Intrapulmonary Percussive Ventilation Research Articles

Lung volume recruitment and airway clearance for children at home in France

BackgroundAirway clearance (ACT) and lung volume recruitment (LVR) techniques are used to manage bronchial secretions, increase cough efficiency and lung/chest wall recruitment, to prevent and treat respiratory tract infections. The aim of the study was to review the prescription of ACT/LVR techniques for home use in children in France. MethodsAll the centers of the national pediatric noninvasive ventilation (NIV) network were invited to fill in an anonymous questionnaire for every child aged ≤20 years who started a treatment with an ACT/LVR device between 2022 and 2023. The devices comprised mechanical in-exsufflation (MI-E), intermittent positive pressure breathing (IPPB), intrapulmonary percussive ventilation (IPV), and/or invasive mechanical ventilation (IMV)/NIV for ACT/LVR. ResultsOne hundred and thirty-nine patients were included by 13 centers. IPPB was started in 83 (60 %) patients, MI-E in 43 (31 %) and IPV in 30 (22 %). No patient used IMV/NIV for ACT/LVR. The devices were prescribed mainly by pediatric pulmonologists (103, 74 %). Mean age at initiation was 8.9 ± 5.6 (0.4–18.5) years old. The ACT/LVR devices were prescribed mainly in patients with neuromuscular disorders (n = 66, 47 %) and neurodisability (n = 37, 27 %). The main initiation criteria were cough assistance (81 %) and airway clearance (60 %) for MI-E, thoracic mobilization (63 %) and vital capacity (47 %) for IPPB, and airway clearance (73 %) and repeated respiratory exacerbations (57 %) for IPV. The parents were the main carers performing the treatment at home. ConclusionsIPPB was the most prescribed technique. Diseases and initiation criteria are heterogeneous, underlining the need for studies validating the indications and settings of these techniques.

Effects of Intrapulmonary Percussive Ventilation in Nonventilated Patients Who Are Critically Ill on Length of Stay, Oxygenation, and Pulmonary Complications: A Randomized Controlled Trial

IntroductionPulmonary complications such as chest infection and pulmonary atelectasis may lead to respiratory failure, prolonged intensive care unit (ICU) stay and poor outcomes. Routine application of respiratory physiotherapy interventions is not supported by the current body of evidence. Intrapulmonary percussive ventilation (IPV) is used to treat various clinical conditions; however, the evidence to support its effectiveness in ICU remains weak. This study aimed to evaluate the effectiveness of IPV in improving outcomes in patients admitted to intensive care. Research questionWhat is the effect of IPV on ICU length of stay, oxygenation and pulmonary complications in non-ventilated critically ill patients compared to commonly applied chest physiotherapy (CPT). DesignRandomised controlled trial MethodsOf 201 patients screened, 106 were recruited. Participants with a respiratory impairment were randomly allocated to either the IPV or the CPT group. Both groups received two treatment sessions daily. Data were analysed for 100 participants for ICU length of stay, changes in oxygenation, respiratory rate and radiological findings. ResultsThe median LOS in the IPV group was 3.5 days (1.9, 5.9); in the CPT group, the LOS was 5.2 days (3.4, 9.9). The mean difference in LOS was 1.56 days (CI = 1.2 to 2.1 P = 0.002). The between-group difference (IPV minus CPT) for pre- to post-intervention SpO2 was 0.94% (95% CI = 0.43 to 1.45, P < 0.001). The between-group difference (IPV minus CPT) in respiratory rate was 2.1 breaths/minute, (95% CI: 0.9 to 3.2, P < 0.001). No significant difference in radiological atelectasis score was observed (P = 0.65). ConclusionsThis study showed that the IPV intervention reduced ICU-LOS and respiratory rate, with a small improvement in oxygenation compared to CPT interventions in non-ventilated patients. The use of IPV intervention may improve outcomes in critically ill patients with impaired respiratory function.

Albuterol Delivery via In-Line Intrapulmonary Percussive Ventilation Superimposed on Invasive Ventilation in an Adult Lung Model.

Intrapulmonary percussive ventilation (IPV) is frequently used for airway clearance, together with delivery of aerosolized medications. Drug delivery via IPV alone increases with decreasing percussion frequency and correlates with tidal volume (VT), whereas drug delivery via IPV during invasive ventilation is not well characterized. We hypothesized that drug delivery via IPV-invasive ventilation would differ from IPV alone due to control of ventilation by invasive ventilation. An adult ventilator circuit was used for IPV-invasive ventilation. A normal or a diseased lung model was configured to airway resistance of 5 cm H2O/L/s and lung compliance of 100 mL/cm H2O or to airway resistance of 20 cm H2O/L/s and lung compliance of 50 mL/cm H2O, respectively. The ventilator settings were the following: pressure control continuous mandatory ventilation mode, 10 breaths/min; PEEP, 5 cm H2O; FIO2 , 0.21; inspiratory time, 1 s; no bias flow; and inspiratory pressure, 10 or 15 cm H2O for the normal or the diseased lung model, respectively, to reach VT 500 mL with IPV off. Albuterol nebulized from an IPV device was captured in a filter placed before the lung model and quantitated by spectrophotometry. The maximum efficiency of albuterol delivery via IPV-invasive ventilation was not different from that via IPV alone (mean ± SD of loading dose, 3.7 ± 0.2% vs 4.2 ± 0.3%, respectively; P = .12). The mean ± SD albuterol delivery efficiency with IPV-invasive ventilation was lower for the diseased lung model versus the normal model (1.6 ± 0.3% vs 3.2 ± 0.5%; P < .001), which increased with decreasing percussion frequency. In contrast, the mean ± SD VT was lower for the normal lung model versus the diseased model (401 ± 14 mL vs 470 ± 11 mL; P < .001). Albuterol delivery via IPV-invasive ventilation was modulated by percussion frequency but was not increased with increasing VT. The delivery efficiency was not sufficiently high for clinical use, in part due to nebulizer retention and extrapulmonary deposition.

Albuterol Delivery During Invasive Mechanical Ventilation via In-Line Intrapulmonary Percussive Ventilation in a Pediatric Lung Model.

Patients receiving mechanical ventilation often require airway clearance and inhaled therapies. Intrapulmonary percussive ventilation (IPV) combines a high-frequency percussive ventilator with a jet nebulizer. Data on aerosol delivery efficiency of the device are scarce. We evaluated albuterol delivery efficiency while using an IPV in-line adapter under different conditions. A pediatric lung model of invasive mechanical ventilation was used. The following independent variables were evaluated: lung condition (normal vs ARDS), ventilator mode (adaptive pressure ventilation vs pressure control), percent opening of adapter (0% vs 25% vs 50%), IPV driving pressure (25 psi vs 40 psi), IPV percussion setting (easy vs hard), and endotracheal tube (ETT) size (3.5 mm vs 5.5 mm). Albuterol delivery efficiency (mass captured in the filter expressed as percentage of loading dose) was selected as the dependent variable. Albuterol was captured on a filter at the tip of the ETT and quantified via spectrophotometry (276 nm). Albuterol delivery efficiency ranged from 0-2.89%. Median (interquartile range) and 95% CI around the median were 0.54% (0.37-1.00) and 0.50-0.63%, respectively. The coefficient of determination (R2) for the model including all variables was 0.363. The 2 main contributors were percent of adapter opening (R2 0.30) and IPV setting (R2 0.039). Albuterol delivery during invasive mechanical ventilation via in-line IPV in a pediatric lung model was inefficient. Alternative methods of delivering bronchodilators and other inhaled medications should be considered when IPV is used.

Clinical application of intrapulmonary percussive ventilation: A scoping review.

Impaired respiratory function secondary to acute or chronic respiratory disease poses a significant clinical and healthcare burden. Intrapulmonary percussive ventilation (IPV) is used in various clinical settings to treat excessive airway secretions, pulmonary atelectasis, and impaired gas exchange. Despite IPV's wide use, there is a lack of clinical guidance on IPV application which may lead to inconsistency in clinical practice. This scoping review aimed to summarise the clinical application methods and dosage of IPV used by clinicians and researchers to provide guidance. A two-staged systematic search was conducted to retrieve studies that used IPV in inpatient and outpatient settings. MEDLINE, EMBASE, CINAHL, Scopus, and Google scholar were searched from January 1979 till 2022. Studies with patients aged ≥16 years and published in any language were included. Two reviewers independently screened the title and abstract, reviewed full text articles, and extracted data. Search yielded 514 studies. After removing duplicates and irrelevant studies, 25 studies with 905 participants met the inclusion criteria. This is the first scoping review to summarise IPV application methods and dosages from the available studies in intensive care unit (ICU), acute inpatient (non-ICU), and outpatient settings. Some variations in clinical applications and prescribed dosages of IPV were noted. Despite variations, common trends in clinical application and prescription of IPV dosages were observed and summarised to assist clinicians with IPV intervention. Although an evidence-based clinical guideline could not be provided, this review provides detailed information on IPV application and dosages in order to provide clinical guidance and lays a foundation towards developing a clinical practice guideline in the future.

Ex-vivo effects of intrapulmonary percussive ventilation on sputum rheological properties

Intrapulmonary percussive ventilation (IPV) has been postulated to enhance mucociliary clearance by improving tracheobronchial sputum rheological properties. The IPV effects on linear (viscoelasticity) and non-linear (flowing) rheological properties of 40 sputum samples collected from 19 patients with muco-obstructive lung diseases were investigated ex-vivo. Each sputum sample was split into 4 aliquots. These aliquots were independently placed in a circuit connected on one side to an IPV device and on the other side to a lung model that simulated spontaneous adult breaths. IPV was superimposed on simulated breathing. Three aliquots were exposed to a different IPV setting, modifying either percussion frequency or amplitude (4 Hz-200 L/min, 10 Hz-200 L/min, 10 Hz-140 L/min). One aliquot was only exposed to breathing (IPV was switched off, control condition). Each aliquot underwent 5 min of the pre-fixed mechanical stimulation before being recollected to proceed to rheological analysis. Neither percussion frequencies nor amplitudes had a significant impact on any sputum rheological properties studied. These results need to be confirmed in vivo.

P097 Assessment of intrapulmonary percussive ventilation on the rheology of bronchial secretions

P097 Assessment of intrapulmonary percussive ventilation on the rheology of bronchial secretions

Conventional chest physiotherapy compared to other airway clearance techniques for cystic fibrosis.

Conventional chest physiotherapy compared to other airway clearance techniques for cystic fibrosis.

Newer techniques of humidification and secretion clearance

This paper begins with a review of airway anatomy, physiology of airway secretions, alterations in disease, and the importance of the mucociliary escalator, especially in airway disease states (asthma, COPD, cystic fibrosis, bronchiectasis etc). Alternatives to treating mild to moderate hypoxemia with high flow nasal cannula oxygen (HFNCO) such as Vapotherm are mentioned. A relatively new technique called Intrapulmonary Percussive Ventilation (IPV®) seems very effective in secretion removal. A newer device called CoughAssist™ assists cough by mechanical insufflation-exsufflation and is very useful in neurological disease. The review then focuses on High Frequency Percussive Ventilation (HFPV), otherwise known as Volumetric Diffusive Ventilation (VDR®). Lastly, the use of biphasic cuirass ventilation for secretion removal has been described.

Intrapulmonary percussive ventilation for children with bronchiolitis on non-Invasive Ventilation support

Objective: Pediatric Intensive Care (PICU) admission of children with bronchiolitis as well as the use of Non-Invasive Ventilation (NIV) are increasing. The current treatment for bronchiolitis is supportive, and there are no specific studies addressing this group of severe bronchiolitis patients supported with NIV. Intrapulmonary Percussive Ventilation (IPV) is a lung recruitment physical therapy technique used in our PICU to augment lung aeration and improve gas exchange. We hypothesized that IPV treatment can be used to improve the clinical course of infants on NIV support suffering from bronchiolitis. Design: A prospective, open, randomized study. Setting: Single-center Pediatric ICU Patients: Children less than 2 years old admitted to our PICU between November 2016 and April 2018 with a diagnosis of bronchiolitis who were prescribed noninvasive positive pressure ventilation as their sole respiratory treatment modality Interventions: Patients were randomly assigned to two intervention groups: IPV vs. control (standard treatment). Measurements and main results: Thirty-eight infants with bronchiolitis treated with NIV support were randomized into two groups. The probability of a superior outcome (less chance of invasive mechanical ventilation and fewer PICU days) was 62.7% (95% CI, 45%-77%, p = 0.18) in the IPV group compared to the control group. Among the IPV group, there were no failures that required intubation in comparison to three intubations (13.6%) among the control group (p = 0.24). For the IPV group, the PICU length of stay (LOS) was 4.13 ± 2.45 days, compared to 6.18 ± 4.72 for the inhalation group. This difference was not statistically significant. Conclusions: In this single-center study, the use of IPV had no adverse reactions. The study failed to show a statistically significant effect of IPV treatment on the course of hospitalization of patients with bronchiolitis on NIV support in the PICU. Trial registration: Clinical Trials.gov NCT03037801.

Demonstration of mucus simulant clearance in a Bench-Model using acoustic Field-Integrated Intrapulmonary Percussive ventilation

Intrapulmonary Percussive Ventilation (IPV) is a high-frequency airway clearance technique used to help in mucus transport for mechanically ventilated and unventilated patients. Despite the many years of usage, this technique does not provide clear evidence of its intended efficacy. This is mainly attributable to the lack of in vitro observations that show “mucokinesis” towards the direction of the mouth. In the current manuscript, we demonstrate and subsequently propose a mechanism that details the movement of a mucus simulant in the proximal (towards the mouthpiece) direction. Towards this end, a novel method utilizing a high-frequency acoustic field in addition to the conventional air pulsations brought forth by traditional IPV is proposed. Under these conditions, at certain parameter settings, it is shown that the simulant is broken down into much smaller parts and subsequently pushed in the upstream direction gradually over a period of half-hour.

A systematic review on the effects of high frequency chest wall compression and intrapulmonary percussive ventilation in patients with neuromuscular disease

Background: Respiratory insufficiency is the most common cause of mortality among patients with a neuromuscular disease. Methods: We followed the PRISMA statement for systematic reviews. We explored the effects of high frequency wall compression and intrapulmonary percussive ventilation, compared to a control intervention, on the lung volume and capacity, and quality of life in patients with neuromuscular disease. We further assessed the effects of these two interventions on clinical value, complications, and survival. The literature search was performed on 30/06/2020 in Embase, MEDLINE, CENTRAL, PEDro and CINAHL on 6/07/2020. Inclusion criteria: patients with neuromuscular disease; interventions of interest mentioned above; randomised controlled trials comparing these interventions with a control intervention. Results: Five studies were included, and results were presented narratively. High frequency wall compression was not shown to be superior to standard care in terms of lung volume and capacity, quality of life, complications, and survival rate. Compared with standard care, intrapulmonary percussive ventilation showed non-significant differences in terms of lung volume and capacity, and the risk of respiratory infection. Standard care was nevertheless associated with a significantly higher risk of days of hospitalisation (Incidence Rate Ratio 8.5 [1.1-67]) and of antibiotic use than intrapulmonary percussive ventilation (Incidence Rate Ratio 43 [6-333]). The assessment with the risk of bias tool 2.0 showed a high risk of bias for all outcomes. Moreover, the evidence is of very low-quality for all outcomes. Conclusions: Due to large variety of reported outcomes, missing data and limited number of studies, no meta-analysis could be conducted. The results should be interpreted with caution as the results have a very low certainty of evidence and reported outcomes have a high risk of bias. The evidence for high frequency wall compression and intrapulmonary percussive ventilation is still insufficient to draw final conclusions. Registration: PROSPERO ID: CRD42017064703.

Chest Physiotherapy for Mechanically Ventilated Children: A Systematic Review.

The aim of this study was to appraise and summarize the effects of chest physiotherapy in mechanically ventilated children. A systematic review was completed by searching Medline, Embase, Cinahl Plus, PEDro, and Web of Science from inception to February 9, 2021. Studies investigating chest physiotherapy for mechanically ventilated children (0-18 years), in a pediatric intensive care unit were included. Chest physiotherapy was defined as any intervention performed by a qualified physiotherapist. Measurements of effectiveness and safety were included. Exclusion criteria included preterm infants, children requiring noninvasive ventilation, and those in a nonacute setting. Thirteen studies met the inclusion criteria: two randomized controlled trials, three randomized crossover trials, and eight observational studies. The Cochrane risk of bias and the Critical Appraisal Skills Program tools were used for quality assessment. Oxygen saturations decreased after physiotherapy involving manual hyperinflations (MHI) and chest wall vibrations (CWV). Although statistically significant, these results were not of clinical importance. In contrast, oxygen saturations improved after the expiratory flow increase technique; however, this was not clinically significant. An increase in expiratory tidal volume was demonstrated 30 minutes after MHI and CWV. There was no sustained change in tidal volume following a physiotherapy-led recruitment maneuver. Respiratory compliance and dead-space increased immediately after MHI and CWV. Atelectasis scores improved following intrapulmonary percussive ventilation, and MHI and CWV. Evidence to support chest physiotherapy in ventilated children remains inconclusive. There are few high-quality studies, with heterogeneity in interventions and populations. Future studies are required to investigate multiple physiotherapy interventions and the impact on long-term outcomes.

Effect of intrapulmonary percussive ventilation on intensive care unit length of stay, the incidence of pneumonia and gas exchange in critically ill patients: A systematic review.

Pulmonary complications such as pneumonia, pulmonary atelectasis, and subsequent respiratory failure leading to ventilatory support are a common occurrence in critically ill patients. Intrapulmonary percussive ventilation (IPV) is used to improve gas exchange and promote airway clearance in these patients. The current evidence regarding the effectiveness of intrapulmonary percussive ventilation in critical care settings remains unclear. This systematic review aims to summarise the evidence of the effectiveness of intrapulmonary percussive ventilation on intensive care unit length of stay (ICU-LOS) and respiratory outcomes in critically ill patients. In critically ill patients, is intrapulmonary percussive ventilation effective in improving respiratory outcomes and reducing intensive care unit length of stay. A systematic search of intrapulmonary percussive ventilation in intensive care unit (ICU) was performed on five databases from 1979 to 2021. Studies were considered for inclusion if they evaluated the effectiveness of IPV in patients aged ≥16 years receiving invasive or non-invasive ventilation or breathing spontaneously in critical care or high dependency units. Study titles and abstracts were screened, followed by data extraction by a full-text review. Due to a small number of studies and observed heterogeneities in the study methodology and patient population, a meta-analysis could not be included in this review. Outcomes of interest were summarised narratively. Out of 306 identified abstracts, seven studies (630 patients) met the eligibility criteria. Results of the included studies provide weak evidence to support the effectiveness of intrapulmonary percussive ventilation in reducing ICU-LOS, improving gas exchange, and reducing respiratory rate. Based on the findings of this review, the evidence to support the role of IPV in reducing ICU-LOS, improving gas exchange, and reducing respiratory rate is weak. The therapeutic value of IPV in airway clearance, preventing pneumonia, and treating pulmonary atelectasis requires further investigation.

Low-frequency Intrapulmonary Percussive Ventilation Increases Aerosol Penetration in a 2-Compartment Physical Model of Fibrotic Lung Disease

In patients with fibrotic pulmonary disease such as idiopathic pulmonary fibrosis (IPF), inhaled aerosols deposit mostly in the les affected region of the lung, resulting in suboptimal pharmacokinetics of airway-delivered treatments. Refinement of aerosol delivery technique requires new models to simulate the major alterations of lung physiology associated with IPF, i.e. heterogeneously reduced lung compliance and increased airway caliber. A novel physical model of the respiratory system was constructed to simulate aerosol drug delivery in spontaneously breathing (negative pressure ventilation) IPF patients. The model comprises upper (Alberta idealized throat) and lower airway (plastic tubing) models and branches into two compartments (Michigan lung model) which differ in compliance and caliber of conducting airway. Aerosol penetration and deposition (using NaF as a model aerosol) in the model was studied in different conditions. The model was able to reproduce the heterogeneous, compliance-dependent reduction in ventilation and aerosol penetration seen in the fibrotic lung regions in IPF. Addition of intrapulmonary percussive ventilation (IPV) induces a 2-3 fold increase in aerosol penetration in the low-complaince/high airway caliber compartment of the model, demonstrating the responsiveness of the model to therapeutic intervention. Thanks to the model, we observed that reduced compliance of target lung regions is a critical determinant of aerosol penetration, and thus presumably of aerosol deposition. This finding underscores the need for techniques specifically tailored to enhance delivery of inhaled aerosols to low compliance regions of lungs. Low-frequency IPV (≤ 3 Hz) pulses may represent an attractive option to increase aerosol deposition in fibrotic lung regions.

A systematic review on the effects of high frequency chest wall compression and intrapulmonary percussive ventilation in patients with neuromuscular disease

Background: Respiratory insufficiency is the most common cause of mortality among patients with a neuromuscular disease. Methods: We explored the effects of high frequency wall compression and intrapulmonary percussive ventilation, compared with standard care or no treatment, on the lung volume and capacity, and quality of life in patients with neuromuscular disease during respiratory infections or in stable periods. We further assessed the effects of these two interventions on clinical value, complications, and survival. The literature search was performed on Embase, MEDLINE, CINAHL, CENTRAL and PEDro. Randomised controlled trials and cross-over studies were eligible. Results: Five studies were included, and results were presented narratively. High frequency wall compression was not shown to be superior to standard care in terms of lung volume and capacity, quality of life, complications, and survival rate. Compared with standard care, intrapulmonary percussive ventilation showed non-significant differences in terms of lung volume and capacity, and the risk of respiratory infection. Standard care was nevertheless associated with a significantly higher risk of days of hospitalisation (Incidence Rate Ratio 8.5 [1.1-67]) and of antibiotic use than intrapulmonary percussive ventilation (Incidence Rate Ratio 43 [6-333]). Conclusions: Due to large variety of reported outcomes, missing data and limited number of studies, no meta-analysis could be conducted. The results should be interpreted with caution as the results have a very low certainty of evidence and reported outcomes have a high risk of bias. The evidence for high frequency wall compression and intrapulmonary percussive ventilation is still insufficient to draw final conclusions. Protocol registration: PROSPERO ID: CRD42017064703.

What’s new in airway secretions clearance for adults? A systematic review

Introduction. Airway clearance techniques are an essential part of routine respiratory physiotherapy, enabling bronchial secretion clearance—the mucus overproduction and retaining results in lung function deterioration and disrupts effective pulmonary rehabilitation. Several mucus clearance methods are included in the physiotherapy daily routine of patients with chronic lung conditions; nevertheless, new techniques and approaches are continuously developed. Aim. Thus, this systematic review summarizes novel airway clearance techniques applied in patients with chronic pulmonary conditions. Material and methods. The PubMed, Cochrane Library, and PEDro databases were searched from 2010 to 2021, and studies were selected based on eligibility criteria. Analysis of the literature. 101 patients from five studies describing four different techniques were included. Novel techniques were non-invasive ventilation, intrapulmonary percussive ventilation, trachea vibration, and PEP-sound wave combination. Significant improvements were noted for ventilation homogeneity (NIV), saturation (NIV), respiratory rate (IPV), and diffusion capacity (VL), whereas cardiovascular function and exercise endurance did not change significantly. Conclusion. The presented methods are considered to have similar effectiveness as well-known airway clearance techniques. However, the systematic use of presented methods in routine pulmonary rehabilitation must be preceded by in-depth investigation to provide no-bias results.

Theoretical investigation for the airway clearance of Intrapulmonary Percussive Ventilation(IPV)

Theoretical investigation for the airway clearance of Intrapulmonary Percussive Ventilation(IPV)

The influence of Intrapulmonary percussive ventilation on gastroesophageal reflux in infants under the age of 1 year

Intrapulmonary percussive ventilation (IPV) is an airway clearance technique used at any age to facilitate the removal of secretions from the respiratory tract. The effect of IPV on gastroesophageal reflux(GER) is not well documented. This study aimed to determine the influence of IPV on GER in infants. During a 24-hour multichannel intraluminal impedance-pH monitoring (MII-pH), infants in the intervention group received a20 minutes session of IPV in upright position, 2 hours postprandial. The control group received no intervention and was placed in the same position for 20 minutes, 2 hours postprandial. The number of reflux episodes (REs) during IPV as compared to the number of REs in the control group during the 20 minutes period. Fifty infants were included in each group;21 infants in the IPV group and 14 infants in the control group were diagnosed with abnormal MII-pH (P = .142). During IPV, the number of REs was significantly lower than in the control group (P < .001). Also in the subgroups with abnormal or normal MII-pH, a significantly lower number of REs during IPV was found (P = .011, P = .011 respectively). IPV decreases the number of REs in infants independent of the results of MII-pH.

Low-Frequency Intrapulmonary Percussive Ventilation Increases Aerosol Penetration in a 2-Compartment Physical Model of Fibrotic Lung Disease.

In patients with fibrotic pulmonary disease such as idiopathic pulmonary fibrosis (IPF), inhaled aerosols deposit mostly in the less affected region of the lungs, resulting in suboptimal pharmacokinetics of airway-delivered treatments. Refinement of aerosol delivery technique requires new models to simulate the major alterations of lung physiology associated with IPF, i.e., heterogeneously reduced lung compliance and increased airway caliber. A novel physical model of the respiratory system was constructed to simulate aerosol drug delivery in spontaneously breathing (negative pressure ventilation) IPF patients. The model comprises upper (Alberta ideal throat) and lower airway (plastic tubing) models and branches into two compartments (Michigan lung models) which differ in compliance and caliber of conducting airway. The model was able to reproduce the heterogeneous, compliance-dependent reduction in ventilation and aerosol penetration (using NaF as a model aerosol) seen in fibrotic lung regions in IPF. Of note, intrapulmonary percussive ventilation induced a 2–3-fold increase in aerosol penetration in the low-compliance/high airway caliber compartment of the model, demonstrating the responsiveness of the model to therapeutic intervention.