The effect of intermittent positive-pressure breathing on airway resistance in normal and asthmatic children

Antiasthmatic therapy in children

The availability of more and better medications for asthma contrasts with reports of an increasing frequency of hospitalization and fatalities. An understanding of the pathophysiology of the disease, its variations in clinical patterns, and the therapeutic potential of the available options for treatment in this overview of asthma management provides a basis for addressing this paradox. A scheme for matching the therapeutic options to the clinical pattern of the disease is presented with comments on the delivery of health care to asthmatic patients. Results of outcome from comprehensive asthma management programs are described.

Clinical applications of mechanical ventilation

This paper reviews recent applications of mechanical ventilation such as controlled hypoventilation in acute asthma, domiciliary nocturnal ventilation in chronic respiratory failure due to neuromuscular disease and improvement of left ventricular performance by raised intrathoracic pressure. Established uses of mechanical ventilation include control of respiratory failure, intracranial pressure and pulmonary hypertension while other uses such as internal splinting of flail chest, simultaneous ventilation-compression cardiopulmonary resuscitation and prophylactic postoperative ventilation are more controversial.

The role of intermittent positive pressure breathing in respiratory physiotherapy

This article reviews the value and limitations of I.P.P.B. as opposed to other treatment methods available to the respiratory physiotherapist. In the treatment of patients with airways obstruction I.P.P.B. is presented as having a limited role. Alternative measures such as the use of simple nebulisation, relaxation therapy and manual methods to remove secretions are described as being preferable to I.P.P.B. in most cases. I.P.P.B. has some value in the early post-operative care of some patients undergoing surgery which results in limitation to spontaneous deep breathing postoperatively. However other methods, notably incentive spirometry should also be considered for these patients. In the treatment and prevention of respiratory complications associated with neuromuscular and skeletal disorders I.P.P.B. can play a significant role in counteracting the possible effects of hypoventilation. I.P.P.B. should be considered as one method among many which is available to the physiotherapist to assist in the treatment of respiratory complications associated with medical and surgical conditions.

Comparison between simple nebulization and intermittent positive-pressure in asthmatic children with severe bronchospasm

Tweinty-three asthmatic children had severe sudden bronchospasm due to numerous factors. Baseline values for the peak expiratory flow rate were less than 25 percent of predicted. Utilizing an analysis of variance, three methods of administering isoproterenol hydrochloride (hand-held Freon-propelled nebulization, continuous nebulization, and intermittent positive-pressure breathing [IPPB]) were compared and found to be similar in reversing the bronchospasm (F = 1.56; degrees of freedom, 2/44; P = 0.22). There were no patients whose condition consistently improved with IPPB over the methods of therapy using simple nebulization. Therapy with IPPB did not offer any advantage over simple nebulization in patients with severe, reversible airway obstruction.