency in the mechanism of mucociliary clearance is associated with respiratory diseases, such as COPD, cystic fibrosis, sinusitis, bronchiectasis and chronic respiratory tract infections. Use of therapeutic techniques that would help enhance MCC function is beneficial to patients with respiratory diseases, smokers, and individuals who are chronically exposed to air pollution.

 

AirPhysio® device is a handheld device that utilizes Oscillating positive expiratory pressure (OPEP) therapy, which effectively enhances MCC function and clears airway secretions in individuals with respiratory diseases, as well as in smokers and those with prolonged exposure to air pollution. OPEP reduces mucus viscoelasticity and makes mobilization of mucus up the airways easier to be either swallowed or coughed out (Myers, 2007). AirPhysio® reduces mucus accumulation in the airways, which may help improve lung function and health-related quality of life.

AirPhysio® Oscillating Positive Expiratory Device.
AirPhysio® Oscillating Positive Expiratory Device.

 

References

Bustamante-Marin, X. M. & Ostrowski, L. E. (2017). Cilia and mucociliary clearance. Cold Spring Harbor Perspective in Biology, 9(4), 1-17. doi:10.1101/cshperspect.a028241

Crotta, S., Ahlfors, H., Dingwell, K., & Smith, J. C. (2016). The aryl hydrocarbon receptor controls cyclin O to promote epithelial multiciliogenesis. Nature Communications, 1-11. doi:10.1038/ncomms12652

Jing, J. C., Chen, J. J., Chou, L., Wong, B. J. F., & Chen, Z. (2017). Visualization and detection of ciliary beating pattern and frequency in the upper airway using phase resolved Doppler optical coherence tomography. Scientific Reports, 7(8522), 1-11. doi:10.1038/s41598-017-08968-x

Leopold, P. L., O’Mahony, M. J., Lian, X. J., Tilley, A. E., Harvey, B., & Crystal, R. G. (2009). Smoking is associated with shortened airway cilia. PLoS ONE, 4(12), 1-11. doi:10.1371/journal.pone.0008157

Munkholm, M., & Mortensen, J. (2014). Mucociliary clearance: pathophysiological aspects. Clinical Physiology and Functional Imaging, 34, 171-177. doi:10.1111/cpf.12085

Myers, T. (2007). Positive expiratory pressure and oscillatory positive expiratory pressure therapies. Respiratory Care, 52(10), 1308-1327.

Tilley, A. E., Walters, M. S., Shaykhiev, R., & Crystal, R. G. (2015). Cilia dysfunction in lung disease. Annual Review of Physiology, 77, 379-406. doi:10.1146/annurev-physiol-021014-071931

AirPhysio Winner of Optus MyBusiness Start-up Business of the Year Award

AirPhysio Winner of Optus MyBusiness Start-up Business of the Year 2017

After being named one of the Finalist in the Optus MyBusiness Awards Start-up Business of the Year, AirPhysio waited for the Awards night on the 10th November 2017 in Sydney.

We were on the edge of our seats as we waited for each of the finalists to be called, but to hear AirPhysio’s name being called as the winner was amazing and we all felt honoured to be apart of the awards.

AirPhysio Announced as Optus MyBusiness Start-up of the Year
AirPhysio Announced as Optus MyBusiness Start-up of the Year

The surprise happened at the end of the night when they started announcing the Business of the Year Award which was the big award for the night and the first name which came up was AirPhysio.

AirPhysio Announced as a Finalist in Optus My Business Business of the Year Award
AirPhysio Announced as a Finalist in Optus My Business Business of the Year Award

AirPhysio, which was also named one of ten national finalists for the Business of the Year award earlier this month, aims to improve lung expansion and mucus with a specially designed clearance device that helps to clear the airways of asthma sufferers.

AirPhysio helps improve lung expansion and mucus with a specially designed clearance device that helps to clear the airways of asthma and COPD (Chronic Obstructive Pulmonary Disease) sufferers.

AirPhysio has a vision of helping to educate sufferers of respiratory conditions to help them improve their lifestyle and quality of life through education and the use of the AirPhysio all natural Oscillating Positive Expiratory Pressure (OPEP) device.

AirPhysio Team with Start-up Business of the Year Finalist and Winning Optus MyBusiness Trophy's
AirPhysio Team with Start-up Business of the Year Finalist and Winning Optus MyBusiness Trophy’s

AirPhysio Interviewed on US Health Radio about New all Natural treatment for Asthma, COPD, Emphysema, Chronic Bronchitis, Bronchiectasis and Cystic Fibrosis

AirPhysio is a new all Natural Treatment for Asthma, COPD, Emphysema, Chronic Bronchitis, Bronchiectasis and Cystic Fibrosis. The device uses a process called Oscillating Positive Expiratory Pressure or OPEP.  This process helps the body’s natural mucus clearance process and Lung Expansion, helping to maintain maximum lung capacity and improve lung hygiene.

On the 26th April 2017, Eric Michaels from eHealth Radio and Respiratory Channels in the US interviewed Paul O’Brien, the Managing Director of AirPhysio about the respiratory system, how it it works and what goes wrong with the lungs when we are diagnosed with respiratory conditions like Asthma, COPD and Cystic Fibrosis.

Listen to interview with host Eric Michaels and guest Paul O’Brien discuss the following:

  • What are some of the respiratory conditions with similar issues?
  • What is a basic description of each condition and how do they differentiate between each other?
  • What is one of the biggest problems that one would suffer from?
  • How does current medication treat these conditions?
  • What is the Body’s Natural Lung Cleaning Process?
  • If I’m taking medication, why would I need anything else?
  • What is AirPhysio and how does this help someone with a respiratory condition?

To view the information about the Interview go to the website

AirPhysio Interviewed on US Health Radio about New all Natural treatment for Asthma, COPD, Emphysema, Chronic Bronchitis, Bronchiectasis and Cystic Fibrosis
AirPhysio Interviewed on US Health Radio about New all Natural treatment for Asthma, COPD, Emphysema, Chronic Bronchitis, Bronchiectasis and Cystic Fibrosis

 

AirPhysio Finalist Optus My Business Awards

Optus MyBusiness AwardAirPhysio only started 2 years ago as a home based business and has now been shortlisted for the prestigious Optus My Business awards in the start-up business category. The winner being announced in November this year in Sydney and it is humbling to be recognised for such a long running and prestigious awards among 1,000’s of other entrants.

2017 Optus My Business Awards Finalist List

The Optus My Business Awards, is the premier event of the year for SMEs.

The Optus My Business Awards, which covers 28 categories, acknowledges best practice within a particular industry sector, as well as individual business leaders, excellence in customer service and achievements in innovation, corporate social responsibility and workplace culture.

Winners from all categories will be automatically shortlisted for the highly coveted Business of the Year Award.

Adam Zuchetti, editor of My Business, said Australian SMEs are at the leading edge of innovation and customer service excellence, as represented by this year’s Optus My Business Awards finalists.

Mr Zuchetti said “My Business is extremely proud to showcase those companies and their leaders that are thriving by pushing the boundaries and challenging the status quo across a diverse spectrum of industries.”

“Determining this year’s finalists was no easy feat, with our selection panel working through an outstanding calibre of entries and the highest submission rate for the awards to date.

He added: “On behalf of the My Business team, I would like to congratulate all of this year’s finalists and wish them the best of luck for the big night”

Paul O’Brien, Managing Director at AirPhysio Pty Ltd said he was humbled by the nomination.

“AirPhysio’s recognition for its excellent contribution to the regional community reinforces the strength of the brand in connecting with the community and engaging with its customers,” he added.

The winners will be announced at a black tie awards dinner on Friday, 10 November at The Westin Sydney.

AirPhysio started 2 years ago as a dream to create and Oscillating Positive Expiratory Pressure OPEP device to help as many people as possible with respiratory conditions like Asthma, COPD, Cystic Fibrosis  and Bronchiectasis and now we have started exporting to 7 countries around the world.

Please see last year’s awards highlights.

[embedyt] http://www.youtube.com/watch?v=l2nWQXweIow[/embedyt]

 

AirPhysio Attends China’s Largest International Trade and Event Expo

AirPhysio attended the 2017 China International Fair for Investment and Trade (CIFIT) from Sept 18 to 21 in Xiamen, Fujian province of China. The event was a great success with alot of interest received from our product, including interest from over 25 potential distributors and multiple media and TV interviews from journalists.

 

China has some major issues with Asthma and COPD (Emphysema and Chronic Bronchitis), ranging in the millions of people and AirPhysio intends on helping these people to help manage and treat their conditions to help improve their lifestyles.

We were on the Australia National Pavilion with a number of other Australian companies.

Australian National Pavilion at CIFIT
Australian National Pavilion at China International Fair for Investment and Trade (CIFIT)

CIFIT is currently China’s only international investment promotion event aimed at facilitating bilateral investment. It’s also the largest global investment event approved by the Global Association of the Exhibition industry. The event has the following major components: investment and trade exhibition, the International Investment Forum (IIF), a series of seminars on hot investment issues, and investment project matchmaking symposia.

AirPhysio TV Interviews at China International Fair for Investment and Trade (CIFIT)
AirPhysio TV Interviews at China International Fair for Investment and Trade (CIFIT)

CIFIT not only comprehensively showcases the investment environments, policies, projects and corporate products in all provinces, autonomous regions and municipalities t in China, but also attracts investment promotion agencies from more than 40 countries and regions.  CIFIT offers optimum opportunity for business people at home and abroad to get an overview on the investment climates in China and other countries. It also provides them with the one-stop shopping service for multilateral investment cooperation, helping them to select from the widest range of investment projects and business partners.

AirPhysio Stand at International Fair for Investment and Trade (CIFIT)
AirPhysio TV Interviews at China AirPhysio Stand at International Fair for Investment and Trade (CIFIT)

In response to the adjustments of the world’s industrial structure and in view of the emerging trends, challenges and opportunities in international investment cooperation, CIFIT carries out China’s latest national development agenda, implementing strategies for coordinated development of regional economies, and promoting bilateral and multilateral economic exchanges and partnerships. CIFIT is poised to become the world’s most prestigious international investment exposition.

CIFIT Numbers

IFIT’s Global co-sponsors include World Trade Organization, UN Conference on Trade and Development (UNCTAD), United Nations Industrial Development Organization (UNIDO), the Organization for Economic Cooperation and Development (OECD), International Finance Organization (IFO) and World Association of Investment Promotion Agencies (WAIPA)

[embedyt] http://www.youtube.com/watch?v=DCUU8PoW8LM[/embedyt]

China International Fair for Investment and Trade (CIFIT) from the Outside
China International Fair for Investment and Trade (CIFIT) from the Outside

AirPhysio Crowd Funding Campaign

AirPhysio’s a Mucus Clearance and Lung Expansion device, which helps people suffering from conditions like Asthma. We’re working with associations to help send these life changing devices to the people who need them and would like your help to do this. Over 250 million people suffer just from Asthma.

This device has helped many people with respiratory conditions, and we are asking others to help us so we can help more people!

AirPhysio is already in talks with a number of Associations to work on donating devices to their members and community programs and AirPhysio is taking on the world hoping to help people to breathe easier, simply and naturally!

Please see how just 1 device has changed a child’s life, imagine what 1,000 devices can do.

Varley Frazer

My son Jet gets chronic asthma and became dependent on asthma medication, to the point where as soon as he stopped the medicine he would start getting a chest cold. Through winter he is the first one to get a cold and since his asthma started, he has never finished a cross country or any sporting events without an asthma attack and the need for a puffer.

Jet started using AirPhysio for the first time only a couple of months ago, but the results have been amazing. Not only has he not had a cold or flu so far this winter (which is an accomplishment in itself), but since starting to use the device, Jet not only finished his first cross country without an asthma attack, but he actually made it to district as well as weekly football and daily surfing.

I love this device, my son has managed to kick his dependency on medicines and he is improving his fitness. Now if only I could get him to use it every day I’d be happy.

Varley Frazer
NSW North Coast, Australia

[embedyt] http://www.youtube.com/watch?v=AEs1IiICFYc[/embedyt]

AirPhysio Awards
AirPhysio Awards

Help us to assist in helping to improve lung health of so many people around the world.

Please help us to help others, every little bit helps!

Click on the following link and any donation is 1 step closer to helping someone else – https://www.indiegogo.com/projects/airphysio-for-naturally-better-breathing-health/ 

AirPhysio International Award Success at 2017 China Yiwu Spring Imported Commodities Fair

This was AirPhysio’s first international conference or exhibition and we were invited by
Global Vitamin4Less to attend the 2017 China Yiwu Spring Imported Commodities Fair with them on the EAUNZ stand between May 6-9, 2017.

2017 China Yiwu Fair Spring - Imported Commodities Fair
2017 China Yiwu Fair Spring – Imported Commodities Fair

Since it was launched in 1995 and approved by UFI, Yiwu Fair has become the third largest exhibition sponsored by the Chinese Ministry of Commerce, and was honoured as “Best Management Fairs in China”, “Best Outcome Exhibition”, “Top Ten Exhibitions in China”, “Best Fair sponsored by the Government” and “Mo

2017 China Yiwu Fair Spring - Imported Commodities Fair
2017 China Yiwu Fair Spring – Imported Commodities Fair

st Influential Brand Fairs”. So AirPhysio saw this as a great opportunity to showcase our respiratory therapy device and gain some valuable insight into the potential market and feedback on the device.

The theme of the exhibition was to ‘promote innovation and the sharing of global resources’. The Fair had a total of 2006 international standard booths, using an exhibition area of more than 50,000 square metres. It attracted more than 100 countries from five continents and 1512 local exhibitors.

Amount the huge array of Australian and international products on display at this year’s Yiwu Fair, AirPhysio offered something which was unique to the fair and to China.

This gained us a great deal of interest not only at the stand, but we were invited to present our product to an array of around 60+ potential distributors in the conference room and the response was overwhelming with between 5-10 distributors swamping us immediately after we had finished our presentation and returned to our seats.

AirPhysio Yiwu Best Product Award Presentation
AirPhysio Yiwu Best Product Award Presentation

When we returned to the stand after our presentation, we found a photographer taking photographs of our product and when asked, we found out that we had won the coveted “Best Product” award for the fair. This was followed up by a presentation and television interview at the end of the show, which sadly we were un able to attend as we were travelling to the airport to travel back to Australia.

We were speechless and found the experience to be beyond our belief that we had taken out the prestigious Best Product award over 3,518 exhibitors from over 100 countries, receiving an international award in our first exhibit outside of Australia.

 

Simplified AirPhysio Oscillating Positive Expiratory Pressure OPEP Device Validation Article

Normal Airway Clearance Process

 The conducting airways (Figure 1) of the respiratory system are lined with hairs, called cilia (Figure 2). Mucus generating goblet cells (Figure 2) produce a mucus film that sits on top of the cilia. The mucus is cleared by the cilia moving back and forth along the conducting airway [called the mucociliary escalator], this action moves the mucus from the smaller peripheral airways to the larger central airways. From these larger airways, mucus and any trapped inhaled particles (i.e. smoke, pollen, pollution, etc…) or bacteria can be cleared, typically using a forced expiratory technique such as a cough or huff.

What Happens with Respiratory Conditions?

Typically, with many lungs diseases, the body creates an excess of mucus secretions.

 

asthma-mucus
Figure 2 – Cilia, Mucus and Goblet Cell


Asthma
– with Asthma (especially Bronchial Asthma, Figure 3), when the airways become hypersensitive from triggers in the air, they can become inflamed and narrow, which also leads to an excess of mucus secretion, which makes it harder for the body to clear naturally.A basic understand of some lung conditions are as follows:

asthma-mucus
Figure 3 – Normal Airway vs Bronchial Asthma Inflamed Airway
  1. Figure 4 – Cystic FibrosisCystic Fibrosis – The body creates an over-supply of ‘sticky’ mucus secretions which are difficult for the body to remove from the airways naturally. (Figure 4)
  1. Chronic Obstructive Pulmonary Disease (COPD) (Figure 5)

Chronic Bronchitis – The airways are continually inflamed and produce mucus, which may lead to the cilia (hairs) becoming damaged from smoke, pollution and irritants, degrading the mucociliary escalator and making it harder to remove mucus secretions.

Emphysema – The smoke and pollution cause the alveoli air sac membranes to break down and be coated with carbon deposits. This causes inflammation and mucus secretions in the air sacs, reducing gas transfer. This makes it harder for the lungs to expel due to the absence of the mucociliary escalator in this section of the lungs.

Figure 5 – COPD (Chronic Bronchitis and Emphysema)

  1. Bronchiectasis –The airway walls are damaged, creating pockets for the mucus to be trapped in and thus also degrading the mucociliary escalator and making it harder to remove secretions. (Figure 6)

Figure 6 – Bronchiectasis

How does Airway Clearance Help Lung Disease?

For lung diseases that result in excess secretions, airway clearance techniques and devices are considered to be essential for optimising respiratory status and reducing disease progression [1].

 

There are a number of airway clearance techniques and devices including postural drainage, percussion, breathing exercises and positive expiratory pressure (PEP).

 

How Do Airway Clearance Techniques and Devices Work?

 

Airway clearance techniques and devices apply external forces to the lungs and airways that manipulate lung volumes, pulmonary pressures and gas flow [2, 3], pushing excess mucus up and out of the smaller airways and into the larger airways, then into the throat to be cleared out of the body [2].

 

Positive expiratory pressure (PEP) devices can assist airway clearance in several ways.

 

  1. The addition of positive resistive pressure as the participant breathes out results in a longer expiration time, which in turn may increase expiratory capacity and a reduction in gas trapping [5].

 

  1. Moreover, it is proposed that PEP stabilises and splints the airways open [6] and increases the gas pressure behind excess mucus via collateral ventilation (Figure 7) resulting in a temporary increase in functional residual capacity (FRC) [7].

Figure 7 – Collateral Ventilation

  1. As the individual breathes through the PEP device, FRC (Functional Residual Capacity or the air present in the lungs at the end of passive expiration), is gradually increased [1]. By increasing the gas pressure behind the mucus, forced expiratory techniques may be more effective in moving excess secretions from the peripheral to central airways [1, 7].

 

Oscillating high frequency PEP (OPEP) devices combines both PEP and airway oscillation techniques.

 

AirPhysio OPEP Device

 

The AirPhysio device is a handheld pipe-like OPEP device which includes several original design features in the device including 3 different versions to allow for differing lung capacities and function.

Figure 8 – Oscillating air of AirPhysio

As the subject breathes out through the device, the ball moves up and down creating an opening and closing cycle as the stainless-steel ball is lifted off and then reseated on the cone throughout expiration [8]. These opening and closing cycles result in oscillations of endobronchial pressure (pressure in the airways to assist in expanding and opening up the airways) and expiratory airflow (air flowing out of the airways, reducing pressure in the lungs) which coincide with the opening and closing cycle of the ball being seated and lifted from the cone [8]. (Figure 8) It is hypothesised that these additional oscillations may enhance sputum clearance by decreasing the viscoelastic properties of sputum and improve clearance through the airways.

 

Recent Cochrane reviews in individuals with cystic fibrosis, bronchiectasis and following an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) suggest that airway clearance techniques are safe and may confer some benefit on clinical outcomes [1, 2, 9]. In AECOPD, there was a greater magnitude of the effect for PEP over non- PEP airway clearance techniques on the need for ventilatory assistance and hospital length of stay [2]. In a large randomised controlled trial comparing PEP with no airway clearance during a hospital stay for AECOPD, resting breathlessness improved more rapidly in the group allocated to PEP when compared control in the first 8 weeks following intervention.

 

The recently published Cochrane review by McIlwaine et al [1] examined the use of PEP devices in individuals with cystic fibrosis. Using outcomes such as changes in lung function, mucus cleared from the airways and quality of life, the authors reported that efficacy of PEP was similar to other forms of chest physiotherapy. Of note these authors compared the efficacy of PEP and OPEP and found similar results for both techniques.

 

An early study by Konstan and colleagues [8] described the efficacy of OPEP devices for airway clearance in 18 cystic fibrosis patients. The authors reported there were no adverse events with the device and that patients expelled significantly greater amounts of sputum (mucus) when compared to the airway clearance techniques of postural drainage and voluntary cough.

 

 

References

  1. Mcllwaine, M., B. Button, and K. Dwan, Positive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis. Cochrane Database Syst Rev, 2015(6): p. CD003147.
  2. Osadnik, C.R., C.F. McDonald, A.P. Jones, and A.E. Holland, Airway clearance techniques for chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 2012(3): p. CD008328.
  3. Pryor, J.A., Physiotherapy for airway clearance in adults. Eur Respir J, 1999. 14(6): p. 1418­24.
  4. Falk, M., M. Kelstrup, J.B. Andersen, T. Kinoshita, P. Falk, S. Stovring, and I. Gothgen, Improving the ketchup bottle method with positive expiratory pressure, PEP, in cystic fibrosis. Eur J Respir Dis, 1984. 65(6): p. 423-32.
  5. Osadnik, C.R., C.F. McDonald, and A.E. Holland, Advances in airway clearance technologies for chronic obstructive pulmonary disease. Expert Rev Respir Med, 2013. 7(6): p. 673-85.
  6. Oberwaldner, B., J.C. Evans, and M.S. Zach, Forced expirations against a variable resistance: a new chest physiotherapy method in cystic fibrosis. Pediatr Pulmonol, 1986. 2(6): p. 358-67.
  7. Myers, T.R., Positive expiratory pressure and oscillatory positive expiratory pressure therapies. Respir Care, 2007. 52(10): p. 1308-26; discussion 1327.
  8. Konstan, M.W., R.C. Stern, and C.F. Doershuk, Efficacy of the Flutter device for airway mucus clearance in patients with cystic fibrosis. J Pediatr, 1994. 124(5 Pt 1): p. 689-93.
  9. Lee, A.L., A.T. Burge, and A.E. Holland, Airway clearance techniques for bronchiectasis. Cochrane Database Syst Rev, 2015(11): p. CD008351.

PEP and OPEP Devices Improve Effectiveness of Aerosol Medication

Previously we had assumed that PEP and OPEP devices (like AirPhysio) would help improve the effectiveness and distribution of medication due to the fact that they clear mucus and lung expansion, allowing improved distribution of the aerosol medication and better access to the inflamed airways in the lungs.

airphysio-device_vibration-300

There are however 5 studies available which show the benefits of improved distribution and effectiveness of aerosol medication when combined with the use of PEP,  OPEP and Pressure Support devices.

The 5 medical studies include 4 different medical studies with the use of bronchiodilators and PEP devices, and 1 study with Pressure Support through different aerosol distribution methods:

  1. Effectiveness of a positive expiratory pressure device in conjunction with beta2-agonist nebulization therapy for bronchial asthma.
  2. Evaluation of lung function and deposition of aerosolized bronchodilators carried by heliox associated with positive expiratory pressure in stable asthmatics: A randomized clinical trial
  3. Treatment of bronchial asthma with terbutaline inhaled by conespacer combined with positive expiratory pressure mask.
  4. Inhaled beta 2-agonist and positive expiratory pressure in bronchial asthma. Influence on airway resistance and functional residual capacity.
  5. Optimization of aerosol deposition by pressure support in children with cystic fibrosis: an experimental and clinical study.

1. Effectiveness of a positive expiratory pressure device in conjunction with beta2-agonist nebulization therapy for bronchial asthma.images

This study assessed the effectiveness of a positive expiratory pressure (PEP) device on beta2-agonist (short term reliever) nebulization therapy by measuring the pulmonary function before and after nebulization therapy in 54 asthmatic patients.

The results show that the use of PEP device after beta2-agonist nebulization therapy improved pulmonary function compared with the use of beta2-agonist nebulization therapy alone, as shown by the increases in forced mid-expiratory flow and forced vital capacity (FVC).

Patients with forced expiratory volume in 1 sec (FEV1) below 85% FVC obtained a significant improvement in FEV1 and FVC after using the PEP device.

When the PEP device was used before beta2-agonist nebulization therapy, there were no obvious direct bronchodilative effects, but the use of PEP device after beta2-agonist therapy, showed significantly enhanced the bronchodilative effect of beta2-agonist therapy in patients with an FEV1 below 85% FVC.

Conclusion

The use of PEP device after the use of beta2-agonist shows a significant enhanced effect of bronchodilative effect in patients with an FEV1 below 85% FVC, over beta2-agonist therapy by itself.

It was put down as this outcome of the additional effect of the PEP device use in improving pulmonary function after beta2-agonist nebulization therapy might be a result of an enhancement in mucus clearance.

Abstract – https://www.ncbi.nlm.nih.gov/pubmed/11456366
Full Articlehttps://www.researchgate.net/publication/11886240_Effectiveness_of_a_positive_expiratory_pressure_device_in_conjunction_with_b2-agonist_nebulization_therapy_for_bronchial_asthma
https://www.pubfacts.com/detail/11456366/

2. Evaluation of lung function and deposition of aerosolized bronchodilators carried by heliox associated with positive expiratory pressure in stable asthmatics: A randomized clinical trialoxygen-therapy

This randomized, double blinded study was carried out to differentiate the effect of heliox (helium and oxygen) and oxygen with and without positive expiratory pressure (PEP), on delivery of radiotagged inhaled bronchodilators on pulmonary function and deposition in asthmatics.

They chose 32 patients between the ages of 18 and 65 years who were diagnosed with stable moderate to severe asthma, and they were randomly assigned into four groups: (1) Heliox + PEP (n = 6), (2) Oxygen + PEP (n = 6), (3) Heliox (n = 11) and (4) Oxygen without PEP (n = 9).

Both gas type and PEP level were blinded to the investigators. Images were acquired with a single-head scintillation camera with the longitudinal and transverse division of the right lung as regions of interest (ROIs).

While all groups responded to bronchodilators, only group 1 showed increase in Forced Expiratory Volume in 1 second (FEV1) %predicted and Inspiratory Capacity (IC) (the amount of air that can be inhaled after the end of a normal expiration) compared to the other groups (p < 0.04).

When evaluating the ROI in the vertical gradient we observed higher deposition in the middle and lower third in groups 1 (Heliox + PEP) (p = 0.02) and 2 (Oxygen + PEP) (p = 0.01) compared to group 3 (Heliox).

In the horizontal gradient, a higher deposition in the central region in groups 1 (Heliox + PEP) (p = 0.03) and 2 (Oxygen + PEP) (p = 0.02) compared to group 3 (Heliox) and intermediate region of group 2 (Oxygen + PEP) compared to group 3 (Heliox).

The increase in IC could be explained by the physical characteristics of heliox, which allows the formation of a less turbulent airflow, thereby generating more flow and time during expiration, leading to a reduction in dynamic hyperinflation and increase in IC. On the other hand, the use of PEP prevents airway collapse during expiration, decreases expiratory resistance, prolongs expiratory time and reduces the intrinsic positive end expiratory pressure (PEEPi),8 promoting an increase in IC.

A significant increase in FEV1 was observed in the heliox þ PEP group, which did not occur in other groups. Our findings can be correlated with those of Tsai et al.28 (document mentioned above) who assessed 54 stable asthmatic patients before and after nebulization with bronchodilators associated with PEPP and observed improvement with respect to FEV1, PEF, FVC, as well as improvement in mucociliary clearance.

Conclusion

They concluded that aerosol deposition was higher in groups with PEP independent of gas used (i.e. both oxygen and Heliox), while bronchodilator response with Heliox + PEP improved FEV1 % and IC compared to administration with Oxygen, Oxygen + PEP and Heliox alone.

Abstract – https://www.ncbi.nlm.nih.gov/pubmed/23664767

pdflogo
Evaluation of lung function and deposition of aerosolized bronchodilators carried by heliox associated with positive expiratory pressure in stable asthmatics: A randomized clinical trial

Full Article – http://www.resmedjournal.com/article/S0954-6111(13)00130-3/abstract

3.  Use of a Mucus Clearance Device (Flutter/OPEP Device) Enhances the Bronchodilator Response in Patients With Stable COPD*

Study objective: To determine whether the use of a mucus clearance device (Flutter OPEP device) could improve the bronchodilator response to inhaled ipratropium and salbutamol delivered by a metered-dose inhaler in patients with stable, severe COPD.

Patients: Twenty-three patients with severe COPD were studied. Mean +or- SD age was 71.7 +or- 6.3 years. Mean FEV1 was 0.74 +or- 0.28 L or 34.5 +or- 12.7% predicted.

Methods: Patients were tested in random order on 2 subsequent days after using an mucus clearance device or a sham mucus clearance device (ball bearing removed from device). A bronchodilator (four puffs; each puff delivering 20 ug of ipratropium bromide and 120 ug of salbutamol sulfate) was administered by metered-dose inhaler with a holding chamber after use of the mucus clearance device or sham mucus clearance device. Spirometry was performed before and after use of the mucus clearance device or sham mucus clearance device, and at 30 min, 60 min, and 120 min after the bronchodilator. Six-minute walk distance was tested between 30 min and 60 min; oxygen saturation, pulse, and a dyspnea score were recorded before and after walking.

Results: Immediately after use of the mucus clearance device, but not the sham mucus clearance device, there was a statistically significant (p < 0.05) improvement in FEV1 and FVC (11 +or-  24% vs 1 +or-  7% and 18 +or-  33% vs 6 +or-  18%, respectively). Whether patients were pretreated with the mucus clearance device or sham mucus clearance device, there was a significant improvement in FEV1 and FVC compared to baseline with combined bronchodilator therapy. At 120 min, the change in FEV1 after treatment with the mucus clearance device was greater than with the sham mucus clearance device (186 +or-  110 mL vs 130 +or-  120 mL; p < 0.05). When comparing the mucus clearance device to the sham mucus clearance device, 6-min walk distance was greater (174 +or-  92 m vs 162 +or-  86 m; p < 0.05), with less dyspnea before and at the end of walking.

Conclusion: Patients with severe COPD may demonstrate a significant bronchodilator response to combined ipratropium and salbutamol delivered by metered-dose inhaler. This response may be enhanced and additional functional improvement obtained with the prior use of a bronchial mucus clearance device.

Use of a Mucus Clearance Device Enhances the Bronchodilator Response in Patients with Stable COPD
Use of a Mucus Clearance Device Enhances the Bronchodilator Response in Patients with Stable COPD

4.Treatment of bronchial asthma with terbutaline inhaled by conespacer combined with positive expiratory pressure mask.

The influence of positive expiratory pressure (PEP) applied during inhalation of a beta 2-agonist in treatment of bronchial asthma was investigated in a randomized crossover study with two-week treatment periods.

In one period, two puffs (0.5 mg) of terbutaline was given from a metered dose inhaler and inhaled through a device consisting of a conespacer connected to a facemask giving PEP (10 to 15 cm H2O).

In a second period, terbutaline 0.5 mg was inhaled similarly but without PEP, and in a third period placebo spray was inhaled with PEP.

Treatments were given three times daily. Peak expiratory flow (PEF) was measured before and after each inhalation and symptom scores for dyspnea, cough, and mucus production were noted in a diary.

All treatments increased PEF significantly (p less than 0.0001). The mean increase was 32 L/min during treatment with terbutaline and PEP.

This was greater than the increase of 25 L/min during terbutaline treatment (p = 0.005).

The increase in PEF during terbutaline treatment was significantly higher than the achieved 18 L/min during PEP (p = 0.026).

Conclusion

The study showed improved bronchodilation when PEP was combined with inhalation of beta 2-agonist compared with beta 2-agonist alone.

 

Abstract – https://www.ncbi.nlm.nih.gov/pubmed/186410
Full Article – http://www.sciencedirect.com/science/article/pii/S0012369216371550

5. Inhaled beta2-agonist and positive expiratory pressure in bronchial asthma. Influence on airway resistance and functional residual capacity.

INTRODUCTION:

Positive expiratory airway pressure seems to dilate narrowed or collapsed airways, but this may be accompanied by a maintained and harmful increase in resting lung volume in obstructive pulmonary disease.

PURPOSE:

To evaluate the influence of inhaled terbutaline and positive expiratory pressure (PEP) on airway resistance (Raw) and functional residual capacity (FRC) in bronchial asthma.

DESIGN:

Randomized crossover design, single blind with regard to inhaled medication, open with regard to PEP (PEP can be felt).

MATERIAL AND METHODS:

Ten patients with bronchial asthma inhaled placebo and terbutaline in doses of 0.125 mg, 0.5 mg, and 1.5 mg by cone spacer combined with a facemask giving 0, 10, or 15 cm H2O PEP on separate days. FRC and Raw were measured by body plethysmography before and after inhalations. Data were analyzed by analysis of variance with terbutaline dose and PEP as factor levels.

RESULTS:

The effect of terbutaline: Raw decreased significantly (p < 0.0001) after 0.125 mg and 1.5 mg. The FRC did not change significantly. The effect of PEP: Raw decreased, but significantly only when the dose of 1.5 mg terbutaline was excluded from the analysis. Raw decreased with PEP 10 and 15 cm H2O, mean 0.6 (95 percent CI: -1.1, -0.2) and 0.9 (95 percent CI: -1.3, -0.4) cm H2O/L/s. The FRC did not change significantly with the PEP level.

CONCLUSION:

PEP only had influence on Raw when insufficient doses of terbutaline were inhaled, whereas once an efficient dose of terbutaline was administered, significant bronchodilation was achieved with or without PEP. Positive expiratory pressure did not increase FRC.

Abstracthttps://www.ncbi.nlm.nih.gov/pubmed/8404176

Inhaled beta 2-agonist and positive expiratory pressure in bronchial asthma. Influence on airway resistance and functional residual capacity
Inhaled beta 2-agonist and positive expiratory pressure in bronchial asthma. Influence on airway resistance and functional residual capacity

Full Article – http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21676/1108.pdf

6. Optimization of aerosol deposition by pressure support in children with cystic fibrosis: an experimental and clinical study.AirPhysio Improved Distribution using Pressure Support

Nebulized aerosols are commonly used to deliver drugs into the lungs of patients with cystic fibrosis (CF).

The aim of this study was to assess the effectiveness of pressure-support (PS) ventilation in increasing aerosol deposition within the lungs of children with CF.

An in vitro study demonstrated the feasibility of coupling a breath-actuated nebulizer to a PS device. An in vivo study was done with 18 children (ages 6 to 21 yr) with clinically stable CF, each of whom underwent both a standard and a PS-driven ventilation scan (control session and PS session, respectively).

In addition, a perfusion scan was used to determine lung outlines and to construct a geometric model for quantifying aerosol deposition by radioactivity counting in MBq.

Homogeneity of nebulization was evaluated from the four first-order moments of aerosol distribution in the peripheral and central lung regions. The time-activity nebulization curve was linear in all patients, with higher slopes during the PS than during the control session (0.43 +/- 0.07 [mean +/- SD] MBq/min and 0.32 +/- 0.23 MBq/min, respectively; p < 0.018).

Quantitatively, aerosol deposition was about 30% greater after the PS session (4.4 +/- 2.7 MBq) than after the control session (3.4 +/- 2.1 MBq; p < 0.05).

Similarly, deposition efficacy (as a percentage of nebulizer output) was significantly better during the PS session than during the control session (15.3 +/- 8.3% versus 11.5 +/- 5.7%, p < 0.05).

No differences in the regional deposition pattern or in homogeneity of uptake were observed.

Conclusion

In conclusion, our data show that driving the delivery of a nebulized aerosol by noninvasive PS ventilation enhances total lung aerosol deposition without increasing particle impaction in the proximal airways.

Abstracthttps://www.ncbi.nlm.nih.gov/pubmed/11112150
Full Article – http://www.atsjournals.org/doi/full/10.1164/ajrccm.162.6.2003069

https://www.researchgate.net/publication/12216300_Optimization_of_aerosol_deposition_pressure_support_in_children_with_cystic_fibrosis_An_experimental_and_clinical_study

Optimization-of-Aerosol-Deposition-by-Pressure-Support-in-Children-with-Cystic-Fibrosis
Optimization of Aerosol-Deposition by Pressure-Support in Children with Cystic Fibrosis

ventalin-airphysio
Evidence of PEP and OPEP Devices Used in Conjunction with Aerosol Medication which Improves Distribution and Effectiveness Article – PDF Version

Based on these studies, the evidence indicates that by combining the use of a PEP or OPEP device with aerosol medication and therapies, the effect and distribution of the aerosol and gases are improved. They also state that bronchodilative effect and response appears to be improved through the combined use of PEP and OPEP device with gas and aerosol treatments and therapies.

Best Kept Secret Treatment for Asthma, Bronchiectasis, CF or COPD

TGA Registered         

AirPhysio is a hand held OPEP airway physiotherapy device, is a mucus clearance device used in hospitals for treatment of respiratory conditions like Asthma, Bronchiectasis, Cystic Fibrosis, Chronic Obstructive Pulmonary Diseases (COPDs), such as chronic bronchitis and emphysema, Bronchiectasis, etc…

asthma-mucus

What is Happening in My Lungs Which Makes it Hard to Breathe?

With respiratory condition like Asthma, COPD, Cystic Fibrosis, etc… When the airways become inflamed, they produce an excess of this mucus. This excess mucus can weigh down the cilia (hairs), potentially damaging them and making the mucociliary escalator less effective. This makes it harder to move out of the airways and can lead to a build up of mucus in the lungs, creating obstruction in your airways, making it harder to breathe.

This mucus is the body’s natural protection against foreign particles like smoke, pollution, pollen and bacteria (particles which can cause inflammation in our airways).

Why is AirPhysio Needed? airphysio-device_vibration-300

AirPhysio is a simple  mucus clearance and lung expansion device.

The ball bearing creates a seal with the cone, so that when you blow into the device, it creates a back pressure in your lungs, helping to open up the airways, loosening any blockages, expanding your lungs.

When the ball bearing lifts off the cone the air rushing out of the cone also helps to push the mucus up and out of the lungs.

This happens between 25-35 times per second, shaking your airway walls and helping expedite both processes, mobilising the mucus and moving it into the throat to cough out naturally, helping prevent your condition from getting worse which could be leading to further complications.

AirPhysio Buy Now Page

Similar devices can cost around $160 + P&H
AirPhysio is  $79 including postage, handling and a free upgrade

For a more indepth understanding of the device and this process, please feel free to read the short paper from Griffith University below.

https://www.airphysio.com/NaturallyBetterBreathing/blogs/validation-of-airphysio-oscillating-positive-expiratory-pressure-device-short-paper/

Or for a simplified version of this, please feel free to visit the Asthma Australia website on the link below. 

asthma-australia-logo-without-supporting-991-pixels
New AirPhysio device to aid in the treatment of asthma!

 

Testimonials

See what some of our people have said about AirPhysio

“The patient has been able to clear his chest of congestion with the AirPhysio. It has been an excellent device, easy to use and very effective. He lives in the country and could not attend a physiotherapist even if could afford to go everyday which is what he would have needed. Thank you for your help. I will be definitely recommending your product and will no doubt purchase one for our family use as it would be great.”

AirPhysio Buy Now

Similar devices can cost around $160 + P&H
AirPhysio is  $79 including postage, handling and a free upgrade

Jacquie Barnes – RN1 General Practice Nurse
Croydon, Victoria

“I have suffered from asthma since I was a kid and the attacks got worse when I became a mother of three young active boys. My day is typically busy and I would often go to bed exhausted and then wake up the next day wheezing and needing my inhaler. A good friend of mine suggested that I try AirPhysio device and for three weeks I used the AirPhysio device every night before going to bed. I noticed the quality of my sleep has gotten better and my breathing easier since using the device. I have not had an asthma attack since. I am so happy with the AirPhysio device that I am going to continue to use it every night to keep my asthma symptoms at bay.”

Maria Lourdes Tala
Cebu, Philippines

AirPhysio buy-now

Similar devices can cost around $160 + P&H
AirPhysio is  $79 including postage, handling and a free upgrade