Therapy for Mucus-Clearance Disorders

Therapy for Mucus-Clearance Disorders

Hardcover

$179.95

Product Details

ISBN-13: 9780824707163
Publisher: Taylor & Francis
Publication date: 05/28/2004
Series: Lung Biology in Health and Disease Series , #188
Pages: 504
Product dimensions: 6.25(w) x 9.25(h) x 1.00(d)

Table of Contents

Introductioniii
Prefacev
Contributorsix
Part 1Introduction
1.Overview of Airway Mucus Clearance1
I.Introduction1
II.Airway Cilia and Ciliary Beat5
III.Airway Mucus, Secretory Cells, and Mucins9
IV.Cough11
V.Mucus Obstruction in Asthma and COPD12
VI.Mucus Clearance in Asthma and COPD13
VII.Differences in Pathophysiology Relating to Mucus Obstruction in Asthma and COPD14
VIII.Considerations for Effective Treatment of Airway Mucus Obstruction16
IX.Conclusions19
References20
2.The Biophysical Properties of Mucus29
I.Introduction29
II.Mucus Viscoelasticity30
III.Surface Properties of Mucus32
IV.Current Methods for Mucus Viscoelasticity33
V.Role of Mucus in Mucociliary Clearance36
VI.Mucus and Cough Clearance37
References38
3.Regulation of Airway Mucus Secretion43
I.Introduction43
II.Components of Mucus43
III.Sources of Mucous Secretions45
IV.Methods for Measuring Mucous Secretions45
V.Preparations for Measuring Mucus Secretion48
VI.Neurohumoral Regulation of Mucus Secretion by Surface Epithelium51
VII.Regulation of Goblet Cell Secretion by Second Messengers53
VIII.Neural Mediation of Gland Secretion56
IX.Effects of Cholinergic Agents on Gland Secretion59
X.Effects of Adrenergic Agents on Gland Secretion60
XI.Regulation of Gland Secretion by NANC Agents61
XII.Regulation of Gland Mucus Secretion by Second Messengers64
XIII.Gland Water Secretion65
XIV.Secretion by Gland Cell Cultures66
XV.Conclusions67
References68
4.Outcomes for Trials of Mucoactive Therapy87
I.Introduction87
II.In Vitro Testing87
III.In Vitro Measurements88
IV.Animal and Tissue Studies90
V.In Vivo and Clinical Testing91
VI.In Vivo Outcome Variables in Short-Term Studies93
VII.In Vivo Outcome Variables: Long-Term Studies96
VIII.Summary98
References99
5.Adherence with the Use of Clearance Techniques105
I.Introduction105
II.Why Is Treatment Adherence Important?106
III.Levels of Adherence107
IV.Definition of Adherence108
V.Measurement of Adherence109
VI.Reasons for Poor Adherence112
VII.Demographic and Clinical Predictors of Adherence115
VIII.Psychosocial Predictors of Adherence116
IX.Evidence for the Effectiveness of Intervention121
X.Methods to Enhance Adherence122
XI.Conclusion123
References124
Part 2Mucoactive Medications
6.Taxonomy of Mucoactive Medications129
I.Overview129
II.Introduction130
III.Expectorants131
IV.Ion Transport Modifiers133
V.Mucolytics135
VI.Mucokinetic Agents138
VII.Mucoregulatory Agents139
VIII.Clinical Use of Mucoactive Therapy140
References141
7.Mucoactive Drug Delivery147
I.Introduction147
II.Aerosol Delivery Systems149
III.Dry-Powder Inhalers155
IV.Aerosolized Mucoactive Drugs156
V.The Future166
References167
8.Expectorants175
I.What Are Expectorants?176
II.Mechanisms of Action of Expectorants177
III.Expectorant Drugs179
IV.Asiatic Expectorants196
V.Conclusions197
References198
9.Mucolytics and Mucus Clearance201
I.Introduction201
II.Role of Mucus in Mucociliary Clearance202
III.Cough Clearance203
IV.Mucus Viscoelasticity204
V.A Molecular Basis for Mucolytic Therapy204
VI.General Approaches to Mucolysis207
VII.Nondestructive Mucolysis: Ionic and Hydrogen Bonds212
VIII.Oligosaccharide Mucolytic Agents214
IX.Physical Mucolysis: High-Frequency Oscillation216
X.Airway Surface Hydration by Epithelial Ion Transport216
XI.Interaction Between Mucoactive Agents217
References218
10.Modulation of Mucociliary Function by Drugs and Other Agents225
I.Introduction225
II.Structure and Function226
III.Measurement of Ciliary Function235
IV.Drug Effects on Mammalian Cilia240
V.Disease States280
VI.Conclusions285
References285
11.Mucokinetic Agents and Surfactant307
I.Introduction307
II.Surfactant Composition and Metabolism307
III.Role of Surfactant in Airway Patency309
IV.Role of Surfactant in Lung Defense Mechanisms310
V.Mucociliary Transport312
VI.Surfactant and Chronic Lung Disease316
VII.Clinical Trials of Surfactant in Chronic Lung Disease317
VIII.Ambroxol321
IX.Agents that Increase Air Flow321
X.Summary321
References322
12.Mucoregulatory Medications327
I.Introduction327
II.Mucoregulators328
References344
13.Hyperosmolar Solutions and Ion Channel Modifiers353
I.Introduction353
II.Hyperosomolar Solutions354
III.Ion Channnels356
IV.Ion Channel Modifiers359
References364
14.Mucoactive Agents and the Upper Airway373
I.Respiratory Mucosa Structures in the Upper Airways373
II.Upper Respiratory Mucosa Under Pathological Conditions374
III.Rheological Properties of Mucus in the Upper Airways376
IV.Mucoactive Agents and Upper Airway Diseases382
V.Conclusions388
References388
15.Issues on Regulatory Approval of Mucoactive Drugs395
I.Introduction395
II.Classification of Products and Labeling Indication396
III.Specific Diseases to Study397
IV.Endpoints and Comparator Selection401
V.Conclusions410
References410
Part 3Physical Therapy and Clearance Devices
16.Airway-Clearance Techniques Individually Tailored to Each Patient413
I.Introduction413
II.Coughing415
III.Forced Expirations, Huffing416
IV.Breathing Techniques420
V.Postural Drainage421
VI.Percussion/Clapping: Vibration/Shaking422
VII.Autogenic Drainage423
VIII.Physical Exercise and Sports424
IX.Final Remarks426
References426
17.High-Frequency Oscillation, PEP, and Flutter433
I.Introduction433
II.Positive Airway Pressure434
III.High-Frequency Oscillation444
IV.Flutter Valve447
V.Percussionaire450
VI.High-Frequency External Chest-Wall Compression453
VII.The Vest453
VIII.The Hayek Oscillator454
IX.Comparison of Flow, Airway, and Esophageal Pressures455
X.Summary465
References465
18.Pediatric Mucus Clearance by Chest Physiotherapy: Principles and Practice471
I.Introduction471
II.Physiological Perspectives473
III.Clinical Perspectives481
IV.Psychological Perspectives484
V.Pathophysiological Perspectives486
VI.Practical Perspectives491
VII.Conclusions495
References496
19.Postoperative Mucus Clearance503
I.Introduction503
II.Postoperative Pulmonary Complications503
III.Pathogenesis of Complications504
IV.Risk Factors for Developing Postoperative Pulmonary Complications508
V.Effect of Physiotherapy on Perioperative Respiratory Function524
References541
20.Management of Airway Secretions in Patients with Severe Respiratory Muscle Dysfunction553
I.Introduction553
II.Ventilatory Versus Oxygenation Impairment554
III.The Normal Cough555
IV.Why Expiratory Muscle Aids Are Needed556
V.Respiratory Muscle Aids557
VI.Glossopharyngeal Breathing557
VII.Inspiratory Muscle Aids558
VIII.Noninvasive IPPV559
IX.The Evolution to Tracheostomy IPPV562
X.Noninvasive Expiratory Muscle Aids564
XI.Treatment Protocol570
XII.Difficulties in Initiating the Use of Noninvasive Aids571
References573
Index577

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