Respiratory Physiotherapy using the Shaker by POWERbreathe

If you have a disease that results in sputum production, your physiotherapist will prescribe respiratory physiotherapy for you. Initially, this will involve the physio assessing you to identify the problem. As a result, management techniques and a treatment plan will be put in place. This will include airway clearance techniques, such as oscillating PEP. Different types of mucus clearance device use oscillating PEP, including the Shaker by POWERbreathe. Such devices combine the techniques of positive expiratory pressure (PEP) with oscillations. Your physio will refer to these as ‘oscillatory positive expiratory pressure’, or OPEP devices.
Respiratory Physiotherapy using the Shaker by POWERbreathe, by BreatheWellPhysio
Respiratory Physiotherapy using the Shaker by POWERbreathe, courtesy of Breathe Well Physio.

Shaker mucus clearance devices

The Shaker device will help to shift your bronchial secretions by combining PEP and oscillations. This combination will help you to expectorate the increasing amount of mucus you’re producing. By coughing out more mucus, you’re helping to prevent infections of your respiratory tract. It is also helpful if you have hay fever, which can make symptoms of asthma, such as coughing and wheezing, feel worse. Devices like the Shaker are easy-to-use without medical supervision, so you may decide to use it as an alternative, or additional, treatment to your prescribed medical respiratory physiotherapy. Although it works similarly to the older Acapella mucus clearance device, research reveals the Shaker to have better linearity at higher airflows. The same research also finds the pressure amplitude produced by the Shaker and Flutter mucus clearance device to be greater at low and high pressures. Finally, the same study shows a higher frequency of oscillation for the Shaker and Flutter at an intermediate pressure. This is all beneficial in helping you get the most from your therapy. The Shaker Classic, Shaker Deluxe and Shaker Medic Plus by POWERbreathe all mobilise mucus using oscillatory positive expiratory pressure (OPEP). An important point to note is that the Shaker devices are all gravity-dependent, as opposed to gravity-independent. This is worth bearing in mind as a 2018 study finds,
“the gravity-dependent devices were the ones to display close mechanical performances and produce optimal operational parameters at the simulated exhalation settings.” https://erj.ersjournals.com/content/52/suppl_62/OA5191
By contrast, this same study finds that the two gravity-independent OPEP devices, the Acapella Choice and Aerobika, “probably require higher expiratory pressure to reach theoretical therapeutic effectiveness.”

Therapeutic effects of the Shaker

If you have a condition such as chronic bronchitis, cystic fibrosis, bronchiectasis or asthma, then you’ll be only too aware of the excessive amount of mucus you produce. You may also notice a change in the type of mucus you’re producing. Because of this, it’s no surprise that you’ll be having difficulty clearing the mucus, even after coughing. But this is where using the Shaker by POWERbreathe for respiratory physiotherapy can help you. The Shaker uses a stainless-steel ball, weighing 30g, to help clear bronchial secretions. It does this by ‘shaking’ and causing a vibration, or percussion, in your chest. This happens as you exhale through the mouthpiece. As you breathe out through the device, the 30g steel ball provides a resistance. This causes the ball to move and shake and makes it more difficult for you to breathe out. All this shaking and vibration loosens the mucus. After breathing out through it a few times, you’ll find you’ll need to huff, or cough, to expel the mucus. You can see this being demonstrated in the video above. After a few uses, you’ll begin to work out for yourself how long and how frequently you’ll need to use your Shaker device, as everyone is different. To further enhance the therapeutic effect of your Shaker airway clearance device, its mouthpiece is designed to allow you to use it in a sitting or lying position.

Respiratory physiotherapy techniques

In respiratory physiotherapy, no one technique fits all. A therapist must take into consideration the strength of their patient, the thickness of their mucus and where it is located. However, as a patient, the price may be a criterion for selecting the most suitable device. In this 2013 study, assessment of the Flutter, Acapella and Shaker shows all three mechanical behaviours to be reliable. However, the Shaker is likely to be the most cost-effective. This type of respiratory physiotherapy aims to help you clear excessive phlegm, sputum, mucus and catarrh. Consequently, breathing effort reduces and exercise tolerance improves, helping you return to a better quality of life. Young children benefit from respiratory physiotherapy too, but they will require something with a lighter resistance to exhale against. If you have children, you’ll know that you’ll also need to make their therapy more fun. Blowing games using the Flowball by POWERbreathe can help them to clear secretions.

Precautions

You should always consult a doctor before starting any treatment if you’re concerned about any medical issue.

Relating to COPD – a report that looks into living with COPD

The World Health Organization (WHO) predicts COPD will be the third leading cause of death in 2030. In fact, the chief causes of death globally has shifted. Whereas the main cause of death used to be from infectious diseases, it is now from noncommunicable diseases. Diseases with chronic conditions, such as COPD.

Living with COPD

COPD (Chronic Obstructive Pulmonary Disease) is a group of lung conditions that cause airflow blockage and result in breathing-related problems. It includes emphysema and chronic bronchitis. The narrowing of the airways makes it harder for people with COPD to breathe in and out. And it’s these breathing difficulties that can affect many aspects of daily life. It can reduce quality of life.

There are many people living with the disease that know how to manage their condition. However, there are millions of others who are living with undiagnosed symptoms of COPD.

Statistics

The UK is 12th on the list of the top 20 countries for COPD mortality in the world. However, rates are higher in New Zealand and the United States. These statistics for COPD are part of the Respiratory Health of the Nation project, for The British Lung Foundation.

Relating to COPD

This report, however, Relating to COPD, takes an alternative look into those living with COPD. It has been compiled from the viewpoint of those with experience of COPD. So, in fact, it looks into the physical and emotional effects of COPD. An online forum inspired the idea. The study looked at keywords and phrases to understand how living with COPD makes people feel, and how deeply it can impact their daily lives.

How COPD Affects Breathing

One of the most common questions asked by people with COPD is how it affects breathing. To understand this, it’s first worth understanding how your lungs work.

How your lungs work

As you breathe in, you bring air down through your windpipe and into your airways. Your airways then branch out in your lungs into thinner tubes, called bronchioles. And at the end of your bronchioles are small air sacs.

Running along the walls of your air sacs are small blood vessels, or capillaries. When the air you breathe in reaches your air sacs, the oxygen passes through the air sac wall and into the blood in the capillaries. As this is happening the waste product carbon dioxide (CO2) moves from the capillaries and into the air sacs. This process is called gas exchange; bringing vital oxygen in to the body while removing the waste CO2.

How COPD affects breathing

Chronic Obstructive Pulmonary Disease is a group of lung conditions used to describe progressive lung diseases. These include emphysema, chronic bronchitis, non-reversible asthma, and some forms of bronchiectasis. All conditions cause breathing difficulties. If you have COPD you’ll know how difficult it is to empty air out of your lungs. This is because your airways have narrowed.

In a person without COPD, their healthy airways and air sacs are stretchy. After filling with air they will bounce back after being emptied. This elasticity helps to move air quickly in and out of the lungs.

However in a person with COPD, their airways and air sacs are no longer stretchy. They no longer bounce back. They also become swollen, thicker, and produce more mucus, making it harder to get air out of the lungs. This is what causes the symptoms of wheezing, chesty cough and breathlessness.

How COPD is treated

Unfortunately damage caused by COPD is permanent. However there are treatments that can help to stop it from progressing. Symptoms can also be managed. So with prevention the key to living with COPD, pulmonary rehabilitation is a hugely beneficial treatment.

Treatments include medication, inhalers and pulmonary rehab, including breathing exercises. Part of a Pulmonary Rehab Toolkit (Lung Foundation Australia) is Inspiratory Muscle Training (IMT), such as POWERbreathe. In fact there are many clinical studies showing the benefits of IMT for COPD. One such study concluded,

“…during IMT in patients with significant COPD, there is an increase in exercise capacity, improvement in quality of life, and decrease in dyspnea. The study also provides evidence that long-term IMT can decrease the use of health services and hospitalization days.”

Pulmonary Rehabilitation Toolkit
Pulmonary Rehabilitation Toolkit

Inspiratory Muscle Training (IMT)

A clinical study, published in the official journal of the American College of Chest Physicians, assessed The Effects of 1 Year of Specific Inspiratory Muscle Training in Patients With COPD.

Using POWERbreathe IMT it found improvements in patients with COPD, of:

  • Inspiratory muscle strength of 55%
  • Endurance of 86%
  • Quality of life by 21%
  • Dyspnoea (difficult or laboured breathing) by 36%

 

Phlegm in lungs – clear naturally with drug-free Shaker

You will usually find phlegm in the back of the throat or in the lungs. It is produced by the lower airways. Mucus on the other hand will normally be found in the mucous membranes inside the nose. It acts like a filter protecting your lungs as you inhale. To clear it you simply blow your nose. Phlegm however is thicker and more viscous. You usually only notice it when you cough it up. An excess of this secretion can be a symptom of a respiratory problem such as bronchitis.

Why you should cough up phlegm

Although unpleasant, you can safely swallow mucus. This is because your body can safely reabsorb it. Phlegm however must be expelled from the body. Advice from healthcare professionals is to cough it up. This is because it will contain virus and dead bacteria. As you cough it up you are helping your body to get rid of the infection.

What to do when phlegm is problematic

Secretions will be more of a problem at night. This is simply because of gravity. These secretions will feel heavy in your chest. This can bring on coughing. You can allieviate this by elevating your sleeping position. Simply prop yourself up more with a pillow. Coughing is actually your body’s natural way of expelling the phlegm. This will help you to get better.

Expel phlegm with drugs – or drug-free

Expectorants can be prescribed to help increase bronchial secretion. They are intended to help make it easier to cough it up. But expectorants are medicines. Shaker by POWERbreathe however is an effective drug-free alternative.

Expel phlegm naturally with the Shaker

The Shaker by POWERbreathe literally ‘shakes’ secretions in your chest to make them more mobile. The shaking breaks these secretions down and makes it easier for you to cough it up.

How the Shaker works

Inside the Shaker device is a weighted ball. As you breathe in through the device the ball rises and then falls again under its own weight. This happens quickly and feels like vibrations. This vibration and gentle resistance dislodges and thins phlegm. You’re then more able to expel it by coughing.

Who can use the Shaker

Because the Shaker is drug-free and easy-to-use, children and adults can use it. And because it shakes up phlegm, it is ideal for people with respiratory problems. These include Chronic Bronchitis, Bronchiectasis, Emphysema, Asthma and Cystic Fibrosis. There are however some precautions which you will find on the Shaker Classic, Shaker Deluxe and Shaker Plus product pages.

A Modified Breathing Exercise Program For Asthma Is Easy To Perform And Effective

Published online (June 2016) is this new study in the Journal of Asthma, A modified breathing exercise program for asthma is easy to perform and effective. The study evaluated a simple, modified breathing exercise program investigating how easy it was to perform and how effective it was as an adjunctive therapy. The program incorporated three different breathing exercises (yoga pranayama techniques, diaphragmatic breathing and pursed lip breathing), each of which was taught to the 74 subjects. Conclusion: “A simple program of breathing exercises was found to be effective and could be completed in less than 10 minutes per day. Furthermore, there was a statistically significant improvement in Asthma Control Test (ACT) scores post-exercise.” One of the exercises, diaphragmatic breathing, can be performed easily in the home without tuition by using POWERbreathe Inspiratory Muscle Training devices. (Please check with your healthcare provider first.) The scientifically proven training regimen is just 30 breaths twice a day which takes about 5 minutes. POWERbreathe exercises the muscles used to breathe in, primarily the diaphragm and intercostal muscles. It uses the principles of resistance training to exercise these inspiratory muscles by making you breathe in through the device against an adjustable variable ‘load’. It’s like ‘dumbbells for your diaphragm’, and the more you use it the stronger your breathing muscles become; the stronger they become the more you increase the load, improving your ability to take a deeper, more satisfying breath. This training not only makes your breathing muscles stronger but it also improves their stamina and reduces fatigue, improving quality of life in those with breathing problems such as asthma and COPD, and improving performance in those who’re physically active.

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POWERbreathe Medic helps patients with breathing problems AND saves NHS money and resources

Health bosses announced back in October 2014 that the NHS in England needed extra money and an overhaul to services in order for patient care not to suffer.

When it comes to respiratory care the NHS could save both money and resources if they prescribed POWERbreathe Medic Respiratory Muscle Training (RMT) for patients with medical conditions such as COPD, Heart Failure, Asthma, Thoracic Surgery, Ventilator Weaning, Cystic Fibrosis and Neuromuscular Disease.

In a 2005 study of the benefits of a 12-month programme of POWERbreathe RMT, researchers observed significant reductions in the use of healthcare resources.1

POWERbreathe RMT for COPD

Accordingly to Professor Peter Calverley (Lung Report III. British Lung Foundation), in the average PCT serving 250,000 people, there would be 14,200 GP consultations per year for chronic obstructive pulmonary disease (COPD), and 9,600 inpatient bed days. Reducing length of hospital stay is an NHS productivity indicator.

POWERbreathe reduced hospital bed days by 29% and GP consultations by 23% compared with placebo (see table above).

POWERbreathe RMT for Asthma

In another study, Weiner et al2 observed an 86% reduction in hospitalisations/emergency room visits following respiratory muscle training in moderate/severe asthmatics (from 1.4 to 0.2 per 3 months per patient).

And in three separate studies, Weiner et al. observed an average 51% reduction in β2-agonist consumption (from 3.9 to 1.6 puffs per day)2,3,4 after respiratory muscle training, and in one study3, corticosteroid use decreased ~80%.

How POWERbreathe Medic could save NHS money & resources

In 2005 when this study was conducted, the total potential annual savings derived from POWERbreathe Medic prescription per average PCT due to reduced hospital bed days and medication consumption (not including savings due to reduction in GP consultations) were substantial.

The POWERbreathe Medic offers an evidence-based, drug-free treatment for patients with medical conditions such as COPD, Heart Failure, Asthma, Thoracic Surgery, Ventilator Weaning, Cystic Fibrosis and Neuromuscular Disease. It is the only Inspiratory Muscle Training device for RMT available for prescription that has been used in research into the benefits of IMT for a variety of medical conditions and prescribed by medical professionals as either a standalone intervention or as part of a rehabilitation programme.

For respiratory care professionals there is a POWERbreathe Medic Try-Before-You-Prescribe demonstration kit; an educational tool designed to help healthcare professionals and patients understand and experience the effect POWERbreathe Medic has on the respiratory muscles.

Since the approval of the POWERbreathe Medic for prescription in 2006, POWERbreathe has introduced the revolutionary, electronic POWERbreathe KH1, intended for use by healthcare professionals for respiratory muscle training and assessment in patients with dyspnoea, including patients with asthma, COPD, bronchitis, cystic fibrosis, emphysema, heart disease, neuromuscular disease, Parkinson’s disease and spinal injury.

The POWERbreathe KH1 is also suitable for use with disposable TrySafe filters and can be used bedside, on the ward, as part of a pulmonary program, or for single patient use at home under medical supervision.

Launched after the POWERbreathe Medic, following the latest technological advances in research and design, is the next generation POWERbreathe Medic: the POWERbreathe Medic Plus for patients to use at home, straight out of the box, with improved airflow dynamics and a more comfortable user experience. And for healthcare professionals (and their patients), is the new POWERbreathe KH2 with Breathe-Link Medic Live Feedback Software.

References:

  1. Beckerman M, Magadle R, Weiner M, Weiner P. The effects of 1 year of specific inspiratory muscle training in patients with COPD. Chest. 2005 Nov;128(5):3177-82.
  2. Weiner P, Azgad Y, Ganam R, Weiner M. Inspiratory muscle training in patients with bronchial asthma. Chest. 1992;102(5):1357-61.
  3. Weiner P, Berar-Yanay N, Davidovich A, Magadle R, Weiner M. Specific inspiratory muscle training in patients with mild asthma with high consumption of inhaled beta(2)-agonists. Chest. 2000;117(3):722-7.
  4. Weiner P, Magadle R, Massarwa F, Beckerman M, Berar-Yanay N. Influence of gender and inspiratory muscle training on the perception of dyspnea in patients with asthma. Chest. 2002;122(1):197-201.

Effects of IMT and Calisthenics-and-Breathing Exercises in COPD

STUDY:

Effects of Inspiratory Muscle Training and Calisthenics-and-Breathing Exercises in COPD With and Without Respiratory Muscle Weakness.

Published in Respiratory Care (Nov 10 2015), the aim of this study was to “compare the effects of inspiratory muscle training and calisthenics-and-breathing exercises associated with physical training in subjects with COPD as an additional benefit of strength and endurance of the inspiratory muscles, thoracoabdominal mobility, physical exercise capacity, and reduction in dyspnea on exertion.”

CONCLUSIONS:

Both the inspiratory muscle training group and the calisthenics-and-breathing exercises group increased their exercise capacity and decreased dyspnea during physical effort.

Inspiratory muscle training however was more effective in increasing inspiratory muscle strength and endurance which could result in a decreased sensation of dyspnea. Also, subjects with respiratory muscle weakness who performed inspiratory muscle training showed higher gains in inspiratory muscle strength and endurance but not of dyspnea and submaximal exercise capacity.

 

Effects of IMT on Breathing Pattern in Patients With COPD

The purpose of this clinical trial, sponsored by Katholieke Universiteit Leuven, Belgium, is based on how improvement in inspiratory muscle function might result in beneficial changes in breathing pattern during whole body exercise. The hypothesis is the effect of inspiratory muscle training as an adjunct to a pulmonary rehabilitation program improves the breathing pattern during an incremental cycle exercise.

Read the clinical trial, Effects of Inspiratory Muscle Training on Breathing Pattern in Patients With Chronic Obstructive Pulmonary Disease

Check out more Inspiratory Muscle Training Research here >

Discover POWERbreathe used in Research here >

Expiratory + IMT Improves Respiratory Muscle Strength in Subjects With COPD

Published in Respiratory Care: September 1, 2014 vol. 59 no. 9 1381-1388

STUDY

Expiratory and Expiratory Plus Inspiratory Muscle Training Improves Respiratory Muscle Strength in Subjects With COPD: Systematic Review

Leonardo F Neves, Manoela H Reis, Rodrigo DM Plentz, Darlan L Matte, Christian C Coronel, Graciele Sbruzzi

Abstract

“Inspiratory muscle training (IMT) produces beneficial effects in COPD subjects, but the effects of expiratory muscle training (EMT) and EMT plus IMT in ventilatory training are still unclear. The aim of this study was to systematically review the effects of EMT and EMT plus IMT compared to control groups of COPD subjects.”

Methods

“This study is a systematic review and meta-analysis. The search strategy included MEDLINE, Embase, LILACS, PEDro, and Cochrane CENTRAL and also manual search of references in published studies on the subject.”

Conclusion

“EMT and EMT plus IMT improve respiratory muscle strength and can be used as part of the treatment during pulmonary rehabilitation of subjects with severe to very severe COPD.”

View the Abstract here

View list of published research that used POWERbreathe as the IMT intervention of choice in POWERbreathe in Research.

Find more published research on our Inspiratory Muscle Training Research blog.

Coping with respiratory problems in the colder weather

Well here in the UK summer seems to have come to an abrupt end, with cooler weather and colder, damp air.

If you have a respiratory problem, such as COPD (Chronic Obstructive Pulmonary Disorder) or asthma, then the cold air that accompanies the change in season might affect you when you venture outdoors.

Respiratory consultant Dr Mat Jones at Nevill Hall hospital says, “Patients with airway diseases, particularly asthma often have hyper-responsive airways which are susceptible to the cold. In response to cold weather they can bronchoconstrict excessively (excessive bronchial narrowing) which can then trigger an exacerbation of their condition.”

“Patients with chronic lung disease have an increased susceptibility to infections of the lung given the structural changes in their lungs. This, accompanied by the frequency of infective organisms in the community in winter months would explain this trend of cold weather having an adverse effect on the lungs.”

The colder and drier air at this time of year, and even more so in the winter, will have sufferers of asthma and COPD feeling breathless, tight-chested and wheezing and coughing.

Although you may feel like staying in the warm and not venturing out, there are a few things you can do to make you feel more comfortable when you do have to venture outdoors.

Here are five handy tips that the British Lung Foundation suggest to help prevent your respiratory problems from worsening in the cold weather:

  1. Wash your hands regularly to avoid picking up winter bugs.
  2. Wrap up warm when heading outdoors, covering your nose and mouth with a scarf as this will help to warm up the air before you breathe it in.
  3. Keep your home well ventilated – air quality inside the home becomes more important in winter as most of us spend more time indoors. If you have a bronchodilator, use it half an hour before going outside.
  4. Make sure you carry your medication with you at all times as cold air can tighten the airways in lung disease patients making it harder to breathe.
  5. Try to breathe through your nose instead of your mouth as this will help warm the air.

You can also warm-up your breathing muscles with your POWERbreathe. In fact a POWERbreathe inspiratory warm-up is used by athletes to warm-up their breathing muscles prior to competition.

You warm up other muscles prior to exercise, so why not your breathing muscles? Physical activity at a moderate intensity is widely accepted as an acceptable and effective means of warming-up your locomotor muscles so that they’re ready to work at an intense level. But this moderate intensity activity is not enough to warm-up your breathing muscles. This was demonstrated in a study reporting that a rowing warm-up:

“that was similar to the routine adopted in preparing for a rowing race had no effect on inspiratory muscle (IM) strength despite the significant improvement in leg muscle peak torque the rowing warm-up elicited. On the other hand, they found that ventilatory activity applied to inspiratory muscle at moderate intensity could increase the force generation capacity of the muscle (Volianitis et al.2001a). Such specific inspiratory muscle activity (‘‘warm-up’’) in addition to a rowing-specific warm-up protocol was further shown to improve subsequent performance in a 6-min all-out rowing test and the improvement was partly attributed to the reduction in intensity of breathlessness sensation (Volianitis et al. 2001b).”

Your POWERbreathe warm-up is simply performed on a reduced load setting.

POWERbreathe uses the principles of resistance training to exercise your breathing muscles, making them work harder. This exercise in turn makes your breathing muscles stronger and less prone to fatigue. And because POWERbreathe is drug-free, it can be used by those with respiratory problems such as asthma and COPD. Because it has no side effects or drug interactions it can be used alongside your regular respiratory medication.

Chris Mulholland, head of British Lung Foundation Wales, said: “As respiratory conditions are often exacerbated by the cold weather, those with mild, early stage respiratory problems – that would otherwise go unnoticed at any other time of year – may notice an increase in symptoms. If you notice you’re getting more chest problems in the winter, perhaps becoming breathless, wheezy or have a persistent cough, then it could be an early warning sign. It is really worth going to see your doctor at this point because the earlier problems are diagnosed, the earlier they can be treated and managed which will have short and long-term benefits.”

Read more about how POWERbreathe could help relieve your symptoms of asthma and reduce dyspnoea in COPD, or if you’re already using POWERbreathe to help with your respiratory problem then please leave a comment here or on the POWERbreathe Forum, Facebook or Twitter as we’d love to hear from you. You can also read about how POWERbreathe has helped others with breathing problems, including asthma and COPD, in our “I have a breathing problem” blog category.