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.
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,
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.
You should always consult a doctor before starting any treatment if you’re concerned about any medical issue.
This new study investigates the effects of inspiratory muscle training (IMT) on smokers and non-smokers. Researchers from Ondokuz Mayıs University and Gaziantep University in Turkey look into how IMT may affect pulmonary function and respiratory muscle strength in both these groups.
Respiratory muscle strength is an indication of how much pressure the breathing muscles generate when a person breathes in or out. Assessment of respiratory muscle strength involves measuring MIP or MEP. MIP or maximal inspiratory pressure reflects the strength of the inspiratory muscles, such as the diaphragm. Meanwhile MEP or maximal expiratory pressure reflects the strength of the expiratory muscles.
The IMT program
For the IMT program, subjects use the POWERbreathe Classic IMT device. The procedure consists of 30 x 2 dynamic inspiratory efforts with a 1-minute interval. They perform this for four weeks, seven days a week. The reason researchers chose this procedure is that it has been previously applied in healthy individuals.
Smokers group, non-smokers & placebo groups
Forty-two healthy males enrol in this randomised, double-blind, placebo-controlled experimental design study. There are 16 subjects in the IMT smokers group (IMTS), 16 in the IMT non-smokers group (IMTN) with the final 10 subjects in the placebo group. This final group receive a sham ‘placebo’ treatment that will have no real effect.
By using a double-blind, placebo-controlled experimental design study, researchers can test out a therapy. The placebo treatment will feel just like the actual treatment, in this case, IMT. The reason for this is so that both the subject and the researcher’s expectations will not affect the outcome. Furthermore, a double-blind controlled study means that neither the researchers nor the subjects taking part know who will be receiving which treatment. This is vital in helping to avoid bias when measuring outcomes.
For the study, the experimental groups (IMTS and IMTN) perform POWERbreathe IMT at 50% of maximal inspiratory pressure. Researchers increase this each week. Meanwhile, in the placebo group, subjects perform POWERbreathe IMT at only 15% of MIP.
Improvements occur in smokers after IMT
Results of the study show significant improvements in respiratory muscle strength and pulmonary functions after the 4-week POWERbreathe IMT program. Even more promising is the fact that improvements in smokers are greater. Potentially, this is a result of a:
“greater influence of exercise on smokers’ lung microbiome in reversing the negative effects of smoking.”
For smokers, this means that their stronger inspiratory muscles will improve their ability to breathe in more air, for longer and with less fatigue. This will have a positive impact on daily life by helping them improve their ability to perform daily activities that may have been prohibitive before.
The automatic nervous system is part of the central nervous system. It controls vital functions, one of which is breathing, which we do without thinking. According to the National Multiple Sclerosis Society, it is unusual for MS to affect the nervous system and therefore breathing.
How Multiple Sclerosis affects breathing
However, patients with MS will experience muscle weakness. This affects all parts of the body, including the breathing muscles. These muscles, mainly the diaphragm and intercostals begin to lose their strength and stamina. As a result, breathing becomes more difficult and breathing in and out feels like hard work. Consequently, this adds to the feeling of fatigue, which is already a debilitating symptom of Multiple Sclerosis. Furthermore, the weakness of the breathing muscles may also impede speech and voice production.
How to improve breathing strength and stamina
A 2007 study shows that Inspiratory Muscle Training (IMT) significantly increases breathing muscle strength in people with MS. Additionally, IMT improves how well the lungs work in people with Multiple Sclerosis who have minimal to moderate disability.
The effects of Multiple Sclerosis on your body
Healthline, the fastest growing health information site, has created this medically reviewed infographic showing the effects of MS on the body.
The infographic itself provides a quick look at the effects of MS on the body. However, the rest of the article goes on to explain in more depth how this progressive neurodegenerative condition has an impact on the whole body.
According to the British Heart Foundation, there are over half a million people in the UK living with heart failure (HF). They say they experience:
Shortness of breath, not only during an activity but also at rest.
Swollen feet, ankles and legs.
Feeling unusually weak and tired most of the time, and feeling exhausted after an activity or exercise.
What causes heart failure?
It usually occurs if the heart is too weak, or ‘stiff’, to pump blood around the body as well as it used to. Consequently, the heart needs some support to help it work better again. Although HF is more common in the elderly, it can also occur at any age.
One of the most common reasons for the heart weakening is heart muscle damage. This may occur following a heart attack. But there are other conditions that can also lead to heart failure, including:
High blood pressure
Heart rhythm problems (also known as arrhythmias)
Coronary heart disease
Congenital heart disease
What can you do to prevent heart failure?
According to NHS Choices, there are a few things you can do yourself to help reduce your risk of HF. The aim of these prevention strategies is to lower blood pressure and reduce levels of bad cholesterol in the blood.
Tip 1: Eat a healthy, balanced diet with low-fat, high-fibre and five portions of fruit and vegetables.
Tip 2: Stay active with regular exercise to make the heart and circulatory system more efficient, helping to regulate blood pressure.
Tip 3: Maintain a healthy weight – you can find your body mass index using a BMI calculator, or ask your GP.
Tip 4: Give up smoking to reduce the risk of developing furring of the arteries.
Tip 5: Cut back on the consumption of alcohol.
What is heart failure treatment?
A cure for this condition is only a possibility when there is a treatable cause, such as replacing damaged heart valves. Otherwise, treatment focuses on controlling the symptoms. By controlling the symptoms people are able to live full and active lives.
Sometimes implantable devices, such as a pacemaker, or other surgery will be needed. However, for the majority of people, a combination of medication and lifestyle changes will be sufficient to control and stabilise symptoms.
How heart failure affects daily living
Because the heart isn’t able to pump blood around the body as well as it used to, the load on the breathing muscles, mainly the diaphragm, increases. This results in a significant contribution to the feeling of breathlessness. Consequently, this affects a person’s everyday life. In fact, something like simple everyday tasks feel tiring. As a result, quality of life diminishes.
Did you know?
During February 11- 17, the Heart Failure Society of America (HFSA) will increase national awareness about the severity of heart failure. In Europe, Heart Failure Awareness Week will fall in May.
These awareness days take place because the number of people with heart failure is increasing. In fact, projections show it will rise by 46% (2030), according to the American Heart Association’s 2017 Heart Disease and Stroke Statistics Update.
Heart failure (HF) is a long-term condition. There is currently no cure and symptoms will get worse over time. Sadly HF also has a poor prognosis, with 30-40% of patients dying within a year. However, if diagnosed early enough, symptoms can be controlled for many years.
In one particular study, findings reveal that in patients with HF and inspiratory muscle weakness, IMT results in:
Marked improvement in inspiratory muscle strength
Improvement in functional capacity
Improvement in ventilatory response to exercise
Improvement in recovery oxygen uptake kinetics
Improvement in quality of life
Training the inspiratory muscles
POWERbreathe IMT is a hand-held breathing muscle training device. It is drug-free with no known side effects and no interactions with existing treatments. There are also no reports of any adverse events. It is easy to use as you only need to breathe forcefully IN through the device for 30 breaths, twice a day.
Because the cardiovascular strain of POWERbreathe training is very low, it is suitable for even the most physically compromised patients and is particularly helpful in patients who are too ill for rehabilitation.
POWERbreathe training is completely safe for the vast majority of patients. However there may be small theoretical risks for some patients. For instance, IMT will not be a recommendation for patients with a history of spontaneous pneumothorax.
The POWERbreathe Medic is approved by the NHS’s PPA and is available on prescription in the UK.
Always check with your doctor first before undertaking anything new for the treatment of any medical condition.
Influenza, or flu as it’s more commonly known, is around all year. However here in the U.K. at this time of year we start thinking about ‘seasonal flu’, so called because it is common in the winter months.
Main symptoms include a high temperature, feeling tired and achy, and a chesty cough. All of these things start suddenly. The symptoms may appear similar to a cold, but flu is a very different set of viruses. And symptoms are more severe and longer lasting. Speak to your GP if you are concerned.
Flu can leave you exhausted, especially when you are suffering from a chesty cough. It can interrupt your sleep so you wake feeling tired. However coughing is actually nature’s way of clearing your lungs. It helps to expel irritants and secretions and prevent infection.
How you catch flu
Droplets that travel in the air from a cough or a sneeze will contain the virus. And anyone who comes into contact from these droplets can catch the flu. This can happen from breathing in the droplets. It is also transmitted after touching surfaces that droplets have landed on and then touching your nose or mouth.
Prevention and treatment
An annual flu vaccine is available in the autumn, from the beginning of October to November. You can also help to prevent spreading the virus by washing your hands regularly, cleaning surfaces to rid them of germs, and by using a tissue to cough or sneeze into.
Expelling sticky mucus from your chest
Mucus clearance devices ‘shake’ the congestion in your chest. This effectively loosens it so that you can expel it. They complement regular medication because they have no side-effects or drug interactions. The Shaker devices by POWERbreathe are easy to use by both adults and children (under supervision). In fact regular use of the Shaker of between 5 to 15 minutes will produce benefits equivalent to that delivered by physiotherapy techniques.
Because of her inspirational story she has been interviewed by the Brazilian TV channel, Globo. Her six-minute interview has been broadcast on prime time TV, and we are fortunate enough to also be able to view it.
During the interview Patricia talks about her experience, from a little girl to where she is now, after her transplant. The video shows her in hospital after her operation. She appears very frail. But the clinical team around her help her to improve her health and fitness.
Heart transplant patient performs breathing training in recovery
During recovery Patricia is provided with the Respiron flow-based lung trainer by POWERbreathe. She uses it to exercise her lung muscles by encouraging controlled, long, slow, deep and focused breathing. It helps to maintain lung capacity and function after periods of inactivity.
Patricia is also provided with a POWERbreathe Inspiratory Muscle Training (IMT) device. This is to help improve the breathing strength and stamina of her breathing muscles. And in turn this reduces breathing fatigue and helps Patricia to improve her respiratory system. This breathing muscle training will also help prepare Patricia for the demands of a triathlon.
Benefits of IMT in triathlon
During triathlon Patricia’s lungs will be subjected to huge demands in each of the three endurance disciplines.
During the swimming stage of the triathlon, Patricia will need to inhale as much oxygen as possible in the shortest time possible. This will help her return to the optimal position for generating propulsive force.
During the cycling stage of the triathlon, the very nature of the hunched position on the bike creates breathing problems. It restricts normal breathing movement and will make breathing feel much harder.
Finally, during the running stage of the triathlon, Patricia’s breathing muscles will not only be working hard at their job of breathing, but they will also be working hard to stabilise her upper body during every foot strike.
Triathlon results post-transplant
The effort and commitment by Patricia Fonseca and her team of professionals in helping her through recovery and training was rewarded with a podium finish by Patricia who won a medal!
As a woman gets older the balance in her sex hormones changes. The ovaries stop producing so much of the hormone oestrogen. This causes what we know as the menopause. Furthermore these changing levels of oestrogen, progesterone and testosterone play a role in age-related inflammation. And although we don’t yet fully understand why, it appears that this decrease in oestrogen corresponds with a rise in the cytokines interleukin-1 and interleukin-6. This changes the rate at which new bone forms and is a leading indicator of osteoporosis.
Lung function decline
It’s this systemic inflammation that is associated with lung function decline. This is because osteoporosis shortens the height of the chest vertebrae. Consequently this limits the amount of air that can be inhaled.
The researchers say that lung function decline in menopausal women is comparable to smoking 20 cigarettes a day for 10 years. And researcher Kai Triebner at the Department of Clinical Science, University of Bergen (UiB), Norway says that “The decline in lung function may cause an increase in shortness of breath, reduced work capacity and fatigue.”
Maintain respiratory health during and after menopause
The study shows this lung function decline exceeded the expected age-related decline. And because women are living longer beyond the menopause, it is important to maintain respiratory health. The study suggests that clinicians should be aware that respiratory health often deteriorates during reproductive ageing.
Reducing lung function decline
Healthy lungs have a large breathing reserve. But if you have reduced lung function you may use a large part of your breathing reserve. And it’s this that will make you feel short of breath. However regular physical exercise can help improve your lung function. In addition breathing exercises such as POWERbreathe Inspiratory Muscle Training (IMT) are also beneficial.
POWERbreathe IMT can help
POWERbreathe IMT exercises your inspiratory muscles; the muscles you use to breathe in. These are mainly your diaphragm and intercostal muscles.
As you breathe in through the POWERbreathe IMT device your breathing has to work harder. This is because you are breathing in against a resistance. This resistance is adjustable so you are able to challenge yourself as your breathing becomes easier. And because you are exercising your breathing muscles they become stronger. And with stronger breathing muscles your breathing stamina improves too. Furthermore breathing fatigue will reduce. This means you’ll be able to do more with less effort. So the increase in shortness of breath, reduction in work capacity and fatigue that is highlighted in the study as a result of the menopause will reduce.
Airway disease is more prevalent in endurance athletes. This is possible because they need to adapt their breathing to cope with large volumes of inspired air. And they need to inspire large volumes of air because of the intense exercise they perform. But the environment they train in may also be relevant.
The study measures the difference between each athlete’s inhaled and exhaled air temperature. It did this during and after a Eucapnic Voluntary Hyperpnea test (EVH). This is the test that is used to diagnose exercise-induced asthma or exercise-induced bronchospasm. It is a 6 minute test during which the athlete breathes a cold, dry gas at very high ventilation rates.
All 23 athletes in the study attend a laboratory on three occasions. Two of these occasions are for baseline measurements and information. The third is to perform a modified EVH test. This is to measure their inspired and expired air temperatures.
No evidence of improved capacity to condition inspired air
The test results show no evidence of improved capacity to condition inspired air. And by ‘conditioned’ air the study means the athlete’s ability to warm and humidify inspired air. If the study did find evidence, this could suggest an increased bronchial blood flow or another adaptive mechanism. Bronchial blood flow supplies nutrients and oxygen to the cells that constitute the lungs, as well as carrying waste products away from them. Therefore the absence of an adaptive mechanism could contribute to airway damage observed in endurance athletes. This may be that colder but mainly dryer air is penetrating deeper in the lung.
Strategies to reduce impact on airway injury
A pre-exercise warm-up is well known to reduce the severity of exercise-induced bronchospasm and exercise-induced asthma. It is thought the reason for this is because of an increase in bronchial blood flow. A warm-up involves performing the athlete’s activity at a slower pace and reduced intensity. It gradually raises the body temperature. Furthermore it increases blood flow to the muscles.
An inspiratory warm-up
It is also beneficial to warm-up the breathing muscles. A scientifically proven way of doing this is with Inspiratory Muscle Training (IMT). POWERbreathe is an IMT device that is quick and easy to use. POWERbreathe IMT is performed as part of an athlete’s daily training. But research and trials have also shown it to be beneficial for an inspiratory warm-up. This means simply reducing the breathing load on the POWERbreathe IMT device to a lower setting. Better still the POWERbreathe K3, K4 and K5 with Breathe-Link Live Feedback Software feature an automatic warm-up mode. This automatically sets the optimal resistance for an inspiratory muscle warm-up.
We recently met up with para-cyclist Leon Selva at his home earlier in November. Leon is training hard with the intention of competing in the Tokyo 2020 Paralympic Games.
As a result of a terrible accident and with a positive frame of mind, Leon decided to start his career as a para-cyclist. Leon became badly injured in a car crash. His lung collapsed and the right side of his body is severely damaged. As a result Leon gets around with the aid of a crutch. But not one to let that get in the way, Leon is setting his sights on the Tokyo Paralympic Games in 2020. His ambition is clear to see.
Leon’s cycle training
Leon has a coach to help with his training. His coach also trains with Leon at the National Cycling Centre in Manchester. And his father is responsible for converting a former bedroom into a training room. This room is kitted out with an elliptical, Wattbike and various other pieces of gym equipment. His bike has a special crank bottom bracket that allows both cranks to work independently as he can generate more power from his uninjured side.
Leon’s initial POWERbreathe Inspiratory Muscle Training (IMT)
After Leon’s recovery from his collapsed lung, he began using the POWERbreathe Plus HR. He uses this to strengthen the muscles he uses to breathe. These are his diaphragm and his intercostal muscles. The diaphragm is the main muscle that is used for breathing. The intercostals are muscles that are located between the ribs.
The POWERbreathe Plus HR is not the most suitable model for Leon. It is the highest resistance model in the Plus series. It is designed only for people who have reached the top of the MR (medium resistance) model. Leon finds it quite hard going and so isn’t using it effectively.
Leon’s current POWERbreathe IMT
Realising Leon was struggling with the Plus HR, his father started looking for a more suitable alternative. And so he bought Leon the POWERbreathe K5 with Breathe-Link Live Feedback Software. The K5 offers Leon a more tapered loading resistance. This will match the contraction curve of his own breathing muscles throughout his entire breath. And it’s this that makes it easier for Leon to use. As a result it’s more beneficial. Leon will no longer struggle with the resistance as the K5 does everything for him.
Leon on the POWERbreathe K5
Upon arrival we set up the K5 and Breathe-Link Live Feedback Software for Leon. Leon then starts to train with it immediately. And thanks to the live feedback software it’s clear that Leon’s initial in-breaths are very weak and uncoordinated. So over a period of 90 breaths, and as Leon looked at his live breathing on screen, we corrected his breathing technique. After a short while Leon shows how to get the most from his diaphragm and his breathing improves tremendously.
Leon was so pleased with his training, he exclaimed, “Dad, this is the best investment you have ever made, my improvement is amazing, it’s epic.” You can see this wonderful reaction in our YouTube video.
Because of this encouraging endorsement, Leon’s father and coach performed a number of breaths on the K5 too. They did this so that they could experience this training for themselves. They are now also able to offer advice and encouragement as Leon continues to train his breathing.
Many conditions may develop post-stroke. There are common conditions that improve over time and with rehabilitation. These include physical conditions, cognitive impairment and how you feel emotionally.
Physical conditions post-stroke
Although everyone will experience different effects after a stroke, there are commonalities. For instance after a stroke you may feel fatigued. And in fact it is fatigue, or lack of energy that is one of the most common effects after a stroke. This can lead to difficulty in everyday life and during rehabilitation. Fatigue is influenced by several factors, including depression, poor sleep, medication and pain. But physical symptoms too will cause fatigue. For instance limb weakness will make movement harder work. Consequently movement will require more energy and subsequently fatigue will set in. Finally this results in a reduction in exercise tolerance, the level of exertion you can achieve before you become exhausted.
Improving exercise tolerance post-stroke
The good news is that new research shows Respiratory Muscle Training (RMT) to be effective at improving exercise tolerance poststroke.
What is RMT
RMT is a technique that aims to improve the function of the respiratory muscles. It is achieved through specific exercises. These exercises increase the strength and endurance of your respiratory muscles. Your respiratory muscles are those you use for inhalation and exhalation. As exhalation is mostly passive, it’s inhalation that you can influence. You can exercise the muscles you use to inhale with Inspiratory Muscle Training (IMT).
POWERbreathe IMT is beneficial post-stroke
POWERbreathe IMT is clinically proven Inspiratory Muscle Training. It is a Class 1 Medical Device. POWERbreathe IMT exercises the muscles you use to inhale, your inspiratory muscles. And scientific tests show that it increases inspiratory muscle strength, improves inspiratory stamina and reduces fatigue.
Latest research in poststroke patients
Findings from this new research are that RMT should be considered an effective method of improving respiratory function, inspiratory muscle strength, and exercise tolerance in patients poststroke.