RT consulted with some leading device manufacturers about today’s airway clearance products and the industry and technology trends in the next few years.
Clearing airway secretions relies on effective technology and devices. In their efforts to optimize patient comfort, mobility, and therapy compliance, respiratory care departments face rising healthcare costs and growing emphasis on reducing hospital readmissions. New developments in airway clearance therapy, including the shift to home care, are having an impact on the market.
To gain additional insight, RT recently spoke with representatives from three of the leading product manufacturers in the market:
- Bob Buehler, chief commercial officer, RespirTech;
- Michael McPeck, RRT, FAARC, director of Clinical Education, Vibralung clinical specialist, Westmed Inc;
- Andy Reding, vice president, general manager, Hill-Rom Respiratory Care.
RT: What’s new in the airway clearance product market? How do you feel products and technology have changed over the last few years?
Bob Buehler (RespirTech): Airway clearance with vest therapy is known to work—it moves mucus out of airways. Now, the focus is on making existing technologies quieter, more connected through integrated data collection and dissemination tools, and more comfortable. When patients have compared the comfort of our inCourage System to other vest therapy systems, we’ve fared very well. We’re extremely pleased that patients have reported being able to perceive a comfort difference because we’ve put a great deal of effort into creating a system that helps patients take a deep, more comfortable breath during therapy. We strongly believe more comfort can contribute to better adherence and that’s our ultimate goal—doing what we can to help patients get the therapy they need to breathe better.
Michael McPeck (Westmed): The only change in airway clearance therapy (ACT) that is genuinely new is acoustic airway clearance. In the realm of OPEP and HFCWO, there are a couple new devices that essentially work the same as the old devices; but whether they are any better is debatable. Westmed’s Vibralung Acoustical Percussor is truly an innovative departure from old ACT devices inasmuch as it provides a highly effective, affordable and exceptionally portable means of providing airway clearance to a wide variety of patients by way of a unique operating methodology that has multiple advantages over other methods.
Andy Reding (Hill-Rom): The VisiVest System is the first airway clearance system to combine market leading High Frequency Chest Wall Oscillation technology with Bluetooth connectivity enabling lower respiratory infections, hospitalizations and medical costs. By providing secure, automatic usage feedback, the system fosters a closer partnership between patients and health care teams, so treatment decisions can be more tailored and responsive enabling better therapy adherence.
RT: Do you believe the trend toward home care has affected the market for airway clearance products? Has this trend affected your company’s product development?
Buehler: For chronic conditions, home is a logical, convenient and cost-effective setting for care. We plan on leveraging wireless and web-based technologies to better monitor ongoing therapy. RespirTech and academic partners are part of an NIH Small Business Innovation Research grant-supported project that is exploring how data provided through remote monitoring of vest therapy and wireless spirometry at home can help detect and address pulmonary issues before they require more serious and costly interventions.
McPeck: Yes, that is a fair statement. The initial success of the Vibralung Acoustical Percussor has been in the home care market, both for patients with cystic fibrosis as well as COPD, bronchiectasis in particular. But the Vibralung’s success in home care is now crossing over into the hospital in-patient market as there is a two-way continuum between them. Devices must be able to travel the home-to-hospital or hospital-to-home continuum fluently if they are to be of value, and the Vibralung is already doing that.
Reding: Yes, patients, caregivers and healthcare teams are looking for airway clearance products that are going to keep their patients out of the hospital and have an improved quality of life at home.
RT: Discuss your company’s most recent products, what makes them innovative, and how they are addressing the need to reduce costs and maximize outcomes?
Buehler: RespirTech is working on wirelessly transmitting vest therapy data to a smartphone. This capability is part of a system that would, for the first time, correlate spirometry results and vest therapy information to provide a more complete, accurate picture of a patient’s status. The intent is for this information to be shared with healthcare providers via a web-based app. They then could use current lung function and vest therapy data to quickly identify and respond to changes in a patient’s pulmonary function. Ideally, closer and more consistent monitoring will facilitate earlier interventions that improve outcomes and reduce costs.
McPeck: The Vibralung is unique in the world of ACT. It is the only acoustic ACT device that is coupled directly to the “column” of gas in the tracheal-bronchial tract and applies vibratory sound waves, over a wide range of frequencies, during both inspiration and exhalation, to loosen and mobilize secretions by sympathetic resonance. The Vibralung works passively and does not require excessive patient effort, specialized breathing maneuvers, or the patient to master PEP breathing techniques. Other devices, such as OPEP, that are applied to the mouth are active only during brief periods of exhalation, rather than the entire respiratory cycle. They require deliberate patient effort and cooperation. Unlike HFCWO, the Vibralung is also very gentle, making it useful for patients with chest injuries, chest tubes, and ports. All of these features of the Vibralung have afforded healthcare facilities with additional effective and less-expensive options to achieve the outcomes that conventional ACT devices cannot provide.
Also in the realm of airway clearance, Westmed has recently begun to market and distribute PulmoSal 7% (pH+) Bio-Balanced Hypertonic Saline as part of its Total Pulmonary Hygiene program that includes the Vibralung Acoustical Percussor and the Circulaire II high-efficiency aerosol drug delivery system. Conventional sodium chloride inhalation solutions, used for mucolysis and secretion clearance, are typically acidic, with a pH ranging between 4.5 and 7.0. Pseudomonas aeruginosa has an affinity to colonize in the airway surface liquid at an acidic pH of ~6.0. PulmoSal 7% (pH+) has been shown in vivo to render a 5X-log decrease in bacterial density compared to a 2X-log decrease for the pH 5.86 and 6.6 solutions.1
Reding: Only Hill-Rom offers the integrated convenience and efficacy of MetaTherapy Treatment delivered through The MetaNeb System. MetaTherapy Treatment maximizes efficiency for patients and clinicians by combining lung expansion, secretion clearance and aerosol delivery into a single integrated therapy cycle. May reduce therapy time to just 10 minutes, and eliminate the need to switch devices.
RT: Are you seeing any market trends as far as patient preference for clearance therapies?
Buehler: We are seeing a definite interest among patients and their caregivers in trying various vest therapy options. Years ago, there was one vest therapy choice. Now there are a few products to choose from. When given the option to try two or three different ACT vests, we’ve found that patients not only perceive differences, but also indicate preferences. It’s not surprising that they prefer vests like the inCourage System that allow them to take a deep, more comfortable breath during therapy. Having the largest selection of vest patterns and sizes also helps. We support patients’ rights to both try and choose the vest therapy system that works best for them. We’re pleased that more CF centers and respiratory care clinics are inviting patients’ input in selecting the products they must use every day.
McPeck: I believe one of the trends in patient preference has been away from vest therapy because it is so restrictive, time-consuming and definitely not portable. The vest companies seem to be scrambling to stay relevant. Although some of the earliest successes with the Vibralung Acoustical Percussor have been in patients with severe bronchiectasis, young and old CF patients are becoming early adopters for many reasons. Many have acquired the Vibralung to facilitate travel and continue therapy discretely during school, work or sports. Some have stated that they like the fact that the Vibralung vibrates only their lungs, rather than their entire body. Others have stated that the Vibralung enables them to cough up more mucus with less effort. I am seeing the portability as an important feature for contemporary patients who have rejected a sedentary lifestyle.
Reding: Patients are looking for an effective and efficient treatment that they can do in their home to improve their quality of life. Patients are caregivers want a treatment that will be convenient without giving up efficacy.
RT: What is the future for airway clearance devices? In your opinion, what types of trends can respiratory therapists expect to see in the next 5 years?
Buehler: We see greater emphasis on comfort and ease of use—factors that can enhance adherence. We also expect that vest therapy will be applied to broader patient populations. As understanding and diagnosis of bronchiectasis grows, we anticipate that more of these patients will be prescribed airway clearance vests. Patients with other chronic lung conditions, such as moderate-to-severe COPD and chronic bronchitis, also may be offered vest therapy more often than currently occurs. Our patient-reported outcomes data registry is allowing us to quantify how vest therapy and other treatments are impacting patients’ respiratory health and quality of life. As more outcomes data becomes available to healthcare teams and payers, they will likely see that intervention with vest therapy may be able to maintain or improve health status in a wider array of chronic conditions. Fewer exacerbations translate into fewer hospitalizations and more cost-effective care, which is good for patients and the healthcare system.
McPeck: Well, for starters, Westmed has released a direct tracheal interface for the Vibralung that will allow it to be used in patients with chronic tracheostomies, for example, in neuromuscular/paralytic disease and spinal cord injury. That is a wide-open, and currently underserved market, because the patients who need therapy the most cannot effectively use most of the currently available devices. The Vibralung with the direct trach interface works so much better and is so easy to use in this population than other devices. I believe that, outside of additional advances with acoustic airway clearance technology, and pH-buffered hypertonic saline, which will dominate the airway clearance market for many years, there will not be any significant new trends. Both acoustic airway clearance and inhaled mucolytic therapy with pH-buffered hypertonic saline offer promising new outcomes for airway clearance therapy and are poised for extensive usage and study in the years ahead.
Reding: They can look for continued advancement and innovations to enhance outcomes for patients and caregivers. Connectivity between healthcare teams and patients will become an even more important aspect of care. RT
Burns JL, Griffith A. pH-dependent differential Pseudomonas aeruginosa killing in CF sputum incubated with hypertonic saline solutions. Peds Pulmonol 2014. 49;S38: 351.