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Abstract
ABSTRACT Several respiratory diseases are characterized by hypersecretion, requiring airway clearance therapy (ACT). Oral high-frequency oscillation (OHFO) devices are effective to enable daily ACT; however, they are still too expensive to become available for low-income patients. We sought to develop a low-cost device (OHFO-LC) and compare its physical properties with those OHFO commercially available (Shaker and Flutter). The OHFO-LC was developed from polyvinyl chloride material and one stainless steel sphere. Pressures and frequencies were measured at flows of 4, 6, 8, 10 and 15L/min. Pressures at the mouthpieces were measured by a transducer connected to a microcomputer. The oscillation frequencies were obtained from the graph of the pressure. The frequencies and pressures were compared among groups using one-way Anova and Tukey’s post hoc tests, p≤0.05. There were no differences among the frequencies of the three devices in all tested flows. The OHFO-LC device showed a higher positive expiratory pressure compared with the Shaker at all tested flows (4 L/min: 4.7±1.2 vs. 1.0±0.2 cmH2O; 6 L/min: 8.6±1.5 vs. 3.5±0.5 cmH2O; 8 L/min: 10.8±1.6 vs. 5.4±0.2 cmH2O; 10 L/min: 13.5±1.2 vs. 7.7±0.4 cmH2O; 15 L/min: 14.3±1.1 vs. 7.8±0.2 cmH2O; OHFO-LC vs. Shaker; p≤0.05) and at 10 and 15 L/min compared with Flutter (10 L/min: 13.5±1.2 vs. 7.5±1.2 cmH2O; 15 L/min: 14.3±1.1 vs. 8.2±1.2 cmH2O; OHFO-LC vs. Flutter, p≤0.05). The cost of the OHFO-LC device was much lower than both the Shaker and the Flutter. Our results showed that the OHFO-LC had physical properties with similar frequencies but higher pressures than other OHFO devices that are commercially available. Future studies are necessary to evaluate its clinical efficacy.
Highlights
Several respiratory diseases such as cystic fibrosis, chronic bronchitis and bronchiectasis are characterized by the increased production and accumulation of mucus secretion in the airways, predisposing these patients to recurrent infections throughout life, contributing to airway and parenchymal damage
There are several techniques of airway clearance therapy (ACT), and some of them such as the slow expiration with glottis opened in lateral posture (ELTGOL, an acronym from the French term l’expiration lente totale glotte ouverte en decubitus lateral), autogenic drainage (AD), active cycle of breathing technique (ACBT) and oral high-frequency oscillation (OHFO) devices can be performed by the patient
The stainless steel sphere, is approximately twice the size of the stainless steel sphere of the other two OHFO devices. This difference is due to the sphere sitting: the Flutter VRP1 and the Shaker spheres sit in a circular cone inside the bowl of the pipe, while the sphere of the OHFO-LC remains in the elbow of a 3/4 inch diameter polyvinyl chloride (PVC) pipe
Summary
Several respiratory diseases such as cystic fibrosis, chronic bronchitis and bronchiectasis are characterized by the increased production and accumulation of mucus secretion in the airways, predisposing these patients to recurrent infections throughout life, contributing to airway and parenchymal damage. Flutter VRP1 (designed by Lindemann[6] and produced by Axcan Scandipharm Inc., Birmingham, Alabama, USA) and the Shaker (a prototype developed by the NCS Indústria e Comércio, São Paulo, São Paulo, Brazil) are OHFO devices that are commercially available with the same vibration mechanism Both devices have the shape of a smoking pipe and consist of four parts: (1) a body with a mouthpiece; (2) a conical cavity; (3) a stainless steel sphere; and (4) a protective cap through which expired air flows. The stainless steel sphere provides resistance to exhaled air, opening and closing the air passage and producing pressure oscillations It produces a vibration at approximately 15Hz, compatible with those necessary for the removal of secretions[2]
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