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Topic Effectiveness of flutter device and the active cycle of breathing technique in non-cystic fibrosis broncheactasis(NCFB) to improve inspiratory

and expiratory effort and exercise capacity.

What is bronchiectasis?

When we breathe, air passes through a series of ever-smaller airways (bronchial tubes) before reaching its destination in the lung. In patients with bronchiectasis, the bronchial tubes are enlarged, allowing mucus to pool and making the area prone to infection. This can initiate a vicious cycle in which recurrent bacterial infections lead to inflammatory responses that cause even more injury to the bronchial tubes. In some cases, the airway and surrounding lung tissue are destroyed. Patients with NCFB typically have a cough that results in a large volume of sputum; sometimes they cough up blood or bloody sputum. They may be short of breath, tire easily, and be unable to enjoy life to the fullest. Many patients with NCFB experience chronic lung infections with bacterial pathogens. The presence of bacteria in the lungs contributes to symptom flare ups (exacerbations), a common problem in patients with NCFB. During exacerbations, symptoms become much worse and some patients may require hospitalization or intravenous antibiotics

Pathophysiology and distribution NCFB is characterized by mild-to-moderate airflow obstruction that generally worsens over time. The most widely known model of the development of bronchiectasis is Cole's vicious cycle hypothesis [1This proposes that an environmental insult, often against a background of genetic susceptibility, impairs mucociliary clearance, resulting in persistence of microorganisms in the bronchial tree and microbial colonization. The microbial infection causes chronic inflammation, resulting in tissue damage and impaired mucociliary motility. This then leads to more infection, with a cycle of progressive inflammation, causing lung damage. The current viewpoint requires two factors for the

development of this condition: persistent infection and a defect in host defenses. Most commonly, this condition is generalized, and seems to be usually found in the lower lobes. The involvement of the lower lobes may

reflect gravity-dependent retention of infected secretions. Symptoms

The symptoms and clinical course of NCFB are variable. Some patients have no symptoms at all or symptoms only during exacerbations, whereas others have them daily.

The classic clinical manifestations of this clinical condition are cough and daily mucopurulent sputum production, often lasting months to years. Blood-streaked sputum or hemoptysis may result from airway damage associated with acute infection. Dyspnea and wheezing occur in 75% of patients. Pleuritic chest pain occurs in 50% of patients and reflects the presence of distended peripheral airways or distal pneumonitis adjacent to a visceral pleural surface. Physical examination of the chest shows adventitious breath sounds, such as crackles (70%), wheezing (34%) or rhonchi (44%) A number of patients have frequent exacerbations of their symptoms due to NCFB. Exacerbations can be defined as patients reporting four or more of the following symptoms: change in sputum production, increased dyspnea, increased cough, fever over 38 C, increased wheezing, decreased exercise tolerance, fatigue, malaise, lethargy, reduced pulmonary function, changes in chest sounds or

radiographic changes

consistent with a new infectious process The pulmonary manifestations of cystic fibrosis (CF) include thick secretions, pulmonary infections, and airway obstruction. Recurrent pulmonary infections lead to irreversible loss of lung function and the development of bronchiectasis. The medical management of the pulmonary

symptoms of CF includes treatment with antibiotics for pulmonary infection, and airway clearance techniques to mobilize sputum and prevent occlusion of the airways by secretions. Airway clearance techniques such as chest physiotherapy remain an important part of treatment in bronchiectasis, together with prompt antibiotic treatment for infective exacerbations.

methodology inclusion criteria 1)Patients with productive bronchiectasis a decrease of at least 10% in predicted value for forced expiratory volume in 1 sec (FEV1) from the most recent value, 2) any decrease in body weight 3) the presence of new crackles on auscultation of the lung fields. 4) above 8 years- till 65 group

Exclusion criteria were In Patients where there is inability to perform pulmonaryfunction tests, Who have current pneumothorax, Who had untreated cor pulmonale, and with recurrent haemoptysis. Materials using for project Flutter device Incentive spiromerty Borg scale

6 MWT or 6MWD Sputum quantification Procedure ACBT 3 component s 1)Breathing control breathing using lower chest, with relaxation of upper chest and shoulders 2)3 or 4 thorasic expansion exersies along with deep breathing exercises emphasissing on inspiration , combined with 3-s end inspiratory hold followed by passive expiration. 3) one to two forced expiration techniques or huffs . Flutter T he Flutter valve has been introduced as an alternative to CPT to clear bronchial secretions. The Flutter is a hand-held device designed to help clear mucus in patients with lung disorders. The principle behind this device is that exhalation into the Flutter valve causes a steel ball-bearing to oscillate at a high frequency, resulting in vibration of the airways and which may be cleared by the forced expiratory technique (FET)