Hyperinflation of the lung

Question

Dear expert team,
for month I (CF) have extreme problems with the hyperinflation of my lung (residual volume 280%), so that I am very handicapped. The hyperinflation occurs mostly in the afternoon, increases in my opinion if I inhale hypertonic NaCL, and does not disappear until I go to bed. Also physiotherapy aimed at deflation does nearly bring anything at all.
If I do not inhale at all or only isotonic NaCL, I have the feeling, that I do not cough up enough. With Bronchitol® I have worries that the lung is not moistured enough.
My CF physician leaves me unfortunately alone with the problem. Do you have a recommendation for me?
Many thanks.
Best regards

Answer

Dear questioner,
you want to know, how a hyperinflation of the lung can be treated.

At the beginning it has to be emphazised, that the expert team cannot make recommendations but give only information, therefore the support of your physician of confidence cannot be abandonned for the soultion of your health problems.

A hyperinflation of the lung (increase of the functional residual capacity FRC and the residual volume RV) is the consequence of bronchial obstruction (narrowing of the bronchi). Therefore at first the anti-obstructive therapy has to be checked and if necessary be optimized. Hereby I think about inahalations with bronchial widening drugs (short and long-acting preparations, humid inhalations and/or powder inhalations). Furthermore, an effective mucolysis should be included in the therapy. Also here it has to be judged individually about an inhalative (hypertonic saline, DNAse, inhalative Mannitol) as well as about an oral therapy (different expectorative drugs like acetylcystein, ambroxol, thymian i.a.)). In case a moisturization of the airways is necessary, always 0,9% NaCL can be inhaled additionally.
For decrease of the FRC and therefore in order to reduce the hyperinflation, a corresponding physiotherapy and sport should be done besides the therapy with drugs. Targeted breathing exercises and possibly the usage of a breast belt during airway therapy can lead to an improvement of the quality of breathing movements.
In any case a physiotherapist should check the inhalation technique of the patient, if one has the feeling, that the hyperinflation occurs after inhalation (e.g. in your case, after the inhalation of hypertonic NaCl).
Even if I could not give you a direct recommendation, I hope, that you can have a good talk with your physician and that you can find with him together an optimal therapy against the hyperinflated lung.
Best regards,
Yours Dr. med. Christina Smaczny

17.02.2015