![]() 9, 11, 12 Additionally, the removal of secretion can decrease inflammation, and the fraction of exhaled nitric oxide (FeNO), a noninvasive breath biomarker of airways inflammation, could be a helpful method to evaluate the effects of CPT. The comparison between inspiratory and expiratory R and X may be used as a marker of airflow limitation in patients with COPD 10, 11 and IOS measures have been used to assess central and distal airway responses to interventions. Impulse oscillometry gives a functional assessment of airways, particularly small airways, beyond that available from conventional lung function tests, 9, 10 based on the concept that the impedance of the respiratory system (Zrs) can be conceived as a generalization of resistance since it embodies both the in-phase (resistance-R) and out-of-phase (reactance-X) relationships between the pressure and the flow. The effects of flutter exercises on airways resistance are not well characterized 5– 8 and impulse oscillometry (IOS) can be a noninvasive, reliable, and easy-to-perform method to assess respiratory system resistance. 4 The flutter creates a fluctuating positive expiratory pressure at the mouth and intrathoracic oscillations within the respiratory tree that mobilize airway secretions facilitating their clearance and improving airflow within the airways. The ACT can include the oscillating positive expiratory pressure devices using the flutter valve that is a simple, small, pipe-shaped device described by Lindemann in 1992. Physiotherapy is an integral part of the multidisciplinary management of COPD patients and a recent Cochrane review indicates that airway clearance techniques (ACT) are safe for individuals with COPD and confer small beneficial effects on some clinical outcomes such as a reduction in the need for hospital admission and improvement in health-related quality of life. 2 These pathophysiological features contribute to clinical manifestations of dyspnea, sputum production, and exercise limitation. ![]() 1 Chronic obstructive pulmonary disease patients exhibit pathological changes in the small airways, where inflammation may cause increased viscid mucus secretions that further narrow the airway lumen and increase the resistance to airflow. The use of flutter can decrease the respiratory system resistance and reactance and expiratory flow limitation in stable COPD patients with small amounts of secretions.Ĭhronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation usually progressive and associated with an enhanced chronic inflammatory response in the airways to noxious particles or gases. Following 20 min of rest, a decrease in the R5, ΔR5, R20, X5, and Ax was observed, with R5, R20, and X5 values lower than baseline, with a moderate effect size there were no changes in FeNO levels or spirometry. Respiratory system resistance (R): in COPD patients an increase in X5insp (−0.21 to −0.33 kPa/L/s) and Fres (24.95 to 26.16 Hz) occurred immediately after flutter exercises without bronchodilator. ![]() Thirty minutes of flutter exercises: a “flutter-sham” procedure was used as a control, and airway responses after a short-acting bronchodilator were also assessed. Randomized crossover study: 15 COPD outpatients from Asthma Lab–Royal Brompton Hospital underwent spirometry, impulse oscillometry (IOS) for respiratory resistance (R) and reactance (X), and fraction exhaled nitric oxide (FeNO) measures. This study aims to evaluate the acute effects of an oscillating positive expiratory pressure device (flutter) on airways resistance in patients with chronic obstructive pulmonary disease (COPD).
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