Coughing and huffing are techniques used to clear secretions from the lungs. Coughing involves a forceful expiration against a closed glottis, while huffing is expiration with an open glottis. Coughing generates higher pressures but can cause complications like bronchospasm, while huffing creates lower pressures but with less risk. Both techniques work in stages - coughing requires inspiration, glottis closure, building pressure, then opening; huffing is a forced expiration from mid to low lung volumes with an open glottis. Huffing can help clearance with less effort than coughing for some patients.
CHEST MOBILIZATION EXERCISES, COUNTER-ROTATION TECHNIQUE, BUTTERFLY TECHNIQUE, BREATH CONTROL DURING WALKING. These Mobilization Techniques are useful to improve Chest Wall Mobility and Expansion in Patients with Restricted Chest wall movements and also Postoperative patients
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
CHEST MOBILIZATION EXERCISES, COUNTER-ROTATION TECHNIQUE, BUTTERFLY TECHNIQUE, BREATH CONTROL DURING WALKING. These Mobilization Techniques are useful to improve Chest Wall Mobility and Expansion in Patients with Restricted Chest wall movements and also Postoperative patients
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
Inspiratory Muscle Training or Respiratory Muscle Training or Ventilatory Muscle Training. IMT is the physiotherapy technique, with the help of different breathing exercises.
physiotherapy management for chronic obstructive pulmonary disease Sunil kumar
role of physiotherapy in chronic obstructive pulmonary disease, principles of physical therapy management in copd, physiotherapy assessing and treatment for copd
\It is a condition of the lung characterized by permanent dilatation of the air spaces distal to the terminal bronchioles with destruction of the walls of these airways.
Chronic Bronchitis
It is a disease characterized by daily cough with sputum for at least 3 months of the year for at least 2 consecutive years and airway obstruction which is irreversible.
Brian Mulligan described novel concept of the simultaneous application of therapist applied accessory mobilizations and patient generated active movements
Application of PEP devices in Cardiorespiratory physiotherapy.
It includes types of PEP devices and their uses in physiotherapy..
It stands for positive expiratory pressure.
It includes spirometry, flutter, rc cornet, acapella, etc.
useful in various cardiorespiratory disorders like COPD, asthma , cystic fibrosis, respiratory failure etc.
Inspiratory Muscle Training or Respiratory Muscle Training or Ventilatory Muscle Training. IMT is the physiotherapy technique, with the help of different breathing exercises.
physiotherapy management for chronic obstructive pulmonary disease Sunil kumar
role of physiotherapy in chronic obstructive pulmonary disease, principles of physical therapy management in copd, physiotherapy assessing and treatment for copd
\It is a condition of the lung characterized by permanent dilatation of the air spaces distal to the terminal bronchioles with destruction of the walls of these airways.
Chronic Bronchitis
It is a disease characterized by daily cough with sputum for at least 3 months of the year for at least 2 consecutive years and airway obstruction which is irreversible.
Brian Mulligan described novel concept of the simultaneous application of therapist applied accessory mobilizations and patient generated active movements
Application of PEP devices in Cardiorespiratory physiotherapy.
It includes types of PEP devices and their uses in physiotherapy..
It stands for positive expiratory pressure.
It includes spirometry, flutter, rc cornet, acapella, etc.
useful in various cardiorespiratory disorders like COPD, asthma , cystic fibrosis, respiratory failure etc.
Dynamic Central Airway Obstruction: Tracheomalacia, Tracheobronchomalacia, An...Bassel Ericsoussi, MD
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Discussion #11. What physical findings might be indicative of a .docxmecklenburgstrelitzh
Discussion #1
1. What physical findings might be indicative of a patient with emphysema? The diagnosis is made on patients that usually are long term smokers, and they complaint of dyspnea, cough, and mucus expectoration. Most patients seek medical attention late in the course of their disease, usually ignoring smoldering symptoms that start gradually and progress over the course of years. The cough typically is worse in the morning with finite production of clear-to-white sputum. Dyspnea, emphysema's most significant symptom, does not generally occur until the sixth decade of life. However, patients with emphysema due to alpha 1 -antitrypsin deficit will exhibit the following characteristics: early presentation (< 45 y), predilection of emphysematous changes in the lung bases, and the panacinar morphological pattern.
Although the sensitivity of the physical evaluation in mild-to-moderate disease is relatively poor, the physical signs are quite sensitive and specific in severe disease. Patients with severe disease may experience tachypnea and dyspnea with mild exertion.
The respiratory rate increases in proportion to disease severity with the use of accessory respiratory muscles and paradoxical contraction of lower intercostal spaces becoming evident during exacerbations.
In end-stage emphysema, cyanosis, elevated jugular venous pressure, atrophy of limb musculature, and peripheral edema due to the development of pulmonary hypertension, right-to-left shunting, and/or right heart failure can easily be observed.
Thoracic examination reveals a 2:1 increase in anterior to posterior diameter (“barrel chest”), diffuse or focal wheezing, diffusely diminished breath sounds, hyperresonance upon percussion, prolonged expiration, and/or hyperinflation on chest radiographs.
2. What is the purpose and interpretations of the pulmonary function test? Pulmonary function tests will test the mechanical function of the lungs, chest wall, and respiratory muscles by measuring the total volume of air exhaled from a full lung (total lung capacity [TLC]) to maximal expiration (residual volume [RV]). This volume, the forced vital capacity (FVC) and the forced expiratory volume in the first second of the forceful exhalation (FEV1), In Emphysema, spirometry may show typical obstructive pattern due to the blockage of the air during expiration. As a result of the air trapping, the spirometry will show decreased in FVC, but less than the FEV 1, and increased FRC and RV.(McCance, & Huether, 2013).
3. What are the pathophysiological findings specifying emphysema? As a result of the cellular apoptosis, and early cellular senescence, the alveolar cells are damaged, and a reduced surface of gas exchanged occurred. The destruction of the alveoli creates bullae, which are large spaces in the lung parenchyma and air spaces adjacent to pleurae(blebs). Both elements bullae, and blebs difficult the air exchange. In addition, areas of the lungs that are bad perfused contributes to w.
The biomechanical properties of connective tissues are critical determinants of how mechanical forces acting on the body/organ produce physical changes at the cellular level.
The Biomechanical properties of lung are discussed
The goal in patients with primary lung disease is to teach them to relax the neck and chest accessory muscles and use more diaphragmatic breathing to reduce the work of breathing.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
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CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
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R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
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Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
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CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
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2. Coughing
• Cough is a complex maneuver that is initiated
either voluntarily or by the stimulation of
cough receptors located primarily in the
central airways.
• It is forceful expiration against closed glottis
Linder SH. Functional electrical stimulation to enhance cough in quadriplegia. Chest. 1993 ;103(1):166-9
McCool FD. Global physiology and pathophysiology of cough:ACCP evidence-based clinical practice guidelines. Chest 2006;129(1 Suppl):
48S–53S.
3.
4. Sequence of Phases
Principles and Practice of Cardiopulmonary Physical Therapy 3rd Edition (Third Edition) by Donna Frownfelter, Elizabeth Dean
Cough is of limited value beyond sixth or seventh
generation of airway branching
5. Impaired Cough
Inspiratory Phase
Inspiratory muscle weakness limits the volume of
air that can be inspired
Expiratory-muscle length-tension and chest-wall
recoil forces are limited
Limits intrathoracic pressure and expiratory flow
and volume,
Limits secretion clearance in the expiratory phase.
Haala K. Rokadia, Jacob R. Adams, Kevin McCarthy, et al. Cough Augmentation in a Patient with Neuromuscular DiseaseAnn Am
Thorac Soc .2015;12,( 12,):1888–1891
6. Cont..
• Inability to close the glottis in order to
generate a compression phase in the cough
maneuver will pose limitation
Expiratory Muscle Weakness
• The inability to generate adequate expiratory
pressure (regardless of how much gas volume
is inhaled) results in lower expiratory flow
velocity.
McCool FD. Global physiology and pathophysiology of cough:ACCP evidence-based clinical practice guidelines. Chest 2006;129(1
Suppl): 48S–53S.
Shawna L Strickland et al. AARC Clinical Practice Guideline: Effectiveness of Nonpharmacologic Airway Clearance Therapies in
Hospitalized Patients. RESPIRATORY CARE. 2013;58(!@):2187-2193
7. Complications of coughing
• Can cause bronchospasm
• Can cause rise in Blood pressures and fall in
cardiac output
• Tussive Syncopy
Oldenburg FA Jr, Dolovich MB, Montgomery JM, Newhouse MT. Effects of postural drainage, exercise and cough on mucus clearance
in chronic bronchitis. Am Rev Respir Dis 1979;120:739-745.
Stern RC, Horwitz SJ, Doershuk CF. Neurologic symptoms during coughing paroxysms in cystic fibrosis. J Pediatr 1988;112:909-912.
8. Huffing
• Huffing maneuver consists of forced expirations
without closure of the glottis.
• Because the intrapulmonary pressures during
huff are lower than with those with cough, it may
lead to less airway compression.
• Forced Expiratory Technique (FET), also known as
"huff coughing," consists of one or two huffs
(forced expirations) from mid-to-low lung
volumes with the glottis open, followed by a
period of relaxed, controlled diaphragmatic
breathing.
Partridge C, Pryor J, Webber B. Characteristics of the forced expiratory technique. Physiotherapy 1989;75(3):193-194.
Shawna L Strickland et al. AARC Clinical Practice Guideline: Effectiveness of Nonpharmacologic Airway Clearance Therapies in
Hospitalized Patients. RESPIRATORY CARE. 2013;58(!@):2187-2193
9. Adequate Huff
• Mouth Open, O shaped to keep the glottis
open.
• Forceful Expiration
• Muscles of chest and abdomen wall should
contract
• Sound is like a sigh, but forced.
Principles and Practice of Cardiopulmonary Physical Therapy 3rd Edition (Third Edition) by Donna Frownfelter, Elizabeth Dean
10. Take away points
• Coughing :Forceful expiration against closed
glottis
• Huffing :Forceful expiration against open glottis.
Sequence of Cough
• Adequate inspiration Glottis clossure
Building of intra thoracic and intra abdominal
pressure Glottis opening and expulsion.
• Patients can use huffing to enhance clearance
without excessive effort.
