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WO2003061749A2 - Systeme de conditionnement des muscles a activite expiratoire pour l'amelioration du systeme respiratoire - Google Patents

Systeme de conditionnement des muscles a activite expiratoire pour l'amelioration du systeme respiratoire Download PDF

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Publication number
WO2003061749A2
WO2003061749A2 PCT/US2003/001811 US0301811W WO03061749A2 WO 2003061749 A2 WO2003061749 A2 WO 2003061749A2 US 0301811 W US0301811 W US 0301811W WO 03061749 A2 WO03061749 A2 WO 03061749A2
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WO
WIPO (PCT)
Prior art keywords
pressure
patient
valve
threshold
expiratory
Prior art date
Application number
PCT/US2003/001811
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English (en)
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WO2003061749A3 (fr
Inventor
Christine A. Sapienza
Antole D. Martin
Paul Wesley Davenport
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University Of Florida
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Filing date
Publication date
Application filed by University Of Florida filed Critical University Of Florida
Priority to AU2003205263A priority Critical patent/AU2003205263A1/en
Publication of WO2003061749A2 publication Critical patent/WO2003061749A2/fr
Publication of WO2003061749A3 publication Critical patent/WO2003061749A3/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/20—Valves specially adapted to medical respiratory devices
    • A61M16/208—Non-controlled one-way valves, e.g. exhalation, check, pop-off non-rebreathing valves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/20—Valves specially adapted to medical respiratory devices
    • A61M16/208—Non-controlled one-way valves, e.g. exhalation, check, pop-off non-rebreathing valves
    • A61M16/209—Relief valves

Definitions

  • the present invention relates generally to the field of breathing exercise and more particularly to an expiratory breathing method which promotes proper pressure breathing by the user.
  • the present invention further generally relates to systems for providing unique physical training programs designed to increase respiratory muscle strength for an improved respiratory system.
  • the process of inspiration refers to the use of the diaphragm and chest muscles to inflate the lung and breathe air into the lung.
  • the process of expiration refers to when a person lets air out of the lung, which typically does not involve the use of the respiratory muscles.
  • a person is engaged in an activity which necessitates strenuous expiration, such as speaking and singing, he or she recruits the muscles of the abdomen and chest to give a pumping force for expiration.
  • the lung has an elasticity that is measured as compliance.
  • An analogy is a balloon. When the balloon is inflated, the latex is stretched from its rest position. Holding the end of an inflated balloon closed one can feel the positive pressure inside the balloon as the latex squeezes the air in the balloon attempting to return to its rest position. If the balloon end is opened, air will flow out of the balloon because of the pressure gradient generated by the elastic recoil of the balloon wall.
  • the lung has elasticity and when the lung is inflated with a large inspiration, the lung walls are stretched.
  • the elastic lung tissue compresses the air in the lung creating a positive pressure that is proportional to the lung stretch, the lung volume.
  • Active contraction of the expiratory muscles squeezes the outer surface of the lung adding to the positive pressure by further compressing the air in the lung. Again, this is analogous to putting an inflated balloon in your hands and squeezing the balloon.
  • the net positive pressure in the lung is the sum of the elastic recoil pressure and the expiratory muscle squeeze pressure.
  • the elastic recoil pressure with an inflated lung is 10 cmH 2 O and the expiratory muscles squeeze the lung with 30 cmH 2 O
  • the total positive pressure in the alveoli is 40 cmH 2 O.
  • pressures are referenced to atmospheric pressure which we consider 0 cmH 2 O ( . e. , the alveolar pressure is 40 cmH 2 O greater than atmospheric pressure). It is also important to recognize that the pressure in the alveoli is 40 cmH 2 O and the pressure at the mouth (or nose) is atmospheric or 0 cmH 2 O. This means that the pressure decreases along the airways going from the alveoli to the mouth with all 40 cmH O dissipating along this path. The pressure is lost due to the resistance of the respiratory tract.
  • the lung and all the airways are within the thorax except for approximately half the trachea, the pharynx, and mouth.
  • the squeeze pressure is applied to the entire thoracic cavity, which applies the squeeze pressure equally to the entire lung (alveoli and airways) within the thorax.
  • the alveoli have a net positive pressure of 40 cmH 2 O because of the combination of the elastic recoil pressure and the expiratory muscle squeeze pressure. This results in a greater pressure in the alveoli than outside the alveoli and the alveoli stay distended.
  • the intra-airway pressure decreases due to loss of pressure from airway resistance. That means the closer to the mouth, the lower the positive pressure inside the airway. At some point in this path, the intra-airway pressure will decrease to 30 cmH 2 O. This happens in intrathoracic airways. At this point, the pressure inside the airway equals the expiratory muscle squeeze pressure outside the airway and is called the
  • Equal Pressure Point (EPP).
  • the intra-airway pressure is less than the expiratory muscle squeeze pressure and there is a net collapsing force applied to the airway. As the airway is compressed, the resistance increases and more pressure is lost due to the elevated resistive forces.
  • the EPP will occur closer to the alveoli as the intra-airway pressure goes from 35 to 30 cmH 2 O quicker than the normal lung which went from 40 to 30 cmH 2 O.
  • the EPP moves closer to the alveoli and can even occur in bronchioles which are airways that do not have cartilage.
  • COPD pulmonary disease
  • One method used to assist patients with COPD is to use pursed-lips breathing. This requires patients to breathe out through their mouths with the lips partially closed as if they were whistling. This increases the airflow resistance at the mouth creating an elevated pressure behind the lip obstruction, like partially covering a water hose with your thumb which creates a gher pressure behind the obstruction. Pursed-lips breathing increases the pressure down the respiratory tract creating a positive expiratory pressure (PEP) and functionally moves the EPP closer to the mouth. This is an airflow-dependent (because it works only when air is moving) method of compensating for dynamic airway collapse in COPD patients.
  • PEP positive expiratory pressure
  • Increasing the intra-airway pressure during expiration by creating a positive expiratory pressure is an important method for maintaining airway patency, decreasing gas trapping and reducing hyperinflation in emphysema patients.
  • PEP positive expiratory pressure
  • Several attempts have been made to manufacture resistance devices which imitate pursed-lips breathing including U.S. Patent Nos. 4,523,137 to Sonne; 4,601,465 to Ray; and 5,598,839 to Niles. These devices are successful in producing the same effect as pursed- lips breathing, but only marginally effective in reducing the dynamic hyperinflation in severe COPD cases. The marginal effectiveness in reducing the dynamic hyperinflation in severe COPD cases occurs as a result of the method being airflow-dependent, i.
  • COPD patients are not the only ones who suffer from loss of intra- airway pressure caused by airway resistance.
  • Another disorder related to expiratory airflow is vocal fold disorder, which creates high upper airway resistance in patients with the disorder.
  • vocal fold paralysis produces upper airway resistance, or vocal fold edema, which results from overuse of the vocal folds.
  • training of their expiratory muscles to increase the muscles' strength to force air out of the lungs provides some treatment. Strengthening the expiratory muscles provides greater expiratory muscle pressure and reduces the stress on the vocal folds, resulting in less laryngeal compensation to the vocal folds.
  • a person when a person is engaged in an activity which necessitates strenuous expiration, such as speaking, singing or playing a wind instrument, he or she recruits the muscles of the abdomen and chest to give a pumping force for expiration.
  • a training program to increase the strength of these expiratory muscles to better force air out of the lungs would increase the expiratory airflow rate (increasing the magnitude of the sound) and endurance (ability to produce a strong force longer).
  • training expiratory muscles to become stronger can assist people to increase the sound intensity of their voice or to generate efficient blowing pressure for playing instruments.
  • Many speakers and musicians perform exercises to increase their sound or voice strength or blow pressure, often requiring hours of training with limited success.
  • OSAS obstructive sleep apnea syndrome
  • the present invention is directed to breathing methods and devices which increase intra-airway pressure, thus causing a positive expiratory pressure (PEP) which is not airflow dependent.
  • PEP positive expiratory pressure
  • the present invention provides methods which utilize a pressure relief valve, preferably a positive end- expiratory pressure (PEEP) valve, for providing positive expiratory pressure (PEP).
  • PEEP positive end- expiratory pressure
  • the PEP is caused by directing the flow of gases exhaled by the patient through the PEEP valve, so that gases must be exhaled against the PEEP valve held closed by threshold pressure, hi this way, gases exhaled by the patient are subject to positive exhalation pressure set by the threshold pressure, which in turn increase the pressure in the patient's airway.
  • the expiratory pressure exceeds the threshold pressure of the valve, the valve opens and air is exhaled.
  • the present invention is further directed to a unique training system which uses the PEEP valve to increase respiratory muscle strength. More specifically, the present invention provides methods to increase the expiratory airflow rate and endurance of the expiratory muscles in a person by increasing the ability of these muscles to force air out of the lungs.
  • PEEP valve creates a PEP equal to the PEEP valve' s pressure.
  • the PEP produced by the PEEP valve results in increased airway patency, such that the amount of gas trapped in the lung decreases (reduced hyperinflation) and the airway resistance decreases.
  • the elevated PEP from a PEEP valve remains in the airway throughout the expiration, even to the very end, moving the Equal Pressure Point (EPP) closer to the mouth, and keeping it there.
  • EPP Equal Pressure Point
  • the decreased hyperinflation returns the diaphragm closer to its normal length, increasing the ability of the diaphragm to generate the inspiratory pumping forces. Improving the ability of these patients to ventilate their lungs increases their exercise tolerance and decreases their sense of breathlessness.
  • One aspect of the present invention is a unique PEEP valve which has been modified by changing the spring within the valve and/or changing the mouthpiece. With these modifications, the valve is now particularly advantageous for treating patients with COPD problems, or for aiding those who wish to strengthen expiration muscles and, with the implementation of a series of exercises to be used by individual people with vocal chord problems.
  • the novel application of the PEEP valve according to the present invention provides an inexpensive and non-pharmacological method of reducing breathlessness, increasing exercise capacity and improving alveolar ventilation.
  • the novel application of the PEEP valve, and the accompanying exercise program, according to the present invention further provides a short and simple respiratory muscle training method for enhancing the respiratory system, and strengthening of expiratory muscles for increased sound intensity and decreased stress on vocal folds.
  • exercises are provided that specifically strengthen the muscles of inspiration and expiration in order to increase the ability of patients to maintain a patent airway during sleep thus reducing the number and severity of respiratory obstructions during sleep.
  • Exercises that increase respiratory muscle strength can also be used to increase upper pharyngeal tone during sleep and prevent airway closure, thereby improving breathing during sleep.
  • Figure 1 depicts an example of a patient's health lung exhalation pressure.
  • Figure 2 depicts an example of exhalation pressure for a patient with emphysema.
  • Figure 3 shows an example of a PEEP valve.
  • Figure 4 depicts a diagram of a modified device of the subject invention based on the Threshold Trainer.
  • Figure 5 depicts a diagram of a modified PEEP valve device of the subject invention.
  • the subject invention provides a method which increases intra-airway pressure in a person, thus causing a positive expiratory pressure (PEP) which is not airflow dependent.
  • the method of the present invention utilizes a pressure relief valve, preferably a positive end-expiratory pressure (PEEP) valve.
  • PEP positive end-expiratory pressure
  • the PEP is caused by obstructing the flow of gases exhaled by the patient through the PEEP valve until the PEP is greater than the pressure threshold of the PEEP valve, so that such gases must be exhaled against the PEEP valve's pressure threshold.
  • the subj ect invention also provides a method to condition respiratory muscles by utilizing the
  • PEEP valve to generate an increased expiratory force, which is not dependent on airflow or breathing rate, for strengthening expiratory muscles.
  • PEEP valves include, but are not limited to, U.S. Patent No.5, 878,743 to Zdrojkowski, as shown in Figure 3, which discloses an unidirectional valve with a spring force to control exhalation pressure; U.S. Patent No. 1,896,719, to
  • McKesson which discloses a mask having an exhaling valve with a spring force adjustable by a set screw to control exhalation pressure
  • U.S. Patent No. 4,182,366, to Boehringer which discloses a spring connected to a diaphragm, whereby the spring urges the diaphragm to close the exhaust port.
  • a thumb screw can be adjusted to control the pressure on the spring
  • U.S. Patent 4,207,884, to Isaacson discloses an annular seat on a disk-shaped valve, whereby a spring urges the valve against its seat in accordance with the setting on a graduated plunger. Additional PEEP valves are disclosed in U.S. Patent Nos. 4,403,616, 4,345,593, 4,870,963, and 5,109,840.
  • the COPD patient breathes out through a valve, generating sufficient pressure to overcome the valve's pressure threshold, allowing air to flow through the valve. Expiring through the valve creates a PEP equal to the valve's pressure threshold.
  • the PEP produced by the valve results in increased airway patency, such that the amount of gas trapped in the lung decreases (reduced hyperinflation) and the airway resistance decreases.
  • the elevated PEP from the valve equal to the pressure threshold of the valve, remains in the airway throughout the expiration.
  • OS AS patients have a reduced (compared to non-OS AS subjects) resting tone of the upper airway during sleep.
  • This reduction in upper airway tone makes these patients more susceptible to upper airway collapse and obstruction of the glottis during sleep, hence obstructive sleep apnea.
  • High intensity, short duration respiratory muscle strength training in accordance with the subj ect invention elicits a central respiratory motor pattern change that results in increased upper airway tone in OSAS patients thus reducing the tendency of the upper airway to collapse during sleep.
  • the subject invention provides respiratory (inspiratory and expiratory) muscle strength training (RMST) to increase respiratory muscle strength and increase upper airway muscle compensation for upper airway narrowing during sleep.
  • RMST respiratory muscle strength training
  • the materials and methods of the subject invention can be used to strengthen the muscles of inspiration and expiration to increase the motor capacity of the respiratory muscles and increase the ability of OSAS patients to maintain a patent airway during sleep, thus reducing the number and severity of respiratory obstructions during sleep.
  • a valve is utilized to increase intra-airway pressure in a patient, thus causing a positive expiratory pressure (PEP) and functionally moving the Equal Pressure Point (EPP) closer to the mouth.
  • PEP positive expiratory pressure
  • EPP Equal Pressure Point
  • the valve is aligned such that the valve's threshold pressure resists the patients exhalation, whereby the threshold pressure is at a level such that the patient is capable of overcoming it upon exhalation through the valve.
  • the patient inhales, filling the lungs, and then exhales through the valve with sufficient force to overcome the valve's threshold pressure. This inhalation and exhalation is referred to as a breathing cycle.
  • the valve comprises a mouth piece, which is placed in the patient's mouth.
  • the method of the subject invention is performed while the patient is at rest, or at limited activity.
  • the valve threshold pressure is set to a relatively low threshold pressure level, about 1- 5 cmH 2 O.
  • the patient continually exhales through the valve for a short duration of time, about 2 - 5 breaths, or about 0.05 - 1.5 minutes.
  • the method is performed on a regular basis, with the valve threshold pressure being increased as the patient's tolerance increases.
  • the valve's threshold pressure is set to about 1 - 50 cm H 2 O. In one specific at-rest embodiment, the valve threshold pressure is set to about 10 cmH 2 O.
  • the duration of continual valve usage is increased as the patient's tolerance increases.
  • the patient breathes through the valve continually for about 2 - 30 breaths.
  • the patient continually breathes through the valve for about 0.05 to about 30 minutes.
  • the patient utilizes the valve while performing physical exercise, such as cardiovascular training.
  • the valve threshold pressure is set to a low threshold pressure level, about 1- 5 cmH O.
  • the patient While exercising, the patient continually exhales through the valve. Initially, the patient will exercise for a relatively short duration, about 0.05-5 min. As the patient's tolerance increases, the duration of the exercise increases.
  • the pressure threshold of the valve is set to about 1 - 50 cm H 2 O. In a specific increased activity embodiment, the valve threshold pressure is set to about 10 cmH 2 O.
  • the duration of continual exercise maybe, for example, for about 0.05 to 30 minutes.
  • a device of the subject invention is utilized in conjunction with daily breathing exercise sessions in order to condition the respiratory muscles, hi one embodiment, the device exhibits substantial modification and improvement over the existing conventional, spring-loaded threshold pressure valves, such as positive end-expiratory pressure (PEEP) valves and the Threshold Trainer (manufactured by Respironics, Inc.), in producing the expiratory pressure threshold load, hi a preferred embodiment, this newly improved device is equipped with increased spring constants which have, in one embodiment, a maximum valve opening pressure of about 160 cmH 2 O, which is eight times higher than those provided by conventional threshold valves.
  • the conventional threshold valves are equipped with a spring having spring constant that results in a maximum valve opening pressure (greatest spring compression) level of only 20 cmH 2 , which is too low of a pressure to produce any significant expiratory muscle strengthening to subjects with normal respiratory muscles.
  • a modified device 4 of the subj ect invention based on the Threshold Trainer is depicted.
  • the spring constant 1 embodied by the existing Threshold Trainer is too weak, with a threshold pressure range of 0-40, to produce respiratory muscle training for normal human subjects. Therefore, the spring constant 1 has been modified and improved in the device of the subject invention to result in a threshold pressure ranging from 0 cmH 2 O to about 160 cmH 2 O. This modification resulted in significant respiratory strengthening in normal subjects who utilized the modified device in the training program according to the subject invention.
  • the valve of the Threshold Trainer which is closed by the spring pressure, is originally perforated and has a latex flap to allow unidirectional airflow.
  • the device of the subj ect invention has been modified and improved by removing the latex flap and closing the perforations to create a solid valve 2. This also changed the manner in which the modified device is used, hi order to take a breath according to the subject invention, the device must be removed from the subject's mouth and then replaced in the mouth for the breathing effort.
  • the original Threshold Trainer also has a knob, which is used to turn the adjusting screw, with too small of a diameter.
  • the modified device of the subject invention increased the size of the diameter of the knob 3 to a range of about 8-22mm for an improved gripping and easier turning.
  • the original Threshold Trainer is also used exclusively as a prescription device for patients under a physician's care.
  • the modified device of the subject invention has been tested and proven effective for non-clinical uses, and thus the device is directed to non-clinical, over-the-counter distribution to all interested users desiring to strength train the respiratory muscles .
  • a modified positive end expiratory pressure (PEEP) valve device according to the subject invention is depicted.
  • the valve changes the spring compression by a threaded cap 1 that pushes the sliding top spring retainer.
  • the expired air goes through the mouthpiece A and out large openings on the side of the tube wall B.
  • the spring constant provided by a conventional PEEP valve is too weak, generating a threshold pressure range of only 0-20 cmH O, to produce any meaningful expiratory muscle training in normal human subjects. Therefore, the modified device of the subject invention replaced the original spring with a spring 2 having a substantially elevated spring constant with a threshold pressure ranging from 0 cmH 2 O to about 160 cmH 2 O. In an embodiment, the threshold pressure is above about 50 cmH 2 O.
  • the travel length for the threaded cap and thus the compression distance available for adjustment in a conventional PEEP valve is 1.5 cm. With such a short length, a quarter turn of the threaded cap produces an 8 cmH 2 O change in threshold pressure. While this is marginally acceptable, the modified device of the subject invention has a 3 cm travel length 3 for a better adjustment of the spring compression for the usage of the device as a respiratory muscle trainer for normal human subjects. i a preferred embodiment, the modified device is functionally adapted to generate a maximum expiratory pressure level ranging from 0 cmH 2 O to about 160 cmH O.
  • the modified device provides a spring constant sufficient to increase the threshold expiratory pressure to a range of about 80 cmH 2 O to 160 cmH 2 O.
  • the device of the subject invention is available for non-clinical use on normal subjects desiring to increase their expiratory muscle strength.
  • the present invention provides the Expiratory Muscle Trainer (EMT), a unique respiratory muscle training system, which is designed to train the muscles to work near their maximum force-generating capacity.
  • EMT Expiratory Muscle Trainer
  • This method of training provided by the present invention is based on a subject's ability to generate expiratory pressure being a function of the power generated by the expiratory muscles. Increasing expiratory muscle strength increases the pressure a subject can generate and increases the sound intensity of the subj ect' s vocalization or even of a wind instrument played by the subj ect.
  • a person uses the modified expiratory threshold device for expiratory muscle training by breathing out (exhaling) through a mouthpiece attached to the expiratory end of the device.
  • the device of the subject invention functions much the same way as the PEEP valve described above, in that the device' s threshold pressure resists the subj ect' s exhalation.
  • the modified expiratory threshold device has a substantially heightened threshold pressure level, which requires the subject to generate stronger force from the expiratory muscles to sufficiently overcome the device's threshold pressure.
  • breathing through the device of the subject invention provides a maximum workout on these expiratory muscles, which may be equivalent to a person's workout of lifting weights at
  • the present invention also provides a non-clinical physical training program.
  • the training program is designed to strengthen the ability of the respiratory muscles to force air in and out of the lung. More specifically, the training program provides methods of breathing through the modified device to train the expiratory muscles to increase muscle strength by using daily exercise sessions comprised of short intense muscle exercises. For example, with the training program of the subject invention, the subject exercises the expiratory muscles for up to 30 minutes, preferably about 15-30 minutes, at least once, preferably twice, a day by breathing through the modified threshold device.
  • the ultimate objective of the framing program is to progressively increase the maximum expiratory pressure level a subject can generate, which results in an increased intensity of expiratory airflow in the subject's respiratory system.
  • the training program begins with measurement of the maximum expiratory pressure (MEP) a subject can normally generate.
  • MEP maximum expiratory pressure
  • the modified threshold device is then adjusted to a threshold pressure which requires the respiratory muscles to generate forces at about 75-80% of the MEP. This means that the subject must produce an isometric force up to about 75-80% of MEP before the valve opens.
  • the training is carried with the modified device's opemng pressure set at about
  • the training program provides a strengthening protocol consisting of a high-load expiratory muscle training designed to improve maximal expiratory force production by utilizing the modified device.
  • the device of the subject invention provides an adjustable threshold load to expiration, and the load is regulated by adjustment of the spring compression, hi one embodiment, the training program provides daily training sessions to be conducted about 5 times a week. Each daily training session, can, for example, consist of about four sets of six training breaths for a total of 24 training breaths. A subject blows through the device at about 75%-80% of the subject's initial maximum expiratory pressure (MEP). A fraining breath preferably last roughly 2-4 seconds, separated by a 10 to 15 second rest. The daily training lasts approximately 15-20 minutes.
  • MEP initial maximum expiratory pressure
  • a subj ect expires through the device at a load of about 80 cmH 2 O threshold pressure. More preferably, subject expires through the device at a load of about 100 cmH 2 O threshold pressure. Even more preferably, a subject expires through the device at a load of about 120 cmH 2 O threshold pressure. Yet in a more preferred embodiment, a subj ect expires through the device at a maximum load of about
  • the modified expiratory threshold device of the subject invention is used for treating patients with vocal disorders.
  • the threshold device of the subject invention is adjusted to require the expiratory muscles to generate expiratory forces at about 75-80% of the maximum expiratory pressure (MEP) the person can generate.
  • MEP maximum expiratory pressure
  • the patient must produce an isometric force up to about 75-80% of MEP before the valve opens.
  • the patient must maintain that force level to produce expiratory airflow.
  • Expiring at this force level for 2-3 seconds exercises the expiratory muscles in a manner that requires expiratory muscle work.
  • This work-out is called expiratory muscle strength training, and this work-out maybe broken into many shorter time-intervals of exercise to total up to a daily exercise ranging from 15 to 30 minutes according to the individual patient's preferences and needs.
  • the modified expiratory threshold device of the subject invention is used for treating patients with COPD.
  • the threshold device of the subject invention is adjusted to require the expiratory muscles to generate expiratory forces at about 75-80% of the maximum expiratory pressure (MEP) the person can generate.
  • MEP maximum expiratory pressure
  • the patient must produce an isometric force up to about 75- 80% of MEP before the valve opens.
  • the patient must maintain that force level to produce expiratory airflow.
  • Expiring at this force level for 2-3 seconds exercises the expiratory muscles in a manner that requires expiratory muscle work. This work-out is called expiratory muscle strength training, and this work-out maybe broken into many shorter time-intervals of exercise to total up to a daily exercise ranging from 15 to 30 minutes according to the individual patient's preferences and needs.
  • the expiratory muscle strength training of the subject invention is very different from the more common, low pressure endurance expiratory fraining methods at pressures of only 10-50% MEP or any other expiratory therapy treatments applied to these patients.
  • the conventional, low pressure expiratory endurance training produces little or no increase in maximum expiratory pressure and thus no therapeutic value, whereas the training devices and methods according to the subject invention effectively provides substantial (35-100% or more) increases in maximum expiratory pressure in less than four weeks of training.
  • the expiratory threshold valve is adjusted to keep the training pressure at about 75-80% of the elevated maximum expiratory pressure (MEP) up to a training pressure of about 160 cmH 2 O. After the person reaches 160 cmH O, further increases in expiratory muscle strength can be achieved by increasing the number of breathing efforts for each fraining session. After an acceptable plateau of expiratory muscle strength is reached, sustained training will keep the expiratory muscles stronger. As a person's expiratory muscles increase in strength, he or she will be able to adjust the expiratory threshold valve and the training schedule to achieve further increases in maximum expiratory pressure.
  • MEP elevated maximum expiratory pressure
  • the users can get increases in expiratory muscle strength by increasing the expiratory training pressure or increasing the number of expiratory efforts (repetitions).
  • This training method according to the subject invention will be useful to all persons interested in increasing maximum expiratory pressure such as athletes, singers, speakers and speech pathologists requiring them to produce the sound with expiratory airflow.
  • the use of this method is also recommended with aging adults that experience a diminished voicing ability and for patients suffering COPD.
  • the benefits of this training are an increased intensity of expiratory airflow and/or an increased ability to sustain an expiratory airflow magnitude. Accordingly, the training system of the subject invention will not only help patients with vocal disorders, but aging adults, healthy vocalists, band students, athletes, and the population of public speakers.
  • the subject invention provides high intensity and low repetition expiratory specific exercises to significantly increase expiratory pressure generating capacity in subjects.
  • the subject invention provides substantial muscle fraining effect. This simple method of expiratory specific strength training is not only effective but also efficient for increasing expiratory pressure support in subjects.
  • the subjection invention can be fitted for animal use in training the respiratory muscles of animals.

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Abstract

La présente invention porte sur des méthodes et des dispositifs qui augmentent la pression à l'intérieur des voies aériennes, ce qui génère une pression respiratoire positive qui ne dépend pas de l'écoulement d'air. Selon un mode de mise en oeuvre préféré, cette invention porte sur des procédés qui utilisent une soupape de sûreté, de préférence une soupape de pression expiratoire terminale positive permettant d'obtenir une pression expiratoire positive. La pression expiratoire positive est générée lorsque le flux des gaz exhalés par le patient est dirigé dans la soupape de pression expiratoire terminale positive de sorte que les gaz puissent être exhalés contre la soupape précitée, maintenue fermée par la pression de seuil. De cette manière, les gaz exhalés par le patient sont soumis à une pression expiratoire positive établie par la pression de seuil qui, à son tour, augmente la pression dans les voies aériennes du patient. Lorsque la pression expiratoire dépasse la pression de seuil de la soupape, la soupape s'ouvre et l'air est expulsé. Cette invention porte également sur un système d'entraînement unique qui utilise la soupape de pression expiratoire terminale positive pour accroître l'intensité musculaire respiratoire. Plus spécifiquement, cette invention porte sur des procédés visant à augmenter le débit d'air expiratoire et l'endurance des muscles expiratoires chez une personne de sorte que la capacité des muscles à expulser l'air des poumons augmente.
PCT/US2003/001811 2002-01-22 2003-01-22 Systeme de conditionnement des muscles a activite expiratoire pour l'amelioration du systeme respiratoire WO2003061749A2 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU2003205263A AU2003205263A1 (en) 2002-01-22 2003-01-22 Pressure relief valve

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US35125602P 2002-01-22 2002-01-22
US60/351,256 2002-01-22

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WO2003061749A2 true WO2003061749A2 (fr) 2003-07-31
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CN112516424A (zh) * 2020-07-30 2021-03-19 四川致坚医疗科技有限公司 一种呼吸机集成的呼吸肌力训练vimt模式系统
CN112516424B (zh) * 2020-07-30 2024-04-02 四川致坚医疗科技有限公司 一种呼吸机集成的呼吸肌力训练vimt模式系统

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AU2003205263A1 (en) 2003-09-02

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