Recent trends, such as the move toward home healthcare, have influenced new innovation in secretion clearance technology and will continue to shape this market in the future.

For most chronic lung disease patients, their health depends on the consistent clearance of airway secretions. As such, new technological developments in this industry are essential for healthcare professionals to maximize patient comfort and outcomes, maintain respiratory health, and reduce costs. Recent trends, such as the move toward home healthcare, have influenced these new innovations and will continue to shape this market in the future.

RT Magazine recently assembled a panel of industry experts to discuss market trends in the airway clearance product market, their company’s newest innovations in this area, and the future of airway clearance devices. The participants in this discussion included:

RT: What’s new in the airway clearance product market? How do you feel products and technology have changed over the last few years? 

Chad Boerst (Hill-Rom): As patients are living longer and have more active lifestyles, we need to have effective solutions to meet those patients/caregivers’ needs. Not one therapy solution is going to work for all patients. They need a variety of options from a provider they trust to meet their needs as their diseases progress.

Eli Diacopoulos (Philips Respironics): With the changing healthcare landscape and the implementation of the Affordable Care Act, leading manufacturers in the airway clearance market are driving innovations that enable cost-effective and outcome-based patient care.

We’re seeing this with the development of devices that offer less invasive solutions, greater patient comfort, and smaller, lighter, more portable products that offer enhanced mobility for easier use in the home. Devices are also smarter, providing clinicians with the data they need to monitor treatment and enhance therapy effectiveness. These trends have also enhanced the need for solutions that address the long-term tracking of a patient’s disease progression.

At Philips Respironics, we’re focused on creating products and solutions aimed at improving quality of life for patients with chronic respiratory disease.

Jim Young (General Physiotherapy): Currently, I see two major technological trends in our segment of Airway Clearance. The first trend is the proliferation of pneumatic wearable “vests” type products for chest postural drainage (CPD). After discussion with many medical practitioners, this is primarily driven by long-term economics.

It is less labor intensive for a hospital/clinic to place a wearable airway clearance device on a patient, and as the product is in operation, the therapist/attendant is free to work with another patient. This is beneficial in a hospital/clinic environment when labor-intensive modalities require therapist time and attention. The initial capital investment is significantly higher than handheld electromechanical percussors, but the long-term labor cost saving could be beneficial in the institutional environment.

To address concerns discussed with me by medical practitioners worldwide concerning current pneumatic “wearable” products, General Physiotherapy has developed an innovative, wearable, new product that does not use an air compressor—The G5 FREEDOM Airway Clearance System.

This secretion clearance system incorporates time-tested electromechanical percussion with micro Percussion Pods powered with sophisticated, high tech electronic software. We expect to have the G5 FREEDOM available to market in mid-year 2015. This new product has been driven by research, treatment effectiveness, and economics.

The second trend is the development and testing of ultrasound devices that show strong promise for cough stimulation. Used in conjunction with accepted percussion modalities for chest postural drainage, these products can be an important addition to support secretion clearance techniques with those patients who do not have an adequate cough mechanism due to a variety of neuro-musculo-skeletal conditions.

Kathleen Skarvan (Electromed): As a result of the Affordable Care Act, there is increased emphasis on providing solutions that reduce certain readmission penalties. Airway clearance therapy like the SmartVest will play a key role in keeping patients from making repeat hospital visits by managing pulmonary secretion clearance.

Our latest system, the SmartVest SQL, was designed with input from patients and clinicians to improve outcomes and keep patients out of the hospital and in their home.

We are seeing market expansion with an aging population and millions of people in the United States with chronic lung diseases such as bronchiectasis. Further, a younger population is being introduced to airway clearance therapy as physicians treat patients at an earlier age.

Regarding product trends, we see a focus on increasing therapy compliance through more user-friendly features and benefits, including ease of use, increased comfort, and making accommodations for the broad spectrum of age demographics.

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? 

Boerst: Yes, I believe the economics of the healthcare system are driving the trend toward care in the home. With increased focus on home care, we are developing solutions to ensure compliance and adherence to our therapies, as well as new innovative products that provide information to healthcare teams so that therapies can be modified to tailor to patients’ needs.

We also have thorough in-home training for patients and caregivers to make sure they understand the products and how they work and are comfortable delivering the therapy before the trainers leave their home.

Diacopoulos: In the current healthcare environment, there is a comprehensive focus on reducing hospital readmissions and keeping patients out of the hospital and in their home. Solutions like our CoughAssist T70 help patients with chronic respiratory disease more effectively clear their airways, reducing the chance for infection that can lead to hospitalization.

And as with any therapy, patients sometimes need a little support to ensure they are following through with their care protocols. Therefore, we continue to innovate solutions to enable clinicians to make informed decisions to better manage patients.

Skarvan: The healthcare trend toward home care is a very positive one for Electromed. The majority of our products are placed in the home. Penalties to hospitals for certain readmissions brought on by the Affordable Care Act will further support keeping patients in the home rather than receiving their treatment in the hospital. That movement has affected our product development and innovation.

If the patient isn’t compliant with their prescribed treatment regimen, the economic benefit is not realized. We’ve designed the SQL for improved therapy compliance by making it comfortable, easy to use, and more portable, allowing the patient to administer their therapy in most cases without a caregiver present.

Young: We have seen a substantial increase in volume sales of our lower cost electromechanical percussors for the home care market (G5 VIBRACARE). This is certainly indicative of market trends with a push of patients to the home care environment.

General Physiotherapy has always been acutely aware of the need for electromechanical airway clearance devices in the home environment and we continue to manufacture these products and ship worldwide for the last 30-plus years. All new product development includes features for both home and hospital/clinic usage.

RT: Discuss your company’s most recent products and what makes them innovative in this market. How are your products addressing the needs of healthcare facilities to reduce costs and maximize outcomes? 

Boerst: Last year, we launched the award-winning MetaNeb 4.0 System, providing three-in-one airway clearances therapies. Recently, we launched the new VitalCough System, providing mechanical insufflation-exsufflation technology. Both of these technologies are focused on reduction of ICU days, length of stay in the hospital, and readmissions.

Diacopoulos: Philips Respironics’ latest airway clearance product release, the CoughAssist T70, incorporates updates driven by the desire to improve patient quality of life and clinician support in their daily practice. These new advancements are designed to help clinicians optimize therapy and enhance patient comfort, mobility, and compliance, helping to reduce the risk of hospital readmissions and thereby helping to ease overall disease management costs.

To enhance patient mobility, the device is lightweight (less than 9 lbs) and can be used with an integrated detachable battery. A Cough-Trak algorithm triggers a full cough upon every inspiration, giving patients more control of their therapy and better synchronization. An intuitive user interface with preset prescriptions simplifies setup and initiating therapy. Data management tools allow for follow-up at home so clinicians can assess therapy efficacy and adapt settings accordingly.

CoughAssist T70 mechanical insufflation-exsufflation provides an effective, noninvasive alternative to deep suctioning and can be used in the hospital, home, or alternative care sites. It is effective in clearing secretions from the lungs while avoiding complications linked to invasive deep suctioning methods, such as hypoxia, tissue damage, and infection. This can lead to fewer hospital readmissions and may contribute to a decrease in the total cost of patient management.

Skarvan: We received FDA clearance for our next generation SmartVest, the SQL, in late December 2013 and began shipping to patients in mid-January 2014. The model SQL is an electrically powered precursor device designed to deliver HFCWO to promote airway clearance, improve bronchial drainage and enhance mucus transport. It is prescribed to patients with a wide range of pulmonary-related health conditions, including bronchiectasis, cystic fibrosis, muscular dystrophy, amyotrophic lateral sclerosis (ALS), quadriplegia, and cerebral palsy.

HFCWO has been demonstrated to reduce lung infections and healthcare costs associated with recurrent pneumonias, antibiotic use, and hospital stays. Integrating the voice of the customer, we innovated many features that provide users with maximum comfort and the freedom to live their lives to the fullest. The outcome is a significant step forward in HFCWO therapy as the new SQL is 25% smaller, 5 dB quieter, and 25% lighter than our previous model, the SV2100.

We also added some new programmable features, such as ramp, pause, save, and restore. Patients have been asking for these improvements and we delivered. We believe the SQL will make therapy adherence even easier, a goal long sought by physicians and clinicians.

Young: In the airway clearance segment, the primary response to the needs of hospitals and other providers has been to reduce the labor-intensiveness of treatment. The proliferation of wearable products for bronchial hygiene procedures frees the therapist/attendant to perform other tasks.

General Physiotherapy has responded to this need with our new G5 FREEDOM Airway Clearance System that is wearable, ultra-quiet, versatile, patient friendly, adjustable in size, comfortable, lightweight, and totally portable for the hospital/clinic and home care environment. In addition, General Physiotherapy has a comprehensive selection of time-tested, electromechanical percussors that reduce labor intensiveness of the treatment process that was previously applied manually.

RT: Are you seeing any market trends as far as patient preference for clearance therapies? For instance, are younger patients preferring a specific therapy, like vest devices? Or is there any preference by condition? Are you seeing any trends?

Boerst: Yes, because of effective airway clearance therapies such as the Vest System, patients are living longer and having a better quality of life. Since patients are living longer, more fulfilled lives, their desire to have therapies that best match their lifestyle has increased.  Look for continued developments from Hill-Rom to meet these patients’ needs.

Diacopoulos: In terms of market trends, we are seeing a desire from patients for devices that are more portable and simple to use. Those dependent upon secretion clearance devices want their therapy options to fit the lives they want to live.

Skarvan: With a number of high-quality HFCWO devices on the market, patients and their healthcare provider have an important choice to make for their HFCWO provider. When HFCWO is used for in-home therapy, their decision will likely impact the patient for the remainder of their life due to the chronic nature of the disease or condition.

To better understand the therapy options available, many patients are becoming more active in their research for HFCWO devices they can best incorporate into their daily routines in a way that supports a high quality of life. Patients are utilizing various mediums to obtain product information and answer their questions about HFCWO therapy.

From a service standpoint, Electromed provides the patient service and customer support needed to deliver the difference-making benefits of high frequency chest wall oscillation. Electromed works with physicians, respiratory therapists, medical assistants, and physicians’ office staffs to provide the information, support, and tools they need to educate their patients about HFCWO therapy.

Further, Electromed provides support to patients by offering in-home training and access to patient service specialists—each one a respiratory therapist—to answer questions or offer technical support, 365 days a year.

Young: Typically, patients with a long-term disease that is degenerative with no known cure, such as cystic fibrosis, tend to purchase our G5 Percussors that they have used in a hospital environment. These G5 Percussors are more powerful, heavy duty, and will last a lifetime of treatments. During the latter stages of COPD, there is a definite increase in the use of our airway clearance devices.

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? 

Boerst: Being the leader of airway clearance, we at Hill-Rom are focused on developing effective solutions that meet the needs of our patients and healthcare teams in the hospital and home that ultimately focus on overall respiratory health.

Diacopoulos: From our perspective, the future of airway clearance will be shaped by technologies that better enable clinicians and caregivers to care for patients with chronic respiratory disease with an added emphasis on care in the home.  Through education, we hope to expand awareness of mechanical insufflation-exsufflation so that clinicians may incorporate products such as CoughAssist into their practice, as a safe, effective, and more comfortable secretion option for patients.

Skarvan: The future for airway clearance devices is bright. The need for airway clearance will continue to grow with the aging population and increased focus to improve patient care while managing costs and outcomes.

Years ago, you may not have expected to see a device used in a hospital setting go home with the patient. That is becoming more and more common as preventative medical practice is advocated by most insurers, including Medicare/Medicaid. Medical treatment in the home rather than the hospital or clinics is very cost-effective. The SmartVest is a product used in the acute care setting and bridges over to the outpatient and in-home therapy.

From a technology standpoint, Electromed sees efforts focused on cost-effectiveness and more efficient ways of reporting compliance with the prescribed treatment. We see insurance companies wanting more and more details about how their patients are complying with their therapy and tying that to outcomes. Electromed continues to work toward innovating our current product line as well as bring complementary airway clearance products to market.

Young: I believe that over the next 5 years we will see the ongoing evolution and improvement of “wearable” type Secretion Clearance products. General Physiotherapy’s new G5 FREEDOM Airway Clearance System answers all requests made by medical practitioners and patients for a wearable, effective postural drainage device that can be used to treat specific lung segments or several at one time. It is quiet, extremely portable, pre-programmable, and uses NO noisy & cumbersome air compressor. Future development will include battery power and Bluetooth technology for total portability and ease-of-use.

Ultrasound devices will continue to evolve and play an important role in cough stimulation. Several variations are in development and clinical tests have demonstrated exceptional results. These devices will be used in conjunction with our G5 electromechanical percussors, both handheld and wearable, for patients that have limited cough capability such as those with neuro-musculo-skeletal conditions, spinal cord injury, muscular dystrophy, or chronic respiratory disease. RT

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