The Airway Clearance Device that May Help You Breathe Easier
There are thousands of Canadians with respiratory conditions that result in lungs filled with mucus and a limited ability to breathe. Chronic obstructive pulmonary disease (COPD) is one of the main causes, but other conditions like bronchiectasis and cystic fibrosis can have the same effect.
When you have a cold, you know how much it can affect your ability to breathe normally. For those with chronic conditions, convenient airway clearance methods can be lifechanging. Fortunately, technology is coming to the rescue in the form of handheld PEP devices.
“PEP stands for positive expiratory pressure,” explains Dr. Maggie McIlwaine, a Cardiorespiratory Clinical Specialist in Physiotherapy based in Vancouver. “It means you’re using a device that applies positive pressure at the mouth, usually equivalent to about 10 or 20 centimetres of water pressure. What that does is allow air to get behind the mucus impactions. It helps to loosen up mucus so that huffing and a good cough can result in expectorating (or ejecting) the secretions.”
Clinical trials have shown that PEP devices are much better than the old airway clearance techniques clinicians used to rely on.
“The old-fashioned way to clear mucus from the lungs relied on postural drainage and percussion, where people were placed in various positions and their chests were tapped on,” says Dr. McIlwaine. “Back in the ‘90s, we did a trial comparing PEP therapy to postural drainage and percussion, and found that PEP was much more effective. That’s pretty much when the landscape changed.”
Not all devices are created equal
The basic principles behind various PEP devices are largely the same, but manufacturers are constantly innovating and looking for ways to improve them. That means patients should be proactively seeking the devices that best suit their needs.
“There are many different PEP devices on the market, and many of them are fundamentally similar,” says Dr. McIlwaine. “But there are also vibrating PEP devices like the Acapella® Choice. The difference with the vibrating PEP devices is that, as you are breathing out against the posi- tive expiratory pressure, you also have an additional vibration happening at between 10 and 20 hertz. That vibration within the airways is like shaking a ketchup bottle. It helps to loosen the mucus more effectively, so you can get it out easier.” Another feature of the Acapella® is that a nebulizer can be attached to deliver medication, such as corticosteroids or antibiotics.
Unfortunately, not all patients who need access to PEP devices are being properly guided by their physicians, underscoring the importance of self-advocacy. “Patients really need to be taking charge of their own well-being,” says Dr. McIlwaine. “They should definitely advocate for airway clearance techniques, because a lot of physicians don’t even think about them.”
This is a common theme for many medical issues, treatments, and therapies in Canada. We have one of the best health care systems in the world, but the patients who receive the best treatment are the ones who educate themselves and advocate for their own needs. With a little bit of empowerment, everyone can breathe easier.
“That vibration within the airways is like shaking a ketchup bottle. It helps to loosen the mucus more effectively, so you can get it out easier.”