Lung Expansion Therapy vs Bronchohygiene Therapy
Lung Expansion Therapy vs Bronchohygiene Therapy
Bronchial Hygiene Therapy is a wide definition of different tactics used for clearing airway which include manual hyperventilation, chest physiotherapy and breathing exercises. In the manual hyperventilation patients are intubated. Chest physiotherapy on the other side is composed of coughing, postural drainage, suctioning and vibration. Breathing exercises on the other hand consists of diaphragmatic breathing for impulsively breathing patients and huffing. The Bronchial Hygiene Therapy (BHT) is done so as to enhance clearance of secretions hence reducing impediments in the airway to increase ventilation and exchange of gases. BHT is required for diseases such as bronchiectasis and cystic fibrosis whereby bronchiectasis is widening of bronchi causing risks of infections. While cystic fibrosis is a hereditary disorder stirring exocrine glands hence leading to production of thick mucus which blocks bronchi, pancreatic ducts and intestines implicating to respiratory infection.
Additionally, when treating cystic fibrosis coughing should be enhanced to the patients because it leads to sputum expectoration. Coughing is effective in BHT hence regular exercises are required to the patients so as to improve pulmonary functioning. Although, there are some conditions which require undermined airway clearance such as use of mechanical ventilation and artificial airways. The conditions include postoperative complications, amyotrophic lateral sclerosis, respiratory disorders, congenital disorders and degenerative neuromuscular diseases (Hampton Regional Medical Center: Bronchial Hygiene Therapy, 2018).
Moreover, manual cough and manual ventilation methods used in Bronchial Hygiene Therapy (BHT) are performed similarly. They involve clear secretions to maintain bronchial hygiene to patients who have weak cough force caused by abdominal muscle weakness. It is done by a therapist who places hands on epigastric area of the patient with the heel of one hand on the abdomen while the other hand is placed on top of the first hand with fingers spread apart and both hands interlocked. The patients breathe deeply as the therapist compresses the abdomen quickly down and inward as the patients tries to cough (Lung Expansion and Bronchial Hygiene Therapy, 2018).
Furthermore, self-manual cough is a technique used in BHT which is done by patients with full extremity function. The patients lock their hands together across epigastric area and push diagonally toward the head as they strive coughing in either sitting or supine position. While to patients with C6 lesions, they do it by throwing their arms across the epigastric area as they move forward while trying to cough in the sitting position and placing a pillow in the lap. The pillow is used so as to increase abdominal compression to enhance coughing. Although a therapist is supposed to supervise them to ensure they are using the right procedures.
Another BHT technique is postural drainage applies positions which enhance movement of diaphragm by reducing weight of abdominal contents on the diaphragm. It is implemented to most patients with weak and good diaphragm strength, paraplegia and patients with high lesions. Corsets might be required in upright position and side lying so as to drain posterior segments of upper lobes. It is done by a quarterly turn on the chest with the arm over a pillow so as to ensure that the diaphragm is not under pressure. In addition, chest auscultation should be performed to patients with spinal instabilities so as to get the best position which is established on distinct lobes that require drainage.
Lastly, suctioning is recommended on top of postural drainage as a BHT technique. It is used because of poor cough function to collect more mucus in the lungs. Although there are cautions taken when it comes to acute tracheostomy patients due to their susceptibility to infection during the first eight weeks. Thus, sterile suctioning techniques are required on them. Additionally, bradycardia patients should be checked well when performing suctioning to them. This is due to the fact that it may stimulate vagus nerve leading to a reduction in heart rate. Moreover, atelectasis patients are recommended intermittent positive pressure breathing due to the fact that they are known for retaining secretions.
On the other side, lung expansion therapy consists a collection of respiratory care techniques designed to increase lung volumes for patients and to improve lung compliance. The therapy has a purpose of preventing or treating pulmonary atelectasis and interconnected issues originated from post-op thoracic or abdominal surgery. Other related issues include chest trauma, weaken breathing muscles, neuromuscular diseases, chest wall injury and heavy sedation. In earlier days intermittent positive pressure breathing was purposely used to solve issues in lung respiratory system.
Although nowadays there are other alternatives for lung expansion therapies which include positive expiratory pressure and continuous positive airway pressure. Thus, combination of the techniques have resulted to improvement in respiratory muscle strength. In that case, the intermittent positive pressure breathing enhances distribution of homogenous gas in the lung resulting in recruitment of collapsed alveoli. While positive expiratory pressure decreases risk of respiratory muscle fatigue by intercepting early airway collapsing during expiration. Although research has shown that there are patients who benefit from them while others do not. Therefore, patients should be carefully selected and the approach administered to them be monitored closely by the respiratory care practitioner (Fisher, 2018).
Lung volume being the consignment of air that a person can hold reduces as an individual ages especially after mid-twenties. Although due to some diseases the reduction speed increases as they affect lung functioning. Therefore, causing breathing problems and shortness of breath. Consequently, there are exercises which assist in lung expansion to enhance healthy lungs by giving the body enough oxygen. Some of the exercises include rib stretch and diaphragmatic breathing.
Rib-stretch involves holding more air in the lungs for as long as it is safely possible. It improves lung space and function when used at least once a day. It is done by a person standing upright with their back arched, exhale all oxygen from their lungs, breathe slowly as they fill the lungs, hold breathe for like ten seconds and slowly exhale. On the other hand, diaphragmatic breathing involves the diaphragm in heavy lifting as the person breathes. It is recommended as a good exercise to people with Chronic Obstructive Pulmonary Disease (COPD) because their diaphragms need to be strengthened. Therefore, people with COPD should be directed by a therapist to enhance better results. Thus, the exercise should be done by relaxing shoulders, sitting back and then lie down. On top of that place one hand on the belly and the other one on the chest. In addition inhale through the nose for like two seconds causing the air to move into the abdomen as it feels the stomach. Finally breathe out for two seconds and repeat (Sconiers, 2018).
In conclusion both bronchial hygiene therapy and lung expansion therapy are aimed at solving breathing complications. The use of IPPB therapy is beneficial for patients requiring prolonged mechanical ventilation. This is due to the fact that it improves lung volume and oxygenation. Moreover, therapists performing the tasks must be cautious when it comes to excluding some patients from some of techniques which might indeed lead to more complications. For example, acute tracheostomy patients who require sterile suctioning techniques due to their vulnerability. Finally, contradictions in the therapies such as patient being unable to breathe deeply and effectively in lung expansion therapy should also be checked upon.
Hampton Regional Medical Center: Bronchial Hygiene Therapy. (2018). Hamptonregional.com. Retrieved 15 March 2018, from http://www.hamptonregional.com/getpage.php?name=BHT
Lung Expansion and Bronchial Hygiene Therapy. (2018). afnanalraimi. Retrieved 15 March 2018, from https://afnanalraimi.wordpress.com/2015/11/29/lung-expansion-and-bronchial-hygiene-therapy /
Fisher, D. (2018). Lung Expansion Therapy. Clinical Gate. Retrieved 15 March 2018, from https://clinicalgate.com/lung-expansion-therapy/
Sconiers, H. (2018). Breathing Exercises to Increase Lung Capacity. LIVESTRONG.COM. Retrieved 15 March 2018, from https://www.livestrong.com/article/22608-breathing-exercises-increase-lung-capacity/