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Vibrating vest and other tx for COPD?

Posted

I am a peds nurse and my specialty is pulmonology (I also do PICU/Stepdown, med/surg).

I was wondering if I can ask some nurses who have COPD patients if they are ever prescribed airway clearance treatments, vibrating vest, flutter devices, etc. I was talking with a friend whose mom is struggling with COPD right now, mostly the clearance and movement of mucous. She's older and not very strong. I asked the friend if she had heard of any of these therapies and she hadn't. I was surprised at this, because I have seen how they make a difference in a lot of my patients with mucous clearance issues, all with different varieties of lung diseases. Would they be too harsh for a COPDer or do they just not work, or do you see success with these therapies?

Edited: not asking for personal advice-- this is a curiosity question. Just in case there was any doubt about my intentions. ;-)

Edited by anon456

OneDuckyRN

Specializes in ICU. Has 3 years experience.

I work with a lot of COPD patients and I have noticed that they are more often prescribed a flutter valve for helping to move secretions. We also get a fair number of young adult CF patients and they use percussion vests more frequently, but I have seen the occasional vest used for a COPD pt. Both seem to work pretty well so long as the patient is compliant and using their device correctly.

Have seen the percussion vest used three or four times but the patients did not have COPD diagnosis. Can't say one way or the other about their effectiveness for airway clearance, but they sure were great for relaxed drifting off to sleep.

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

Lots of flutter valves for anyone with pulmonary issues. I've never seen a vest used in an adult. Occasionally we'll do percussion if we've got someone with terrible pneumonia. Seems more palliative than anything at that point.

I've seen the vest in the home setting a couple of times, prescribed by the same doctor. The flutter devices are fairly common.

Thanks! I learn something new every day! :-) Good to know those flutter valves are used by more than just CFers.

HouTx, BSN, MSN, EdD

Specializes in Critical Care, Education. Has 35 years experience.

AHA! Where might one obtain a one of these wondrous vibrating vests you speak of? (chronic asthmatic here, dealing with a severe exacerbation at the moment) Sounds like pure heaven for my poor, tired intercostals.

AHA! Where might one obtain a one of these wondrous vibrating vests you speak of? (chronic asthmatic here, dealing with a severe exacerbation at the moment) Sounds like pure heaven for my poor, tired intercostals.

If you search youtube you can see videos of them. I'm actually thinking about one of those flutter valve things the next time I get asthmatic bronchitis from an illness! They seem like a great idea.

Those vests-- A lot of my patients have them at home, I assume delivered from home health suppliers with an order. It's fun to watch them getting their treatments. It's like an amusement park ride and they often make vocalizations and giggle through treatments.

~PedsRN~, BSN, RN

Specializes in Acute Care Pediatrics. Has 4 years experience.

I'm not sure what a vest would accomplish in an asthma exacerbation unless you were full of some thick snot. :D They are chest PT but done with a machine vs. manually. They are there to mobilize secretions. Our CF population used to use them extensively, but we are now moving towards meta nebs.

They are very $$$$. :(

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

Our flutter valves come from respiratory therapy. I'm sure you could order them online somewhere. Brand name is Acapella.

I'm not sure what a vest would accomplish in an asthma exacerbation unless you were full of some thick snot. :D They are chest PT but done with a machine vs. manually. They are there to mobilize secretions. Our CF population used to use them extensively, but we are now moving towards meta nebs.

They are very $$$$. :(

For asthma not so much, but for the bronchitis part of it when I get sick and develop the secondary yuck infection that takes forever to clear out. For anyone who has mucous, pretty much, I can see this possibly helping.

The Vest is not tolerated very well by older adults with COPD and especially some women with breast implants or surgery hx. Back injuries can also be exacerbated with the Vest in older adult. Obesity also makes it difficult. We rarely use the Vest in adults unless they are CF or Bronchiectasis.

The Acapella (Flutter device) provides both resistance and flutter which are great for rehab and mucus clearing. It is used widely in Pulmonary Rehab for COPD.

PEP and Acapella are what CF patients use when they don't use the Vest like s/p port or peg tube surgical procedures or they are in a place where they can not take the Vest like school.

Asthmatics also like the PEP and Acapella. The Acapella can be use with a nebulizer attached.

The Cornet is another clearance device.

Nice device but a nebulizer can not be attached.

Newer devices are now on the market which are gaining in popularity in the home care situation especially for asthmatics.

Aerobika® Oscillating Positive Expiratory Pressure (OPEP) Therapy System | Monaghan Medical

The Harmonica (the little musical instrument) is a great exerciser for COPD and Asthma patients. Look up Pulmonica.

Pulmonica Harmonica Helps Patients Manage Asthma, COPD According To Experts Lung Disease News

A good article to provide an overview of devices:

Current devices of respiratory physiotherapy

The MetaNeb is not accepted for CF because it has not been studied for that population. It is also totally a pneumatic machine which requires a 50 psi oxygen source to operate. This means it is not available for home situations. There is a form of IPV which can be used at home but it is not getting good reviews by the patients who have tried it since it lacks the oomph of 50 psi gas pressure source.

All of the above, except the harmonica, require a doctor's prescription to be covered by insurance. None of these devices are cheap when they have the words "medical device" attached to them.

Consult a Pulmonologist after you have a read a few articles and talked to some RTs to get the most out of a professional opinion and recommendation.

This is great info! I wonder why the acapella is not used more widely in my unit with the kids who are able to use it? It sounds like it works great for many different mucous situations.

I could see why the vest would not be a good choice for frail, older people, or anyone with implants. I'm sure pacemakers are included in that category, too. I have seen them used with implanted ports. They have a large special foam pad placed around it.

Yes there are foam pads in the shape of a donut which can be used for ports and pegs. But, there are times when they have the needle in the port during IV therapy which can be painful if jiggled around especially in teenage girls.

The Acapella is expensive and hospital departments on a budget struggle to keep them stocked. The same with the Incentive Spirometer. Some give them away like candy without a charge generated in the hospital. Big cost and they go away never to be ordered again.

The CF population do take their equipment very seriously since they rely on it everyday. They live with multiple clinic appointments and PFTs with education hammered into them. Asthma education is still in its infancy. Many with asthma will wander throughout most of their childhood and adult life without having any concrete information provided and numerous doctors failing them.