Respiratory Therapy Research Paper

Respiratory Therapy
Eric S. Coolong
CCSD
RES205
July 21, 2014
Maura Sommers

Respiratory Therapy
Respiratory therapist will deal with multiple different types of pulmonary diseases ranging from obstructive to restrictive diseases. Over the last few months we have learned how to assess and treat these patients. Today we will discuss four acute conditions where bronchial hygiene is indicated. Compare the types of bronchial hygiene therapy for chronic lung conditions. Three types of diseases that myself as a respiratory therapist will see frequently on a regular basis. Respiratory therapy is constantly changing as doe’s most medical fields with the advancement of technology and the better understanding of pulmonary diseases.
Bronchial
Hygiene for Acute Conditions
Four acute conditions were bronchial hygiene is indicated are; patients with copious secretions, acute respiratory failure with retained secretions, acute lobar atelectasis, and V/Q abnormalities caused by unilateral lung disease. When treating acute conditions a respiratory therapist will want to use bronchodilators to open up the airways so bronchial hygiene therapy can be effective. For acute conditions with infections the use of antibiotics can be used after the bronchodilator therapy to be most effective. “The primary goal of airway clearance therapy is to help mobilize and remove retained secretions, with the ultimate aim to improve gas exchange, promote alveolar expansion, and reduce the work of breathing (Kacmarek, 2013).” Bronchial hygiene is a way to clean out the airways so the lungs can do their job. Being able to produce a productive cough is also when bronchial hygiene will be needed. There are four factors to a productive cough. There are four distinct phases to a normal cough: irritation, inspiration, compression, and expulsion. In the irritation phase abnormal stimulus provokes sensory fibers to the airways to send impulses to the medullary cough center in the brain (Kacmarek, 2013).” Examples of impairments for the irritation phase are anesthesia, CNS depression, narcotic-analgesics. The second phase of the cough is when the cough center generates a reflex stimulation to initiate a deep inspiration. Examples of impairments for the inspiration phase are pain, neuromuscular dysfunction, pulmonary restriction, and abdominal surgery. The third phase is the compression stage which last about 0.2 seconds. Impulses are received and the glottis is closed to build up plueral and alveolar pressures. Examples of impairments for the compression phase are laryngeal nerve damage, artificial airway, abdominal muscle weakness, and abdominal surgery. The fourth phase expulsion is when the glottis is opened and a forceful expulsion occurs creating the cough. Examples of impairments for the expulsion phase are airway compression, abdominal muscle weakness, and inadequate lung recoil. There are many different types of therapies a respiratory therapist can use if a patient is unable to clear their own airways.
Bronchial Hygiene Therapy for Chronic Conditions
Hygiene therapy has many different approaches that can be used alone or in conjunction with each other.
Indications for bronchial hygiene therapy for acute conditions are copious secretions 25-30 ml/day, acute respiratory failure with retained secretions, acute lobar atelectasis, and V/Q abnormalities caused by unilateral lung disease. Chronic conditions that indicate therapy are cystic fibrosis, bronchiectasis, ciliary dyskinetic syndromes, and chronic bronchitis. First we must assess the need for bronchial hygiene therapy. We do this by looking at the patient’s history, presence of artificial airway, CXR, results of PFT, age, and any type of surgery the patient has under gone. We also look at the patient’s appearance such as posture, breathing pattern, vital signs, general physical appearance. There are five general approaches to bronchial hygiene therapy. The first approach is postural drainage. Postural drainage uses gravity to clear retained secretions there are positions the patient can be put in to effectively drain secrections. Some positions are for anterior upper segments the patient is sitting up with a pillow under their knees. A second position is right lateral segment the patient is lying on their left side with their legs elevated eighteen inches. There are many other postural position a patient can be put in these are just a couple examples. Assessing the effect of postural drainage the respiratory therapist looks at the change in sputum production, change in
vital signs, change in CXR, and patients overall response to the therapy. Percussion and vibration is another therapy used to remove retained secretions. Percussion uses cup like tools that are slapped over the affected area to break free any secretions in that area. Vibration is also use to help mobilized any retained secretions. Percussion and vibration can be used in conjunction with postural drainage. Directed cough is another airway clearance method. Directed cough is exactly what it sounds like the patient is coached how to cough. Some patients don’t have the ability to cough naturally but with a little instruction a patient can produce a fake cough that is beneficial in moving secretions. Directed cough also requires patient positioning and can be used with other hygiene therapies. Directed cough therapy can be modified by forced expiratory technique, active cycle breathing, autogenic drainage, and mechanical insufflation-exsufflation. Positive airway pressure therapy is also very effective. Examples are CPAP, EPAP, PEP, IPV, and HFCWC. “PEP application through a nasal mask and a flow resistance device might have the potential to be used during daily physical activities as an auxiliary strategy of ventilatory assistance (Wibmer, 2013).” PEP along with exercise and mobility brings us to our last type of therapy. Mobilization and exercise is a great bronchial hygiene therapy. Immobile patients have a higher chance for copious amounts of retained secretions.
Typical Diseases
Three common lung diseases seen by respiratory therapist are asthma, emphysema, and chronic bronchitis. These three diseases make up what a chronic obstructive pulmonary disease patient will have. One will be predominant with the other exacerbating the main one. “Asthma is a chronic respiratory disease characterized by reversible airway obstruction that is secondary to airway inflammation and excessive smooth muscle contraction (Tian, 2013).” Patients with asthma will show symptoms and signs of wheezing, shortness of breath, and coughing. Asthma is usually cause by extrinsic factors like allergies, smoking, and smog or bad air do to traffic and industrialization. Asthma can be treated with bronchodilators and steroids for inflammation if necessary. Emphysema is another obstructive disease that a respiratory therapist will deal with frequently in his or her career. There are two types of emphysema acquired and true emphysema. Acquired emphysema is caused by smoking. Smoking breaks down the lung making it less compliant creating a lung that is less productive in ventilation and perfusion. True emphysema is a genetic disease that is seen in male patients around the age of 30-40. This type of patient never smoked or lived in a highly polluted area that was bad for their lungs. A true emphysema patient doesn’t produce antitrypsin or antiprotienase which keeps phagocytic activity from destroying the compliance of the lung. “Alpha-1 antitrypsin deficiency is a genetic condition that predisposes to COPD and to liver disease (Stoller, 2013).” Emphysema is not reversible once the damage is done it is done. But we can keep it from getting worse through bronchial hygiene therapy and positive pressure therapy. Chronic bronchitis is when a patient has a productive cough for three months out of the year for two years. One of the causes for chronic bronchitis is smoking. “In industrialized countries, cigarette smoking is widely acknowledged as the most important risk factor for chronic diseases, including cardiovascular disease, many types of cancer, as well as chronic respiratory distress (Tremblay, 2013).” Smoking is one of the main causes for lung disease. With proper bronchial hygiene techniques, antibiotics, and if the patient quits smoking they will see some relief.
Conclusion
Respiratory therapists really have their hands full when it comes to pulmonary diseases. As a future respiratory therapist I look forward to the challenge of identifying what is wrong with a patient and helping them. Bronchial hygiene is just a small part of respiratory therapy but has many moving parts. There will always be plenty of work for respiratory therapist as our country grows older and with medicine improving. As time progresses so will respiratory therapy.

References
Kacmarek, Robert M., James K.
Stoller, Albert J. Heuer, and Donald F. Egan. Egan 's Fundamentals of Respiratory Care. St. Louis, MO: Elsevier/Mosby, 2013. Print.
Stoller, James K. MD, Strange, Charlie MD, Schwarz, Laura, Kallstrom, Thomas J. RRT MBA, Chatburn, Robert L. MHHS. (2013). Detection of Alpha-1 Antitrypsin Deficiency by Respiratory Therapists; Experience With an Educational Program. Respiratory Care, vol 59(No 5), p 667.
Tian, Jing-wei MD, Chen, Jin-wu MD, Chen, Rui PhD, Chen, Xin PhD. (2013). Tiotropium Versus Placebo for Inadequately Controlled Asthma: A Meta-Analysis. Respiratory Care, vol 59(No 5), p 654.
Tremblay, Michele MD, O’Loughlin, Jennifer PhD, Comtois, Dominic. (2013). Respiratory Therapists’ Smoking Cessation Counseling Practices: A Comparison Between 2005 and 2010. Respiratory Care, vol 58(No 8), p 1299.
Wibmer, Thomas MD, Rudiger, Stefan, Heitner, Claudia, Kropf-Sanchen, Cornelia MD, Blanta, Ioanna, Stoiber, Kathrin M. MD, Rottabauer, Wolfgang PhD MD,Schumann, Christian MD. (2013). Effects of Nasal Positive Expiratory Pressure on Dynamic Hyperinflation and 6-Minute Walk Test in Patients With COPD. Respiratory Care, vol 59(No 5), p
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