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abnormally thick, tenacious mucus. Without assistive
interventions, CF patients suffer frequent, severe infections,
rapid lung deterioration and early death. Striking improvements
in PFT stability, general health and survival among CF patients
have encouraged physicians to prescribe HFCC for patients with
any condition characterized by MCC impairment such as
bronchiectasis, chronic bronchitis and dyskinetic ciliary
disorders. 30,58-61 HFCC therapy has been prescribed to manage
lung problems tied specifically to inhaled UFP, most notably in
coal miners with pneumoconiosis associated with coal dust
exposure.
The inCourage PAC
For exposed firefighters, prompt on-site or routine post-shift infirehouse
removal of inhaled UFP may be a more practical
intervention. A new HCFF device, the inCourage PAC (Portable
Airway Clearance), has been designed specifically to meet
emergency airway clearance needs and ongoing maintenance
therapy. HFCC with the inCourag PAC is easy to administer and
can be performed in any setting with access to a power source.
Users secure an inflatable wrap-like garment over their chest
and connect two tubes to both the garment and a pulsating
therapy unit (PTU). When activated, rapid compressions of the
chest wall produce oscillations within the airways that increase
airflow velocities and create brief changes in lung airflow
patterns similar to coughing. Physiological effects are threefold:
1) mucus adherent to bronchial walls is loosened; 62-64 2) thick
secretions are physically altered, thus enhancing clearability 64-66
and; 3) an airflow bias mobilizes particle-laden secretions
toward central airways for elimination by coughing or
expectoration. 62-64,67 Measurements of tracheal mucus clearance
rates (TMCR) show that HFCC increases mucus mobilization up
to 240% of that achieved by healthy MCC systems. 62 Radioactive
tracers attached to carbon particles demonstrate cephalad
movement of mucus from smaller to larger airways. 67 HFCCinduced
interruption of glycoprotein bonds favorably alters
mucus rheology to enhance mucus-mobilizing ciliary activity. 61,
63-66
Up-to-date reviews on the management of fire-associated
inhalation injury routinely advocate airway clearance
interventions to remove both excess mucus and particulate
matter. 68 In its most recent guideline document, the American
Physical Therapy Association (APTA) recommends airway
clearance therapy with modalities including mechanical
techniques for chest wall manipulation/percussion/vibration (ie
HFCC) to manage lung problems caused by UFP. 69 The
guidelines include ICD-9 codes for conditions including coal
workers’ pneumoconiosis and other pneumoconioses due to
silica or silicates, due to other inorganic dust, due to other dust,
due to unspecified inhaled matter and due to asbestosis. 69
Anticipated benefits
For firefighters with occupational exposure to byproducts of
combustion, on-site and post shift HFCC treatments may be
expected to:
• improve clearance of particle-laden airway secretions
• enhance cough function
• reduce work of breathing
• improve gas exchange
• increase physical endurance
• enhance health, wellness and fitness
• improve work-related quality of life
• reduce absenteeism and job-related healthcare costs
• reduce risk for long-term lung disease
Summary
Lung function is directly related to lung health; decreasing lung
function is a consistent occupational risk factor among
firefighters and is strongly associated with quality of life
deficits, progressive illness and premature mortality. The health
consequences of overexposure to UFP are clear. Compelling
studies, including WTC disaster-related investigations,
demonstrate the adverse effects of UFP on lung defenses,
mucus production and clearance, and on pulmonary function.
Indisputably, UFP contribute to the development of a broad
range of pulmonary and systemic diseases. Acute and long-term
respiratory damage is prevalent following major fire, explosive,
or industrial disasters. In the light of such evidence,
interventions are urgently needed that will modify the impact of
occupational exposures among firefighters, rescue workers and
civilians. Both basic research and extrapolated clinical
experience support the rationale for firehouse use of HFCC.
Routine use of aggressive airway clearance therapy with the
inCourage PAC may be a simple, reliable and effective way to
reduce risk for occupational lung injury among firefighters.
References
1 Banauch GI, Hall C, Weiden M, Cohen HW, Aldrich TK,
Christodoulou V, Arcentales N, Kelly KJ, Prezant DJ.
Pulmonary function after exposure to the World Trade
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Respir Crit Care Med. 2006 Aug 1; 174(3):312-319.
2. Herbert R, Moline J, Skloot G, Metzger K, Baron S, Luft B,
Markowitz S, Udasin I, Harrison D, Stein D, Todd A, Enright
P, Stellman JM, Landrigan PJ, Levin SM. The World Trade
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3 McClellan, RO. Particle interactions with the respiratory
tract. In: P Gehr and J Heyder, Eds. Particle-Lung
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4 Fireman EM, Lerman Y, Ganor E, Greif J, Fireman-Shoresh
S, Lioy PJ, Banauch GI, Weiden M, Kelly KJ, Prezant DJ.
Induced sputum assessment in New York City firefighters
exposed to World Trade Center dust. Environ Health
Perspect. 2004 Nov; 112(15):1564 - 1569.
5 Moline J, Herbert R, Nguyen N. Health consequences of the
September 11 World Trade Center attacks: a review. Cancer
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6 Mauderly JL, Cheng YS, Hoover MD, Yeh, HC. Particles
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7 Banauch GI, Hall C, Weiden M, Cohen HW, Aldrich TK,
Christodoulou V, Arcentales N, Kelly KJ, Prezant DJ.
Pulmonary function after exposure to the World Trade
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Respir Crit Care Med. 2006 Aug 1; 174(3):312-319.
8 Lin S, Reibman J, Bowers JA, Hwang SA, Hoerning A, Gomez
MI, Fitzgerald EF. Upper respiratory symptoms and other
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32 Respiratory Therapy Vol. 2 No. 3 � June-July 2007