Hyperinflation Therapy

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7 Hyperinflation Therapy

Note 1: This book is written to cover every item listed as testable on the Entry Level Examination (ELE), Written Registry Examination (WRE), and Clinical Simulation Examination (CSE).

The listed code for each item is taken from the National Board for Respiratory Care (NBRC) Summary Content Outline for CRT (Certified Respiratory Therapist) and Written RRT (Registered Respiratory Therapist) Examinations (evolve.elsevier.com/Sills/resptherapist/). For example, if an item is testable on both the ELE and the WRE, it will be shown simply as: (Code: …). If an item is testable only on the ELE, it will be shown as: (ELE code: …). If an item is testable only on the WRE, it will be shown as: (WRE code: …).

Following each item’s code will be the difficulty level of the questions on that item on the ELE and WRE. (See the Introduction for a full explanation of the three question difficulty levels.) Recall [R] level questions typically expect the exam taker to recall factual information. Application [Ap] level questions are harder because the exam taker may have to apply factual information to a clinical situation. Analysis [An] level questions are the most challenging because the exam taker may have to use critical thinking to evaluate patient data to make a clinical decision.

Note 2: A review of the most recent Entry Level Examinations (ELE) has shown that an average of two questions (1% of the exam) will cover hyperinflation therapy. A review of the most recent Written Registry Examinations (WRE) has shown that an average of two questions (out of 100), or 2% of the exam, will cover hyperinflation therapy.


1. Instruct the patient in deep-breathing techniques (Code: IIID1a) [Difficulty: ELE: R, Ap; WRE: An]

Explain to the patient that taking in deep breaths keeps the small air sacs in the lungs inflated and healthy. Deep breathing and coughing are indicated in patients with atelectasis, pulmonary infiltrates, or pneumonia. These exercises should help to increase secretions. It is especially important to use deep breathing and coughing to prevent or limit atelectasis and pneumonia in patients who have just had abdominal surgery such as cholecystectomy or splenectomy. Ideally, the patient is taught these techniques before surgery is performed. If not, teach them the following postoperatively:

Teach the following cough techniques to the patient with obstructive airways disease:

Coaching is important because patients in pain or who are suffering from chronic lung disease tend to be uncooperative and to not try hard. Give positive reinforcement when the patient does well. Correct any problems that the patient is having in trying to follow the instructions. Demonstrations often are helpful, so the patient can copy a good example.

2. Instruct the patient in inspiratory muscle training techniques (ELE code: IIID1b) [Difficulty: R, Ap]

Initially, teach the following steps to patients with obstructive airways diseases:

After these first steps have been mastered, teach the following steps to patients with obstructive airways diseases:

Increasing the strength and endurance of inspiratory muscles usually requires a training program similar to the following:


1. Instruct the patient in incentive spirometry techniques (Code: IIID1a) [Difficulty: ELE: R, Ap; WRE: An]

Incentive spirometry (IS) is a technique whereby a patient is encouraged to breathe deeply by seeing his or her inhaled volume on the spirometry device. The patient receives positive feedback by seeing that the volume gradually increases as his or her condition improves. IS is indicated in any patient who has developed or is likely to develop atelectasis and can perform the procedure. Clinical situations and individuals in which atelectasis is likely to be seen include postoperative thoracic or upper abdominal surgery, the aged, the obese, inadequate sigh, cardiopulmonary disease, and quadriplegia and/or dysfunctional hemidiaphragm(s).

Because the goal of IS is to prevent or treat atelectasis, the patient should inhale a near-normal inspiratory capacity (IC). The patient can benefit more by holding the IC for several seconds, which is referred to as sustained maximal inspiration (SMI). Before the operation, the cooperative surgical patient should have the IC measured at the bedside or calculated from a pulmonary function test in which vital capacity (VC) is measured (review Chapter 4 for IC information). The IC is measured again postoperatively.

Before you start to provide instruction, make sure that the patient is alert and cooperative enough to follow instructions. The patient’s respiratory rate should be less than 25 breaths/min if the procedure is to be performed properly. Use the following steps in teaching IS: