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Thursday, February 3, 2011

What's the best method of airway clearance

Where I work, all patients get your plain old chest physiotherapy where you clap on their back or chest with cupped hands and position the patient accordingly. Sometimes we have a CF patient bring in their own mechanical percussor, yet that doesn't happen too often.

I've heard that acapella and flutter work good, yet since those devices are not reimbursed by medicare, our hospital does not want to absorb this cost.

So what means of sputum enhancement really is the best for our patients. The truth is, there really is no scientific evidence to support the use of any one over the other. The best method of proof lies in the eyes of the patient.

So, that in mind, I was doing my weekly perusal of medical blogs this past week and came across a post by Cystic Fibrosis fatboy called, "Acapella, Flutter, Vest, or Manual CPT?" Which one works best?.

Here is what CF fatboy writes in his own words:
  • Manual CPT – In my opinion, this is THE best method for airway clearance when done properly. The downsides are the obvious space/time requirement, as well as a willing second party unless you’re somehow able to do it yourself. You can’t help but cough if you have anything in a particular lobe that needs to come out. If I had unlimited time and resources, I’d opt to have this as my treatment, but I have a life/job, and so does Beautiful. It just wouldn’t work for us.
  • Flutter - I’d rank this as the second best. I was able to get the percussion sensation longer with Flutter than Acapella, so I think it did more, and I seem to remember it being a stronger feeling, even though the Acapella is adjustable. It’s so small, it’s ridiculous, not to mention it only being 3 parts and the easiest thing in our arsenal to keep sterile.
  • Vest – Not all vests are created equal. I couldn’t be happier with my inCourage Vest system that I got last August, but it serves a purpose, but not the one I thought. I don’t go crazy coughing with it, but it does a fantastic job alleviating any wheezing I have at the time. It’s quite expensive, even with insurance (our durable medical equipment co-pay was still $1200, and I have an excellent HMO package. Is it worth it to me? Absolutely.
  • Acapella – I have 2 of them that I bought out of pocket because my HMO wouldn’t pay for the device. I was keeping one in the car for my way to school if I had a wheeze and I keep one by my Vest. I find using both the Flutter and Acapella exhausting to use because of the deep breathing and strenuous spasms that follow, but I know they work.
I think it's important to listen to our patients so we can improve on what we do, which is why I follow chronic lunger blogs. For more on the perspective of CF bloggers, check out CF fatboy's blog, or these lung links.

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