Air Stacking vs Glossopharyngeal Breathing in Neuromuscular Diseases
Condition: Neuromuscular Diseases
MeSH terms: Neuromuscular Diseases
Study type: Interventional

Summary: 
      Neuromuscular diseases (NMD) are characterized by a reduced maximum insufflation capacity
      (MIC), which contributes to increased morbidity and mortality from respiratory diseases.
      Techniques such as glossopharyngeal breathing (GPB) and insufflation using a manual
      resuscitation bag, or "air stacking (AS)", can be used to increase the MIC. These techniques
      employ different mechanisms, and the ability to learn the technique plays a key role in its
      proper implementation and effectiveness. The objective is compare the effects of AS and GPB
      on the MIC in patients with NMD.

      Children and adolescents with NMD who were users of non-invasive mechanical ventilation were
      recruited. Vital capacity (VC) and MIC were measured prior to and after the intervention with
      AS and GPB. Values were compared pre- and post-intervention and were considered statistically
      significant if p <0.05.
    

Detailed description: 
      In neuromuscular diseases (NMD), progressive weakness of the respiratory muscles causes
      changes in the cough mechanism and prevents the elimination of secretions, which is the main
      cause of morbidity and mortality in this population.

      Improving the cough response and achieving effective secretion elimination is required to
      increase lung volume and optimize the peak cough flow (PCF). It has been shown that a high
      PCF decreases respiratory complications in NMD. Vital capacity (VC) and maximum insufflation
      capacity (MIC) are the most important factors in increasing the PCF and, consequently,
      obtaining a more effective cough; thus, optimizing the lung volumes to achieve an adequate
      cough flow is important for effective bronchial hygiene. Currently, manual techniques are
      used to increase the MIC to achieve an effective PCF.

      The most important manual techniques used to improve the MIC and, consequently the PCF, are
      air stacking (AS) and glossopharyngeal breathing (GPB). These have the advantages of low
      cost, patient autonomy and relative ease of learning compared to other techniques using
      electromechanical devices (e.g., volumetric ventilators and mechanical cough assist devices),
      whose main disadvantages are the high cost and complexity of use. AS involves delivering
      multiple breaths into a manual resuscitation bag and holding the insufflation volumes with
      the momentary closure of the glottis, which is repeated until the MIC is reached. GPB uses
      the glossopharyngeal muscles to successively introduce small amounts of air into the lungs to
      induce coughing and assist the weak inspiratory muscles. These techniques have been useful in
      treating different NMD, such as Spinal Muscular Atrophy (SMA) Type II, Duchenne Muscular
      Dystrophy (DMD) and Spinal Cord Injury (SCI).

      The aim of this study was to compare the effects of two low-cost techniques, AS and GPB, on
      the MIC in children and adolescents with NMD. The hypothesis of this investigation was that
      although both techniques are effective, using AS results in a higher MIC than GPB.
    

Intervention name(s): Glossopharyngeal Breathing; Air Stacking
Intervention type(s): Procedure; Procedure
Intervention description(s): Glossopharyngeal Breathing is a type of lung recruitment technique where the patients take a multiple inssuflations with their glossopharyngeal muscle.; Air Stacking is a type of lung volume recruitment technique where insufflations are stacked in the lungs to maximally expand them, here done with a manual resuscitator.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Treatment