The Clinical Use of Intermittent Positive Pressure Breathing Combined with Nebulization in Chronic Pulmonary Disease

¹ The Barton Memorial Division of the Jefferson Medical College Hospital and the Department of Medicine of the Jefferson Medical College of Philadelphia, Penna.

1. Impairment of pulmonary function in chronic pulmonary disease is related basically to the amount of fibrosis, the degree of emphysema, and the pressure of bronchospasm and retention of secretions. Some of these disturbances of function are reversible.

2. Intermittent positive pressure breathing combined with nebulization of bronchodilators and other aerosols is an effective method of treatment of chronic pulmonary conditions where respiratory difficulty or insufficiency due to these factors is present.

3. The results of treatment in 750 cases of chronic pulmonary disease are presented of whom 5.1 per cent showed no improvement, 13.8 per cent a slight degree, 47.5 per cent a moderate degree and 33.6 per cent a marked degree of improvement.

4. Symptomatic improvement was manifested by lessened dyspnea, decrease in cough and expectoration and increased strength.

5. The degree of improvement was recorded objectively by determination of vital capacity and maximal breathing capacity before and after treatment. The vital capacity showed an average increase of 7.0 per cent after one treatment and of 14.9 per cent after a course of treatment. The maximal breathing capacity showed an average increase of 15.8 per cent and 28.5 per cent respectively.

6. Intermittent positive pressure breathing provides relief and control of symptoms through better ventilation of the lungs, improvement of bronchial drainage, more uniform distribution of aerosol to all parts of the lung with relief of bronchospasm, more uniform alveolar aeration and improvement in muscle tone.

7. The beneficial effects of intermittent positive pressure breathing are most pronounced where bronchospasm, loss of lung elasticity, and retention of secretions constitute reversible factors in the production of disability.

8. The details of treatment and the contraindications are discussed.