Out with the Old, In with the New (Dynamic Hyperinflation)

I can’t even begin to tell you guys how much I love teaching people about lung function in the presence of disease (read: HUGE NERD). Teaching patients how to correct for dynamic hyperinflation is one of those things that I really love teaching.

If you remember from a few weeks ago, we talked about how to facilitate hyperinflation for those who suffer from restrictive lung diseases like COVID-19, pulmonary fibrosis, or who were recently extubated. But for people with obstructive disease, hyperflation is actually their biggest issue. Airways get obstructed and CO2 gets trapped in the lung. This takes up space and prevents usable oxygen from reaching the alveoli. So, for people with obstructive diseases like COPD, cystic fibrosis, and emphysema, we actually need to decrease and prevent hyperinflation to improve their function.

Dynamic hyperinflation is hyperinflation that keeps building on itself as they takes breaths. The end result is that the usable space for tidal volume becomes less and less and the patient gets short of breath. Take a look at this video a made for you. It’ll help you understand dynamic hyperinflation as well as a few techniques to correct for it! Enjoy!

(Brockway, K., 2020)

Utilizing these techniques before you get started with exercise is important for a couple reasons. You want the patient to have the most lung volume available for tidal exchange which means getting all the trapped CO2 out that you can. Also, you want to give them some time to practice these techniques. It can be very difficult to breathe this way as oxygen demand increases with activity or exercise so practice is important. In addition to practice, your patient will probably need lots of cueing to keep this up as they become more active.

However, if you can start them off on a good tidal volume, improve their V/Q matching at rest and with activity, and rehabilitate them back to even better than where they were before, you are really doing them the service they need. Make sure to keep monitoring their oxygen saturations with training as they may sink as they learn how to change their breathing. They have spent years trying to figure out how to get air in and you will probably be the first one trying to teach them how to get air out!

What are your favorite methods for getting the old air out and the new air in? Tell me about them in the comments!

More from the Pulmonary Rehab Toolbox…


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