Overview of Incentive Spirometer and Inspiratory Muscle Training
An incentive spirometer is a tool that helps you understand the amount of air you breathe into your lungs. When you breathe in through this device, a part inside it called the piston lifts up. This shows the amount of air you’re breathing in. This tool is very popular in different types of therapies like physical, speech, and respiratory therapy, as it motivates the patient to take slow, deep breaths by showing them a visual feedback.
Breathing in slowly with the spirometer is important because it allows the lungs to stretch out and the airways to open up. This type of breathing is similar to when we yawn or sigh, which are types of deep breaths.
Through visual cues, an incentive spirometer can help gauge how big a breath a patient is taking. It’s a great tool for rehabilitation as it’s not costly, easy to handle, and doesn’t have any adverse effects. It’s easy to learn and you won’t need any help once you know how to use it correctly. Plus, the visual feedback encourages patients to keep using it.
Medical studies have shown that using an incentive spirometer during lung muscle exercises can help maintain or increase the amount of air you can take into your lungs, prevent lung infections after surgery, and help clear out the lungs. While research on how effective incentive spirometry is for chronic conditions is not conclusive, lung muscle exercise is key in reducing or preventing complications after lung surgery. Using an incentive spirometer after surgery can help keep the lungs clear and healthy. These deep breaths help move mucus and other substances, and help open up lung spaces that might have collapsed. This kind of lung exercise keeps the lungs active, especially during recovery after surgery.
Anatomy and Physiology of Incentive Spirometer and Inspiratory Muscle Training
The respiratory system carries fresh oxygen we breathe to all areas within our lungs. These lungs have a large surface area to allow for the transfer of gases with our circulatory system. They are capable of efficiently replacing gases, whether we are resting or doing strenuous activities like exercising. This system has sophisticated mechanisms at all stages that ensure the lungs can effectively distribute and deliver oxygen, particularly when our body’s demand changes.
In this process, the right chamber of our heart pumps blood that lacks oxygen to the lungs. It does this through a valve and a large artery known as the pulmonary artery. This artery then splits into two smaller arteries at the level of our fourth thoracic vertebrae (part of the spine found in the chest region). The split arteries direct blood to the right and left lung. These arteries continue dividing and eventually become tiny, thin-walled vessels called capillaries.
Once in the capillaries, our blood releases carbon dioxide, a waste product, which passes through the walls of the capillaries into tiny sacs in our lungs called alveoli. At the same time, oxygen from the air within the alveoli is absorbed by the blood. The now oxygen-rich blood travels back to the left section of our heart through the pulmonary veins. This process is very efficient, making it ideal for effective gas exchange.
When we breathe in, the muscle underneath our lungs, known as the diaphragm, and some muscles between the ribs contract causing the lungs to expand. After the phase of inspiration, these muscles relax, and some muscles in the throat constrict to slow down any compression of the lungs. During active breathing out, muscles of the inner ribs and abdominal area contract depending on our body’s needs.
Why do People Need Incentive Spirometer and Inspiratory Muscle Training
There are many situations in which a patient may need inspiratory muscle training. This is a type of therapy to strengthen the muscles that help you breathe. Here are some examples:
Long hospital stays following surgery: After an operation, it’s not enough to use an incentive spirometer alone (a device that helps you breathe deeply to keep your lungs clear). This device works best as part of pulmonary rehabilitation – a group of therapies that help improve lung function. These methods include deep breathing, directed coughing, adequate pain control, early movement, and the spirometer itself, which should be used for ten breath exercises each day. Other ways to prevent lung complications after surgery include oral hygiene, raising the head of the bed by at least thirty degrees, sitting up for meals, and moving about, like dangling the legs or transferring several times per day.
Extended time spent in bed: Immobilization affects almost every system in your body. Breathing problems like decreased air movement, lung collapse (atelectasis), and lung infection can occur. Atelectasis happens when part of or the entire lung deflate or fill with fluid – it’s a common issue after surgery.
Muscle or spinal cord disease/injury: Injuries to the spinal cord disrupt the muscles that help with breathing, especially in those with total paralysis of the upper body (tetraplegia) and those with long-term spinal injuries. In these cases, mmuscle training to aid breathing should be a significant treatment focus.
Cerebral palsy patients in childhood: Using the incentive spirometer has been shown to improve lung function and breath control for speech production in children with cerebral palsy.
Rib fractures: This injury can lead to various problems, such as lung contusions (bruising), lung collapse, breathing failure, and even death. Patients with rib fractures often suffer from chest pain resulting from lower airway obstruction or damaged lung hygiene, which can lead to atelectasis and hypoventilation (slow or shallow breathing). The incentive spirometer can decrease complications and improve lung function.
Chronic obstructive pulmonary disease (COPD): This preventable lung disease causes progressive breathing difficulties. Studies show mixed results for pulmonary rehabilitation’s effect on COPD, but overall evidence supports its use. This method, combined with lifestyle changes, exercise, and quitting smoking, can help manage the disease better.
Video-assisted thoracoscopic surgery (VATS) for lung cancer: Using an incentive spirometer and inspiratory muscle training can lower hospital costs and reduce the chance of pneumonia for those undergoing surgical removal of lung cancer.
Sickle Cell Disease: This causes a typical lung dysfunction called acute chest syndrome in children. To treat this, diagnosis must be followed by IV fluids, the incentive spirometer, pain relief, oxygen or respiratory assistance, antibiotics, and transfusion treatment.
Ankylosing Spondylitis and Parkinson’s Disease: Incentive spirometry and inspiratory muscle training can benefit both these conditions by improving lung function.
Mild to moderate asthma, Cystic Fibrosis, COVID-19, and Idiopathic pulmonary fibrosis: These may all benefit from such treatments as well.
When a Person Should Avoid Incentive Spirometer and Inspiratory Muscle Training
When using a medical device called an incentive spirometer, which helps you breathe more deeply, there are some situations where you might need to be extra careful. Even though there’s no situation where you absolutely cannot use it, there are some health issues where caution is recommended:
If you have a lung infection, are coughing up blood and don’t know why, have a pocket of air trapped in the area around your lungs (pneumothorax), have high blood pressure that’s not under control, have an aneurysm (a bulge in a blood vessel), have recently had surgery on your chest, stomach, or eyes, are feeling sick to your stomach, in pain, or have a mental condition like confusion or dementia, it’s best to be cautious when using an incentive spirometer.
People with a lung condition called bullous emphysema, where large, air-filled pockets form in the lungs, should also be careful, especially when using the spirometer a lot. There was a case where a person with emphysema may have ended up with a partly collapsed lung after using an incentive spirometer a lot. This might have been because the frequent, hard breaths put too much pressure on the already weak lung tissue.
Equipment used for Incentive Spirometer and Inspiratory Muscle Training
An incentive spirometer is a hand-held device you use to help you breathe more effectively. You’ll be guided to take slow deep breaths through a mouthpiece attached to the device. As you breathe, the device provides a visual representation of the air you’re taking in. This helps you see if you’re taking in enough air and teaches you how to breathe properly. There are two types of incentive spirometers; one shows the volume of breath you’re taking in and the other tracks the speed of your breath.
A flow-oriented incentive spirometer has three chambers that you breathe into via a mouthpiece. Each chamber contains a ball that moves upwards with the power of your breath. The amount of air needed to lift the balls is visually represented on the device. When all three balls reach the top with an airflow speed of up to 1200 milliliters (mL) per second, the patient has reached a flow speed of 1200 mL/second. Watching the balls move up offers a clear visual cue of the amount of air you’re taking in, which motivates you further.
A volume-oriented incentive spirometer tracks how much breath volume you’re taking in. Your medical provider can adjust the device to match your breath target, based on your individual circumstances like age, height and health condition. The device has a piston that moves up as you breathe in, showing how much air you’re taking in. There is also a smaller chamber that measures the speed of your breath. The instrument also has a feature to alert you if you’re breathing too fast or too slow.
You’ll be asked to hold your breath for about 5 to 10 seconds after taking in the maximum amount of air you can. After holding your breath, you’ll take out the mouthpiece and let the piston measure return to its original starting point.
Research suggests difference between the volume and flow-oriented devices. Volume-oriented devices seem to make breathing easier and give the diaphragm a better workout, while flow-oriented devices trigger more activity in the upper chest. Volume-oriented devices appear to help more in improving lung function, physical ability, and functional difficulty when compared to flow-oriented devices and diaphragmatic breathing exercises.
Who is needed to perform Incentive Spirometer and Inspiratory Muscle Training?
Incentive spirometry is a method used to improve your lung function. This involves using a device that helps you breathe more deeply and keeps your lungs healthy. Interestingly, there aren’t any legal rules specifying who is allowed to carry out this procedure.
How is Incentive Spirometer and Inspiratory Muscle Training performed
Using an incentive spirometer, which is a device used to help your lungs recover, involves sitting or standing with good posture and holding the device correctly. You’re encouraged to breathe in slowly and deeply through the mouthpiece. The goal is to breathe in enough to make a part of the device, called a piston, rise to a certain level. This level depends on things like how tall you are and how old you are. After you breathe in as much as you can, you should hold your breath for at least 2 to 3 seconds before breathing out gently. It’s important not to keep your lips on the mouthpiece as you breathe out. After doing this exercise 10 times, you should cough to help clear any mucus from your lungs. It is recommended to do this exercise at least 10 times every hour you are awake.
The way you breathe when using an incentive spirometer really matters. It’s better to fill up the lower part of your chest, instead of just the upper part. This is because it helps your lungs to expand more effectively. It’s also better to breathe in slowly and keep your breath for a short while, rather than breathing in quickly. These methods have been shown to help your lungs recover more effectively.
Possible Complications of Incentive Spirometer and Inspiratory Muscle Training
Exercises to strengthen the muscles used in breathing, also known as inspiratory muscle training, usually don’t have many complications. The intensity and length of the exercises can be adjusted to fit the patient’s condition and strength. The main goal is to focus on taking slow and deep breaths, with an aim to take in at least 500 cubic centimeters of air with each breath. Patients should be made aware that deep breathing might cause them to cough.
What Else Should I Know About Incentive Spirometer and Inspiratory Muscle Training?
After surgery, patients can face several issues related to the lungs, such as the lungs not fully expanding (atelectasis), low oxygen level in the blood (hypoxemia), infection in the lungs (pneumonia), problems in breathing, not being able to breathe deeply (hypoventilation), and fluid around the lungs (pleural effusion). Several factors can lead to these pulmonary complications, such as the anesthesia used, the nature of the surgical incision, and the surgical procedure followed.
One common problem after surgery is that patients often start to take more shallow breaths instead of deep ones, and they don’t sigh or yawn as frequently. This change in breathing habits can happen due to various reasons – staying in bed for a long time, decreased body’s natural way of cleaning out foreign substances from the lungs and throat, or an ineffective cough response due to pain. This change can potentially lead to a build-up of lung secretions, which is not good for the lungs.
Special exercises known as pulmonary rehabilitation are crucial in preventing and handling these post-surgery lung-related concerns. The therapy includes deep breathing exercises, training to strengthen the breathing muscles, movement exercises, posture training, and rhythmic tapping on the chest to loosen mucus (percussion and postural drainage). Mechanical devices, like incentive spirometers, help in lung expansion and are commonly used as part of clinical practice.
These lung-related complications after surgery are quite common, and they can increase the risk of death, lead to longer hospital stays, and cause readmissions. Patients with respiratory diseases such as sleep apnea, asthma, and chronic obstructive pulmonary disease, or those who smoke, or have recently had a respiratory infection, or those with low oxygen saturation before surgery, are likely at a higher risk. Research shows that quitting smoking before surgery can reduce the risk of these lung complications. Pre-surgery training of the inspiratory muscles using an incentive spirometer or following a regular exercise program before surgery, may lower the risk even further, especially for patients with low cardiorespiratory fitness, or those going in for surgery.