The Science Journal of the American Association for Respiratory Care

2003 OPEN FORUM Abstracts

CHANGES IN DYSPNEA AND PEAK FLOW RATE AFTER AEROSOLIZED ALBUTEROL AND SQUEEZING TECHNIQUE IN HOSPITALIZED ASTHMA PATIENTS

Yoshihiro Uzawa, RRT, CPFT, RPT, Norihiro Kaneko, MD, Department of Rehabilitation and Pulmonary Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan

Introduction: Asthma is a disease characterized by airway obstruction due to edema, constriction of bronchi and viscous mucoid bronchial secretions. Aerosolized beta agonist therapy is a common treatment for patients with asthma. The purpose of this study is to compare the effects of aerosolized albuterol therapy given to patients without any additional intervention and aerosolized albuterol therapy with chest physiotherapy (Squeezing Technique) in hospitalized asthma patients.

Method: Subjects were eight adult asthma patients, mean age 57.3 +/- 14.3, 1 female and 7 males, who were hospitalized due to difficulty breathing and hypoxemia. The subjects were given two types of treatment: aerosolized albuterol therapy alone and aerosolized albuterol therapy with squeezing technique, in randomized order. Aerosol therapy (2.5mg albuterol sulfate in 3 cc normal saline) was given by a hand-held nebulizer; the subjects were instructed to breathe according to standard protocol. Squeezing technique was performed by having a therapist place his hands over the area of the subject's chest wall, then during expiration, increased amounts of pressure were applied in a medial and caudal direction. Just prior to the patient's inspiration, the therapist released his hands from the chest wall and allowed the patient to inhale. Visual analog scale (VAS), which evaluated dyspnea, and peak flow rate were measured before and after each treatment. The percentage of change was calculated {(post treatment value- pre treatment value) / pre treatment value}×100.

Result: There was no significant difference in peak flow rate and VAS between the two study groups prior to treatment. Both treatments resulted in a significant improvement peak flow rate and VAS (p<0.05). Regarding the percentage of change, VAS was significantly improved in the groups receiving aerosol therapy and the squeezing technique over the aerosol therapy alone (p<0.05). Even though there was no significant difference, peak flow rate tended to increase in the group receiving aerosol therapy with the squeezing technique.

CONCLUSION: Squeezing is one of the chest physiotherapy techniques that increases tidal volumes and expiratory flow rate due to compression of the chest wall during exhalation. Increased expiratory flow rate helps patients to exhale against obstructed airways. We presume that either breathing from a lower lung volume or overall increased tidal volumes may enhance delivery of aerosolized medication into the airways, resulting in a greater deposition of medication. Consequently, dyspnea and peak flow rate were improved after aerosolized albuterol and squeezing. This study suggest that adding the squeezing technique to aerosol therapy in asthma patients may be more effective as compared to aerosol therapy alone.

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