Physiotherapy with Asthma and CF

Question

Hello,

When would you inhale Pulmozyme®?

I feel that the secretion gets looser more easily if I inhale Pulmozyme® first and then wait for an hour before I do physiotherapy.

1. NaCL 0.9% and 4 dr. Ventolin® (salbutamol)
2. Pulmozyme® (DNAse)
3. Symbicort® (budesonide and formoterol) and Spiriva® (tiotropium bromide)
4. Therapy

And if I combine the autogenic drainage with the humid inhalation (PariBoy®) and the PEP®, how can I hold my breath briefly with an open mouth? Would it be better to take out the mouthpiece briefly and keep the lips closed?

Answer

Hello,

Many thanks for your questions.

Concerning the order of inhalation, I would like to say the following:

Spiriva® is usally inhaled only once a day in the mornings. Apart from this, you can keep the order of points 1 and 2. Symbicort®, however, I would inhale only after the lungs are cleaned (i.e., after physiotherapy for secretolysis). It is supposed to protect the lungs/bronchia. Symbicort® is usally inhaled in the mornings and evenings. In case of doubt, please ask your treating doctor.

Humid inhalation can be combined with the PEP® system in different ways. Humid inhalation with a compressor (here: Pari®) is based on the breathing technique applied in autogenic drainage. Here, the glottis (larynx or epiglottis, respectively) should remain open during the breathing pause. This can be done with both a closed and an open mouth.

In your case, practicing the breathing pause with an open glottis as part of physiotherapy would make sense. Please practice this with your physiotherapist, for the main point about the breathing pause is that there is no forced expiration while it lasts. Therefore, it does not matter whether you perform the breathing pause with your mouth open or closed; it is most important that you avoid forced expiration (since the epiglottis will then close).

Good luck and kind regards

Kathrin Könecke
Physiotherapist

19.07.2012