Recent advances in Respiratory physiotherapy covers a comprehensive aspect of newer technologies helpful in the field of pulmonary physiotherapy. Useful for MPT students. Has articles added up for reference.

1. REVIEW OF
LITERATURE

2. Recent Advances in
Respiratory
Physiotherapy
Saumya Kine
MPT CVTS
2nd Year

3. CONTENTS
DEVICES
OUTCOME MEASURES
TREATMENT TECHNIQUES
1.
3.
2.

4. Role of Technology
in Respiratory
Medicine
Wearables
Smart Inhalers
Portable
spirometers
Digital
Stethoscope
Artificial Intelligence
Diagnosis

5. WEARABLES
 Definition
 Sites
 Examples
 Measurements
 Internal
 External

6. RPM (REMOTE PATIENT MONITORING) BY
SPIREHEALTH
• Spire’s unique Health Tag sensors capture
medical grade physiological data. Health tags
adhere to patient’s clothing.
• Spire Health’s remote patient monitoring
approach has the potential to identify and
predict health events, enable early
interventions, and prevent hospital admissions.
• Deviations from patient clinical baselines are
automatically detected and shared with the care
team. Changes in patient health can be
detected days before a patient reports
symptoms or experiences physiological decline.

8. Doctors order SpireHealth for patients who would benefit from continuous
monitoring.
They are identified and enrolled.
Equipment mailed to patients home and setup.
Real time monitoring and data available to the doctors via Healthcare
Providers Dashboard.
Health Tags notify care team when patient health changes
Notifications are managed by care team 7 days/week
Patients are contacted within 24 hours and a provider visit is scheduled if
necessary

9. SMART INHALERS
 What it is?
 Uses
 Types / Categories

10. Title: The Effect of Connected “Smart” Inhalers on Medication Adherence
Authors: Caroline Zabczyk and John D. Blakey
Journal: Frontiers in Medical Technology, August 2021
Problem statement: Asthma and chronic obstructive pulmonary disease (COPD) being highly
prevalent worldwide, yet key barriers to reduce the harm from these conditions are the
widespread and related issues of low use of prescribed inhaled therapy, use of medicines
differently from that prescribed, suboptimal inhaler technique, and lack of adherence are the
action plans.
This systematic review supports the use of smart halers due to following reasons:
• The use of smart inhalers leads to more doses of preventative treatment being taken on time
and with appropriate techniques.
• Smart inhalers are used with audio-visual reminders and healthcare professional feedback,
which substantially improves the number of doses of preventative treatment taken.
• Feedback from smart inhalers improves true concordance (doses taken correctly and on
time), though only for a single type of smart device.

11. PORTABLE ELECTRONIC
SPIROMETERS
 Efficacy
 Uses

12. DIGITAL
STETHOSCOPE
 Definition
 Modules
 Working

13. ARTIFICIAL
INTELLIGENCE (AI)
DIAGNOSIS
 Definition
 Working
 Applications

14. ResApp
• ResApp is a digital solution to the challenges of diagnosing
respiratory diseases.
• It instantly diagnoses and manages respiratory diseases using a
smartphone.
• Using artificial intelligence (AI), the ResApp listens to a
patients cough sounds and enables rapid, low cost, point of care
and remote diagnosis of respiratory diseases.
• ResApp was created to diagnose and measure the severity of a
wide range of chronic and acute diseases such as pneumonia,
asthma, bronchiolitis and chronic obstructive pulmonary disease
(COPD).
• The algorithm requires the input of five cough-sound segments
and four patient-reported symptoms and provides a result in less
than one minute. The tool does not rely on the input of vital
signs, clinical examination, or radiological findings, and
delivers an immediate, point-of-care result.
*The platform is based on sound alone and does not require physical contact with the patient. With modern smartphones
integrating high quality microphones, the platform can be delivered without the need for additional hardware.

15. • ResApp has developed an obstructive sleep apnoea screening test that uses overnight
breathing and snoring sounds recorded on a smartphone placed on the bedside table.
• ResApp’s machine-learning algorithms analyse overnight breathing and snoring
sounds to identify obstructive sleep apnoea (OSA).
AHI (APNEA-
HYPOPNEA
INDEX)
GRADING
<5 / hr None / minimal
≥5 but <15 / hr Mild
≥15 but <30 / hr Moderate
≥30 / hr Severe

16. TITLE AND AUTHORS METHODOLOGY RESULTS AND
CONCLUSIONS
Identifying acute exacerbations
of chronic obstructive
pulmonary disease using
patient reported symptoms and
cough feature analysis
Scott Claxton, Paul Porter,
Joanna Brisbane, Natasha
Bear, Javan Wood, Vesa
Peltonen, Phillip Della,
Claire Smith, Udantha
Abeyratne
npj Digital Medicine (2021)
The app uses technology like that
employed in speech recognition
technology, a smartphone-based
algorithm was developed for rapid and
accurate diagnosis of AECOPD. The
algorithm incorporates patient reported
features (age, fever, and new cough) and
audio data from five coughs. Cough
events are recorded by a standard
smartphone and combined with simple
patient-reported clinical signs by the in-
built diagnostic algorithm to provide a
rapid diagnostic result without contact
with participants. They compared the
accuracy of the algorithm to expert
clinical assessment.
The algorithm correctly identified
the presence of AECOPD in
82.6% of subjects. The absence of
AECOPD was correctly identified
in 91.0% of individuals. The
diagnostic agreement was
maintained in milder cases of
AECOPD, who typically comprise
the cohort presenting to primary
care. The algorithm may aid early
identification of AECOPD
and be incorporated in patient self-
management plans.

17. TITLE AND AUTHORS METHODOLOGY RESULTS AND CONCLUSIONS
Diagnosing community-
acquired pneumonia via
a smartphone-based
algorithm: a prospective
cohort study in primary and
acute-care consultations
Paul Porter, Joanna Brisbane,
Udantha Abeyratne, Natasha
Bear, Javan Wood, Vesa
Peltonen, Phillip Della, Claire
Smith and Scott Claxton
British Journal of General
Practice, April 2021
The aim of the study was to
develop and test a
smartphone-based
algorithm for diagnosing
CAP without need for clinical
examination or radiological
inputs.
The smartphone-based algorithm had
high percentage agreement (PA) with
the clinical diagnosis of CAP in the
total cohort. The algorithm provides
rapid and accurate diagnosis of CAP.
It offers improved accuracy over
current protocols when clinical
evaluation is difficult. It provides
increased capabilities for primary and
acute care, including telehealth
services, required during the COVID-
19 pandemic.

18. SMART CARE
OPEN LOOP CLOSED LOOP
SmartCare™ is a unique automated weaning system that measures selected respiratory
variables, adapts ventilator output to individual patient needs by operationalizing predetermined
algorithms and automatically conducting spontaneous breathing trials (SBTs) when
predetermined thresholds are met.

19. TITLE AND AUTHORS METHODOLOGY RESULTS AND CONCLUSION
Smart Care™ versus
respiratory
physiotherapy–driven
manual weaning for
critically ill adult patients: a
randomized
controlled trial
Corinne Taniguchi, Elivane
S. Victor, Talita Pieri,
Renata Henn, Carolina
Santana, Erica Giovanetti,
Cilene Saghabi, Karina
Timenetsky, Raquel Caserta
Eid, Eliezer Silva, Gustavo
F. J. Matos, Guilherme P. P.
Schettino and Carmen S. V.
Barbas
Critical Care 2015
The authors hypothesized that weaning
with SmartCare™ would be as effective
as respiratory physiotherapy–driven
weaning in critically ill patients. Adult
critically ill patients mechanically
ventilated for more than 24 hours in the
adult ICU were randomly assigned to be
weaned either by progressive
discontinuation of pressure support
ventilation (PSV) with SmartCare™.
Demographic data, respiratory function
parameters, level of PSV, TV, PEEP,
FIO2, SpO2, EtCO2 were recorded at the
beginning of the weaning process and
before extubation. Mechanical ventilation
time, weaning duration and rate of
extubation failure were compared.
There was no difference in MIP,
MEP, FVC or RSBI at the
beginning of the weaning trial.
PEEP, VT, FIO2, SpO2, RR,
EtCO2 were similar between the
two groups. Total duration of
mechanical ventilation and
extubation failure were similar
between the two groups. Weaning
duration was shorter in the
respiratory physiotherapy–driven
weaning group. A respiratory
physiotherapy–driven weaning
protocol can decrease weaning
time compared with an automatic
system, as it takes into account
individual weaning difficulties.

20. METANEB®
• The MetaNeb® System combines lung expansion, secretion clearance, and aerosol
delivery into a single integrated therapy session—without having to switch
between different devices.
• The MetaNeb® System is indicated for mobilization of secretions, the treatment
and prevention of pulmonary atelectasis, lung expansion therapy and also has the
ability to provide supplemental oxygen when used with compressed oxygen.

21. • MetaNeb introduces continuous high-frequency oscillation (CHFO)
therapy immediately after lungs have been expanded through
continuous positive expiratory pressure (CPEP)
• Integrates aerosol delivery of medications for maximum efficiency
• 10 Minutes Total*: Alternating cycles of CPEP and CHFO combined
with aerosol delivery helps maximize therapy effectiveness.

22. Title: Innovative chest physiotherapy techniques (the MetaNeb® System) in the intubated
child with extensive burns : A case report
Authors: Alexandra Ferguson, Sarah Wright
Journal: Respiratory Medicine Case Reports, 2017
Case:
An 8 year old patient came to the hospital with 61% TBSA flame burns. The child was
difficult to ventilate, immobile, and had retained secretions. The chest x-ray (CXR) demonstrated
multifocal regions of atelectasis.
Day wise treatment:
Day 4: On day 4 post injury donor sites were harvested and burns debrided. The child experienced
significant blood loss and no grafting could be completed.
Day 6 - 8 post burn the patient had a Split Skin Graft (SSG) of his posterior torso, buttocks,
posterior upper thighs, right lower leg and bilateral upper arms. But patient became septic and thus
difficult to ventilate and the chest x-ray (CXR) demonstrated multifocal regions of atelectasis
change. The patient's level of sedation resulted in no spontaneous cough. Indicators for respiratory
physiotherapy treatment included increasing ventilator requirements, raised peak inspiratory
pressures (PIP's), and retained secretions associated with hemodynamic instability with episodes of
hypotension requiring fluid resuscitation and inotropes.

23. Conventional physiotherapy techniques were extremely limited due to the new grafting sites.
Physiotherapy treatment included repositioning using bed tilt only, manual hyperinflation (MHI),
saline lavage, suction and passive mobility of the unaffected joints. These techniques had limited
effectiveness and secretions still persisting post intervention.
MetaNeb® treatment was implemented, for a period of approximately 10 minutes per treatment.
Outcome measures included sputum volume and quality, CXR, and PIP values pre and post treatment.
Vital signs remained stable throughout intervention

24. VOSCN by VentecLife
VOCSN, seamlessly integrates five separate devices
including:
• a ventilator,
• oxygen concentrator,
• cough assist,
• suction, and
• nebulizer
into one unified respiratory system.

25. VENTILATOR
Provides invasive, noninvasive,
and mouthpiece ventilation.
VOCSN delivers a
comprehensive and varied set
of ventilation modes and
settings to meet patient needs.
OXYGEN
Can deliver the equivalent of 6
L/min of oxygen or up to 40
percent oxygen in adult patients.
Using the onboard internal
oxygen concentrator. Most
importantly, it makes traveling
and using oxygen easier.
SUCTION
High flow suction working in
conjunction with the Secretion
Trap, suction can be used to clear
secretions from the patient’s
airway. Also has a unique sound
muffler, making it more than three
times quieter than traditional
suction machines.
COUGH
Using the Cough + Suction feature, the
suction is activated during the cough
therapy to clear secretions. Patients using
invasive ventilation can use the Secretion
Trap™ to easily clear secretions from the
circuit. Once the set number of cough cycles
is complete, ventilation automatically
resumes.
NEBULIZER
Integrated 6 L/min nebulizer drive
to make medication delivery
seamless. The nebulizer can be
battery operated for use on the go.
Plus, VOCSN records data about
each treatment and turns off the
nebulizer once the therapy is
complete.

26. TITLE AND AUTHORS METHODOLOGY RESULTS AND
CONCLUSION
Validity and Reliability of a
New Tool to Evaluate Impaired
Airway Clearance in
Hospitalized Pediatric Subjects
With Respiratory Distress
Brittany L Shutes, Laura R
Evans, Melissa D Moore-
Clingenpeel, and Todd J Karsies
Respiratory Care
July 2019
This study aims to validate the
Airway Clearance and
Expansion Index (ACE-I) for
assessment of hospitalized
pediatric patients
with impaired airway clearance
and to establish its reliability
score in pediatric respiratory
disease.
The validity indices, namely
I-CVI and S-CVI were 1 and
0.75 respectively, which
suggests excellent and good
validity. It also had an ICC
(intraclass correlation
coefficient) of 0.77 which
says excellent inter-rater and
intra-rater reliability.
AIRWAY CLEARANCE AND EXPANSION INDEX
(ACE-I)

27. A clinical measure that reflects a given patient’s overall airway clearance status. It has
categorized secretions, chest radiograph findings, cough quality, and breath sounds into
a single numeric score.

28. Title: Development and Validation of a New Clinical Scale for Infants with Acute
Respiratory Infection: The ReSVinet Scale
Aim: A properly validated scoring system allowing objective categorization of infants
with acute respiratory infections (ARIs), avoiding the need for in-person assessment
and that could also be used by non-health professionals. The secondary aim was to
provide the parents with a simple tool for evaluating the severity of their children’s
disease.
Total score: 20 points
Scoring:
0–6 for mild affection
7–13 for moderate distress
14–20 for severe respiratory affection
ReSVinet SCALE
Validity: Cronbach’s alpha > 0.7 good
Reliability: Weighted Kappa = 0.73 good

31. Title: Combination of inspiratory and expiratory muscle training in same respiratory cycle
versus different cycles in COPD patients: a randomized trial
Authors: Wenhui Xu, Rui Li, Lili Guan, Kai Wang, Yuhe Hu, Limei Xu, Luqian
Zhou, Rongchang Chen and Xin Chen
Journal: Respiratory Research, 2018
Problem Statement: Patients with COPD generally suffer from respiratory muscle dysfunction.
Severe respiratory muscle dysfunction can lead to problems such as dyspnea, hypoxemia,
and decreased exercise capacity. But in addition to impaired inspiratory muscle function,
expiratory muscle fatigue may also occur in COPD.
Methodology:
I/C: Patients with clinically stable COPD, naive to pulmonary rehabilitation and willing to
participate.
E/C: Patients with cognitive disorders, organ failure, malignant tumors, or metabolic diseases.
92 subjects were randomly and equally assigned for:
• Sham training
• Inspiratory muscle training(IMT)
• Combined inspiratory and expiratory muscle training in same cycle(CTSC)
• Combined inspiratory and expiratory muscle training in different cycles(CTDC)

32. Intervention: Subjects in all groups trained daily, with each session lasting for 48 minutes per day, 7 days
a week, 8 weeks. Each set consisting of 3 minutes of training and 2 minutes of rest.
• Sham training performed 16 sets of no-load respiratory muscle training daily.
• IMT performed 8 sets of inspiratory muscle training and 8 sets of no-load respiratory muscle training
per day.
• CTSC performed 16 sets of combined training in one respiratory cycle daily.
• CTDC performed 8 sets of inspiratory muscle training and 8 sets of expiratory muscle training
separately in different cycles daily.
They modified a threshold device to include a monitoring device, threshold inspiratory trainer and
threshold expiratory trainer.

33. • Subjects received follow-up by telephone weekly and in the clinic every 2 weeks.
• In the clinic follow-up, staff checked the discomfort record, re-measured PImax and
PEmax for load reset.
• The inspiratory load started at 30% PImax, and incrementally increased 5% every two
weeks until reaching 45% PImax.
• The expiratory load was adjusted from 15% PEmax plus 5% PEmax every two weeks
to 30% PEmax.
Outcome measures:
• Primary: Respiratory muscle strength.
• Secondary: Dyspnea, breathing pattern, spirometry, exercise capacity, quality of life,
emotional status, BODE index, and nutritional status.

34. OUTCOME MEASURES MEASURED WITH
Respiratory muscle strength MIP and MEP
Dyspnea mMRC scale
Breathing Pattern RR, TV, IC with pneumotachograph
Spirometry FEV1, FVC, FEV1/FVC ratio with spirometer
Exercise capacity 6MWT
Quality of Life St George’s Respiratory Questionnaire (SGRQ)
and COPD Assessment Test (CAT); Hospital
Anxiety and Depression Scale (HADS)
Nutritional status BMI
BODE Index BMI, airflow obstruction, Dyspnea, Exercise
capacity

35. OUTCOME MEASURES MEASURED WITH
Respiratory muscle strength ΔPImax of IMT, CTSC, and CTDC group was significantly > Sham
training but was no difference among IMT, CTSC, and CTDC.
Improvement of PEmax in CTSC and
CTDC group > than IMT group and Sham training
CTSC = CTDC
Dyspnea The ΔmMRC of IMT, CTSC, and CTDC group were
significantly improved as compared to Sham training but IMT = CTSC =
CTDC
Breathing Pattern No significant difference in any groups
Spirometry No significant difference in any groups
Exercise capacity No significant difference in any groups
Quality of Life ΔSGRQ and ΔCAT of IMT, CTSC, and CTDC
were notably lower than Sham training. In addition, there was no
significant difference in depression and anxiety scores among groups.
Nutritional status No significant difference in any groups
BODE Index No significant difference in any groups

36. REFERENCES
1. Validity and Reliability of a New Tool to Evaluate Impaired Airway Clearance in
Hospitalized Pediatric Subjects With Respiratory Distress | Respiratory Care [Internet]. [cited
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2. The Current and Future Role of Technology in Respiratory Care | SpringerLink
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022-00191-y
3. Smart CareTM versus respiratory physiotherapy-driven manual weaning for critically ill
adult patients: a randomized controlled trial - PubMed [Internet]. [cited 2023 Mar 1]. Available
from: https://pubmed.ncbi.nlm.nih.gov/26580673/
4. Ferguson A, Wright S. Innovative chest physiotherapy techniques (the MetaNeb®
System) in the intubated child with extensive burns. Respir Med Case Rep. 2017;22:232–4.
5. Diagnosing community-acquired pneumonia via a smartphone-based algorithm: a
prospective cohort study in primary and acute-care consultations | British Journal of General
Practice [Internet]. [cited 2023 Mar 1]. Available from: https://bjgp.org/content/71/705/e258

37. 6. Combination of inspiratory and expiratory muscle training in same respiratory cycle
versus different cycles in COPD patients: a randomized trial - PubMed [Internet]. [cited 2023
Mar 1]. Available from: https://pubmed.ncbi.nlm.nih.gov/30458805/
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