Precautions / Contraindications

1. General Precautions

• A patient must not make changes to any prescribed medication or prescribed treatment programme without consulting their doctor.
• Do not use the POWERbreathe EMT device whilst taking part in other activities where you may become distracted, such as walking, running, and driving.
• To prevent the potential transmission of infections, we recommend that your POWERbreathe EMT device is not shared with other users, including family members.
• POWERbreathe EMT is not intended to diagnose, treat, cure or prevent any disease.
• POWERbreathe EMT devices are designed for exercising the expiratory muscles only. No other use is intended or implied.
• Anyone who is under the age of 16 should only use a POWERbreathe EMT device with supervision from an adult. POWERbreathe EMT devices contain small parts and are not suitable for children under 7 years.
• Whilst training with the POWERbreathe EMT device, you should feel resistance when exhaling but it should not be painful. If you feel pain whilst using the POWERbreathe EMT device, stop immediately and consult your healthcare professional.
• Some users may experience slight ear discomfort when training with the POWERbreathe EMT device, especially if they are recovering from a cold. This is caused by inadequate equalisation of pressure between the mouth and ears. If symptoms persist, you should consult your doctor.
• If you are suffering from a cold, sinusitis, or respiratory tract infection, we advise that you do not use your POWERbreathe EMT device until symptoms have disappeared.
• If you start to feel dizzy using POWERbreathe EMT, please pause until recovered and take longer gaps between breaths.

2. Medical Precautions

Healthcare Professionals should take into consideration the following conditions before prescribing the use of POWERbreathe EMT to patients and assess its use on a case-by-case basis:

1. A history of spontaneous pneumothorax (a collapsed lung that was not due to traumatic injury e.g., broken rib), as this may lead to a recurrence of the condition. Following a traumatic pneumothorax and/or broken rib, the POWERbreathe EX1 should not be used prior to full recovery.
2. Pulmonary hypertension or large bullae on chest x-ray.
3. Seek medical advice and approval before using POWERbreathe EX1 with a patient who is undergoing Cerebrospinal Fluid Drainage (CSF drainage).
4. Epistaxis (nosebleeds).
5. Active haemoptysis.
6. Marked osteoporosis with a history of rib fractures.
7. Tracheostomy patients.
8. Recent (acute) stroke
9. Cardiac abnormalities

For the following conditions, POWERbreathe is not recommended until medical clearance has been obtained from a healthcare professional:

1. Patients who have undergone recent abdominal surgery and those with abdominal hernia.
2. A patient undergoing or recovering from oesophageal surgery.
3. Chest trauma or surgery, including cardiac surgery, as well as any recent oral, face or neck and skull surgery.
4. A patient suffering from Chostocondritis
5. A patient undergoing or recovering from a lung resection or lung transplant

3. Medical Contraindications

When determining if a patient is suitable for EMT, it is worth considering if a Valsalva manoeuvre would be contraindicated for their condition. This is because like the Valsalva manoeuvre, EMT involves exhaling as hard as possible while the nose is pinched closed. Therefore, if the generation of intrathoracic pressure (ITP) and/or intracranial pressure (ICP) is contraindicated for the Valsalva manoeuvre, then so too is the use of EMT.

Expiratory muscle training, such as the POWERbreathe EX1, is not recommended for patients with certain conditions, which include the following:

• Asthma patients who have a very low symptom perception and suffer from frequent, severe exacerbations or with an abnormally low perception of dyspnoea.
• If a patient is suffering from a ruptured eardrum or any other condition of the ear.
• Patients with marked elevated left ventricular end-diastolic volume and pressure.
• Patients with worsening heart failure signs and symptoms after Respiratory Muscle Training (RMT).
• A patient suffering excessive intraocular eye pressure.
• A patient who is or might be pregnant
• Untreated/uncontrollable gastroesophageal reflux disease
• Untreated and uncontrollable hypertension.