The present disclosure relates to systems for respiratory secretion management. In particular, the present disclosure relates to systems for applying waves, such as pressure waves, to the respiratory system of a subject for loosening and/or dislodgement of secretion from the airway.
Mucociliary clearance describes the self-clearing mechanism of the respiratory system. It involves the mucociliary escalator which serves to mobilise secretions. The mucociliary escalator thus prevents airway obstructions and maintains optimal function of the respiratory system.
In healthy individuals, 10-100 ml of airway secretions are continuously produced and cleared by the mucociliary escalator.
This mucous clearance mechanism may be compromised by a variety of factors, including pathophysiological conditions affecting the mucociliary escalator—such as bronchiectasis and ciliary dyskinesia—and disorders that alter the production and composition of mucus—such as sinusitis, cystic fibrosis and chronic obstructive pulmonary disease (COPD). The resulting stasis of secretions obstructs conducting airways, providing a nidus for recurrent infections and inflammatory responses, leading to repeated insults to the airways and parenchyma.
For these reasons, regular use of airway clearance techniques (ACTs) and devices are critical for effective mucus mobilization and expectoration for those with negatively affected mucociliary escalator. This helps to prevent recurrent infections thereby preserving long-term lung function.
ACTs typically employ physical and mechanical means to manipulate airflow in the respiratory system. The intention is to mobilise secretions from distal sections of the respiratory system towards easily evacuated parts of the respiratory system such as, from the distal airways towards the central airways, wherein evacuation is effected by coughing or natural swallowing. Physical manipulations include breathing manoeuvres, postural drainage, and manual techniques. Mechanical devices, including chest percussion devices and oscillatory pressure devices function on principles of altering air flow, leading to and/or generating an evacuation-like effect.
Regardless of the intervention technique, ACTs are generally time-consuming, and thus likely responsible for poor adherence to the prescribed therapy. The use of devices and prescribed therapies can require two to six hours of active patient involvement every day and has been described as a major factor contributing to reduced compliance rates to ACT in cystic fibrosis (CF) patients.
Stasis of secretions in respiratory diseases leads to chronic infection, inflammation and lung destruction. Respiratory physiotherapy has been used for many years to help in removal of secretions. However, the lack of availability and accessibility to adequate therapy outside of a clinical setting have led to the advent of mucus clearance device development.
Early devices were aimed at using robotic means to either self-administer percussive therapy or to manipulate airflow in order to effect mucus clearance. The latter includes positive expiratory pressure devices developed in the 1970's and first introduced in the United States as an alternative to conventional physiotherapy. The mechanism of action lies in (i) splinting airways open to allow movement of secretions and (ii) allowing air behind secretions, pushing them towards larger airways during forced expiration.
High Frequency Chest Wall Oscillations (HFCWO) were then found to be able to loosen mucus from airways. HFCWO elicit fluctuations in air-flow during respiration, resulting in “mini-coughs”. Originally embodied as respirators with oscillating airflows, the devices have since evolved to deliver oscillating pressures externally via a pneumatic vest which surrounds the thorax. These air pulses compress and release the chest repeatedly and rapidly, leading to vibrations that cause transient flow increases in the airways, loosening mucus and producing cough like shear forces. The first HFCWO vest was licensed in 1988, representing a move towards “passive systems” which were not dependent on the effort of the patient.
This was succeeded by a trend in the 1990's to develop miniaturised, patient-powered devices combining features of oscillation with positive expiratory pressure (PEP). Termed Oscillatory Positive Expiratory Pressure (OPEP), these devices typically comprise vibration systems which produce positive expiratory pressure and cyclic oscillation of the airways during expiration.
Taken together, these trends suggest a dearth of devices which combine features of the above, highlighting the as-yet unmet need for miniaturised and discreet devices that may be used by patients in an unobtrusive manner.
It is desirable therefore to provide a system for airway secretion management that overcomes or ameliorates one or more of the abovementioned problems in the prior art, or at least provides a useful alternative.
Disclosed herein is a system for respiratory system secretion management, comprising:
In the examples given herein, the term “intranasal module” may be used. However, except where context dictates otherwise, it will be understood that the term “nasal module” or “extranasal module” may be used in its place.
As used herein, the phrase “delivering a wave through a nasal passage” includes embodiments in which the nasal module is positioned in the nasal passage to deliver the wave through the nasal passage—i.e. using an intranasal module. The phrase “delivering a wave through a nasal passage” also includes embodiments in which the nasal module is positioned outside the nasal passage—e.g. on the nose—to deliver the wave into, and thereby through, the nasal passage—i.e. using as extranasal module.
The system for respiratory system secretion management may be a system for airway secretion management.
The nasal module may thus be an intranasal module. In some embodiments, the nasal module may be an extranasal module.
The oscillatory wave generator may comprise a waveform generator for generating an electrical signal corresponding to the wave, and at least one of:
The oscillatory wave generator may be adjustable to control output waveform characteristics. The waveform characteristics may comprise one or more of frequency, amplitude, intensity, pressure, duration of use—i.e. duration over which the waveform will be applied to the subject—and shape—e.g. sinusoidal, square etc.
The oscillatory wave generator may be located extra-nasally—e.g. where the nasal module is an extranasal module, in that extranasal module, or otherwise separate from the nasal module. Alternatively, the oscillatory wave generator may be located intranasally—e.g. where the nasal module is an intranasal module, in that intranasal module.
The nasal module may be shaped to be positioned in the nasal passage of the subject.
The nasal module may be in communication with the oscillatory wave generator via a waveguide.
The nasal module may comprise a housing shaped to be compatible with—e.g. received in or on, and potentially to grip—the nasal passage of the subject. The nasal module may comprise an acoustic window at a distal end of the housing, through which the wave is delivered into the nasal passage.
The nasal module may be adapted to grip the nasal passage.
The nasal module may comprise an anchor component for preventing irretrievable slippage of the intranasal module into the nasal passage of the subject. The anchor component may comprise a hook for catching onto a columella of the subject.
The communication module may be operable to configure the wave by adjusting the oscillatory wave generator.
The system may further comprise an interface module for providing instructions to the communication module, thereby to control the communication module. The interface module may be configured to instruct the communication module to adjust waveform characteristics of the wave. The interface module may be configured to instruct the communication module to toggle power to the system. The interface module may be configured to instruct the communication module to adjust waveform intensity of the wave.
The interface module and communication module may be in wireless communication. Alternatively, wired communication may be used.
The system may comprise a patch for attachment to facial skin of the subject, the patch comprising at least one of the oscillatory wave generator, power module and communication module. The system may also comprise the nasal module where the nasal module is an extranasal module.
Some embodiments of systems for respiratory system secretion management, components of such systems and experimental usages, in accordance with present teachings will now be described, by way of non-limiting example only, with reference to the accompanying drawings in which:
Embodiments of systems for respiratory system, or airway, secretion management as disclosed herein may be used to introduce waves, such as acoustic waves, into the nasal passage of a subject. By being adapted to introduce waves through the nasal passage, wave attenuation between the source and lungs has been shown to reduce. The system thus has greater efficacy in transmission of waves to the lungs and thus, it is considered, shall have greater efficacy in loosening and/or dislodging secretion (e.g. mucus) from the lungs and airways.
The present disclosure provides an intranasal system (which may be a device) which generates oscillatory pressures. These oscillatory pressure, in the form of pressure waveforms, are directed via the nasal passages to lungs, where they serve to loosen and/or dislodge the mucus. As such, the system will be used as an aid in clearing and/or preventing accumulations of mucus in the airways, including the nasal passages, sinus cavities and the bronchial tree.
While the terms “airway” and “intranasal module” are used in the following discussion of embodiments for illustration purposes, it will be appreciated that those terms may respectively be substituted for “respiratory system” and “nasal module” or “extranasal module” unless context dictates otherwise. The oscillatory wave generator (OWG), hereinafter referred to as OWG module 102, is for generating a wave for loosening secretion from an airway of a subject (not shown). The OWG module 102 is a module capable of generating a wave being, for example, a pressure wave, where that wave may be regular, periodic, aperiodic, variable frequency/power/intensity or any other kind of wave designed to loosen (which may include loosening per se and also dislodgement) secretion from the airway of a subject. The OWG module 102 generates the desired waveforms necessary for, for example, mucus clearance.
In the embodiment shown, the OWG module 102, comprises:
The OWG module 102 receives power from the power module 106. The power renders the OWG module 102 operable. The OWG module 102 may be assembled as a single entity or component. Alternatively, the OWG module 102 may comprise multiple components housed separately. For example, the submodules 110, 112, 114 may be housed separately or in combination.
In the present embodiment, the OWG module 102 is adjustable to control output waveform characteristics. The waveform characteristics may comprise, for example, one or both of frequency and amplitude.
Control of the waveform characteristics may be applied at one or more stages in the OWG module 102. For example, the waveform characteristics may be evident in the wave generated by the waveform generator 110. The waveform characteristics may instead be those of the wave as amplified by the amplifier 112—e.g. the OWG module 102 may define the magnitude of amplification applied by the amplifier 112, to achieve a desired amplitude. Alternatively, the waveform generator 110 may produce a wave of a particular, controlled or predetermined frequency, and the amplifier 112 may then set the amplitude of the wave.
The OWG module 102 may generate a wave having predetermined frequency of between 5 to 5,000 Hz, between a range of 10-2000 Hz, around 300 Hz, 500 Hz, 1,000 Hz or 1,500 Hz. The frequency may also vary between consecutive peaks of the wave.
The OWG module 102 may also produce a wave with an expected output sound pressure level (SPL) of 90 dB or higher. The output may be, for example, 100 dB, 105 dB, 110 dB, 115 dB or any other sound level.
The OWG module 102 achieves production of waves conforming within the ranges of 3 to 20 voltage peak-to-peak, which is the voltage input to the system at any point of operation.
In the embodiment shown in figure three, all three submodules 110, 112, 114 are provided. However, the OWG module 102 may be configured to have the waveform generator 102, and only one of:
As discussed with reference to
The waveform generator (submodule) 110 is for generating a signal, e.g. an electrical signal, corresponding to the wave outputted from the OWG module 102. The waveform generator 110 of the present embodiment comprises a tuner responsible for emitting an electrical waveform. The tuner can be adjusted under instruction from the communication module 108, to adjust one or more of the waveform characteristics of the wave.
The waveform generator 110 is currently conceptualised as a stand alone entity. The power received from the power module 106 may be from 3 to 20 voltage peak-to-peak, at any point of operation, and may be, for example, at 3-6V input voltage. The waveform generator 110 and may be accessed or controlled from the communication module 108, via a user interface module (described below), to control output waveform characteristics of frequency and/or amplitude. For example, an output sine wave may be generated at a predetermined frequency, or a predetermined variable frequency, of 5 to 5000 Hz, and may be 10-2000 Hz, frequencies with up to 120 dB.
The amplifier (submodule) 112 increases the power and/or amplitude of the electrical signal, and may comprise a pre-speaker/transducer module. The pre-speaker/transducer can be used to boost the power or amplitude of output signals. The gain applied to the wave generated by the waveform generator 110 may be any desired gain, such as 50, 60 70, 80 90, up to 100 or over.
The amplifier 112 is used to modulate power of the output, to increase the amplitudes of the generated wave—i.e. pressure wave. Additionally, the amplifier 112 may be used as a means to control the amplitude, in order to cater to user-assessed requirement for efficacy and comfort. In the present embodiment, the amplifier 112 is accessed via a user interface module connected to the communication module 108.
The amplifier 112 may be designed as a stand-alone on-board component or introduced as a DC bias.
The acoustic generator (submodule) 114 converts the electrical signal produced by the waveform generator 110 into an acoustic signal. Where the acoustic generator 114 is provided in the OWG module 102, the acoustic signal outputted by the acoustic generator 114 is the wave outputted by the OWG module 102. The acoustic generator 114 receives the electrical waveform for the waveform generator 110 and converts it into a pressure waveform. In the embodiment shown, the acoustic generator 114 is an electromagnetically-driven speaker—e.g. a miniature speaker. The miniature speaker is functional at a frequency range of 5-5000 Hz.
The acoustic generator 114 may be housed within the intranasal module 104. Thus, in use, the acoustic generator 114 may be designed or shaped to fit into the nasal cavity when within the intranasal module 104. Thus, the acoustic generator 114 may be housed within a 10 mm diameter×15 mm long cylindrical space in the intranasal module 104. Alternatively, the acoustic generator 114 may be used with a wave guide or acoustic channel/tunnel to carry the acoustic waves into the nasal cavity. Thus the intranasal module 104 may be in communication with the oscillatory wave generator 102 via the waveguide. In some embodiments, where a signal other than a wave is propagated to the intranasal module 104, the wave guide may be replaced by a wire or other mechanism for communication of signals.
For example, with reference to the system 200 shown in
In some embodiments, the acoustic generator 114 may be housed within intranasal module 204, the waveform generator 110 or amplifier 112 communicating with the acoustic generator 114 via wave guide 206. Alternatively, the acoustic generator 114 may be housed with the waveform generator 110 or amplifier 112 in the external housing 202, and communicate with the intranasal module 204 via the wave guide 206. Thus, depending on the arrangement of submodules of the OWG module 102, the wave guide 206 may be configured to propagate an electrical wave or signal or an acoustic wave or signal to the intranasal module 104, which then delivers a wave corresponding to the acoustic wave or electrical signal into the nasal passage of the subject.
The intranasal module 104 is in communication with the oscillatory wave generator 102, to deliver the wave generated by the oscillatory wave generator 102 through (e.g. into, so as to progress down) a nasal passage (not shown) of the subject. With reference to
The intranasal module 104 comprises a housing 402 housing shaped to be compatible with the nasal passage of the subject. The housing 402 contains the in-nose components, including the acoustic components—e.g. acoustic generator 114—of embodiments described above. Positioning the acoustic generator 114 in the intranasal module 104, rather than in an external housing, reduces the distance the wave—i.e. an acoustic or pressure wave—travels between the source, being the acoustic generator 114, and destination in the subject's airway. There is therefore a reduction in attenuation of the acoustic signal when compared with locating the acoustic generator in an external housing. The same may apply where the waveform generator 110 directly generates the wave that is outputted from the intranasal module 104, and is positioned in the intranasal module 104 rather than in an external housing.
The housing 402 also seals against the nasal passage and thus reduces leakage of acoustic signals. The housing 402 of the present embodiment comprises a bullet-shaped cylindrical casing—presently 10 mm diameter×15 mm long, with a 2 mm wall thickness—and a 5 mm×8 mm acoustic window 406 on the wall of the distal end 408. The distal end 408 is presently in the shape of a dome. The window 406 allows transmission of the wave, hereinafter referred to as a pressure wave, being a wave produced by the acoustic generator 114. Thus, the wave is delivered through the window 406 into the nasal passage.
The intranasal module 104 may be fabricated by any appropriate method, including blow-moulding, extrusion and/or casting. The intranasal module 104 or the cylindrical portion thereof may be formed from any appropriate material, such as a polymer—for example acrylonitrile butadiene styrene (ABS), polyurethane, polycarbonate or ultra-high molecular weight polyethylene (UHWMPE). These materials are intended to avoid or reduce leakage of the wave. The acoustic window 406 may be fabricated from a sound-conductive material, such as steel.
The intranasal module 104 may be adapted to grip the nasal passage. In other words, the intranasal module 104 may grip a wall of the nasal passage. As shown with reference to
The present intranasal module 400 comprises an anchor component 410. The anchor component 410 prevents irretrievable slippage of the intranasal module 400 into the nasal cavity of the subject. The present anchor component comprises a hook for catching onto a columella of the subject. In some other embodiments, the anchor component may be a circumferential flange that is marginally larger than the nostril of the subject, so as not to fit into the nostril of the subject. In these cases, the anchor component defines the maximum distance at which the distal end 408 (and acoustic window 406) project into the nose of the subject.
The intranasal module 400 further comprises a sheath 412. The sheath 412 provides a waterproof barrier for the intranasal housing 402 and enclosed components. The sheath 412 of the present embodiment is a disposable slip-on, silicon-based polymer sheath, designed to fit over the intranasal housing 402. The sheath 412 may remain attached to the housing 402 by friction fit, and thus be removable by overcoming the frictional attachment. The sheath 412 may alternatively wrap around the housing 402 and connect, for example, to the anchor component 410 or wave guide 206.
The present sheath 412 is 0.2 mm thick. The sheath 412 has embossing—e.g. ribbed structures such as circumferential ribs 414—to improve grip to the nasal cavity or passage. The sheath 412 may be fabricated by blow-moulding, extrusion, casting and/or calendaring. The sheath 412 may be formed from any appropriate material such as a polyurethane, polyethylene (PE) and polyethylene terephthalate (PET).
The intranasal module 104 may thus be held in place in the nasal passage through a combination of features—i.e. the embossed features described for the sheath 412, and anchor component 410.
The power module 106 is configured to power the system 100. the power module 106 comprises a power source 116 for supply, and may also include a switch 118 for toggling, power to the communication module 108, the wave generator 102 and, where the intranasal module 104 contains some powered components (e.g. the acoustic generator 114 of the wave generator 102), the intranasal module 102. The power source 116 may provide power for all other components for at least one hour of continuous operation.
The form factor of the power module 106 is selected to meet user acceptance for non-obtrusiveness. In the present embodiment, a ⅓ AAA battery with a capacity of 150 mAh may be used, to gain at least one hour of continuous operation. Alternative power sources meeting a specified form factor and power requirements may also be used.
The switch 118 may also be provided in the power module 106, coupled to the power source. The switch 118 is for controlling or toggling operation of the device. These include physical on-device switches, as well as potentially wireless activation or integration into the tuner component described below.
The communication module 108 is coupled to at least one of, and presently both, the intranasal module 104 and the oscillatory wave generator 102, for selectively communicating power and/or one or more waveform characteristics to the respective intranasal module 104 and/or oscillatory wave generator 102. The waveform characteristics may be one or more of power, intensity, amplitude, pressure, frequency, duration of use and shape—e.g. sinusoidal, square etc. The communication module 108 is coupled in the sense that relevant components—e.g. modules 102, 104 and 106—can be controlled by the communication module 108. The communication module 108 may be wirelessly connected to one or more of those components, or may be connected by hardwire to one or more of those components.
The communication module 108 serves to provide a means for the user to access the device. The communication module 108 is used primarily to (i) toggle power (ii) configure pressure waveforms—e.g. adjust or set amplitude and/or frequency.
The communication module 108 may be accessed via a user interface 120 for providing instructions to the communication module 108, thereby to control the communication module 108—i.e. cause the communication module 108 to issue instructions to the wave generator 102 and other components, if necessary. The user interface 120 will provide the user with means to provide instructions, as well as to obtain feedback from the device. The current conception employs a graphical user interface on a mobile device (e.g. user interface 600 shown in
The interface module and communication module may be in wireless communication, or may be connected by a wired connection such as connection 602 shown in
The system 100 may assemble into a fully intranasal system with minimal external componentry. The design of system 100 is not limited to a fully intranasal system. For example, any or all of the modules such as the power module 106, oscillatory wave generator 102, housing 202, and communication module 108 may be located outside the nasal cavity and, in the nasal passage, are provided components for secondary therapy communication—i.e. components capable of transmitting the therapy that may be, but are not limited to, acoustic or electrical waves. The system 100 may thus enable:
The components of the system of
The system of
The airway was first identified and the absence of any obstruction was confirmed. SPL measurements were performed at 50 Hz at the point of source (105.8 dB) and the tracheal opening (93 dB), respectively.
The experiment design was for determining transmission of acoustics as a function of frequencies. Here, acoustic waves at 200, 300, 400, and 500 Hz were generated at the source. Acoustics were captured and recorded using a digital stethoscope. The acoustic generator was placed in the nostril. The stethoscope readings were obtained from the anterior apex of the right lung in a supine position.
The systems taught herein were developed on the basis that is was found the nasal passage provides ease-of-access and adequate space for the placement of intranasal devices. The nasal passage was then determined to be preferred, or ideal, when compared with the oral cavity for delivery of waves for the purpose of airway secretion management.
The present teachings may be used to produce a device or system for airway secretion management as described herein.
Many modifications will be apparent to those skilled in the art without departing from the scope of the present invention.
Throughout this specification, unless the context requires otherwise, the word “comprise”, and variations such as “comprises” and “comprising”, will be understood to imply the inclusion of a stated integer or step or group of integers or steps but not the exclusion of any other integer or step or group of integers or steps.
Number | Date | Country | Kind |
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10201710079P | Dec 2017 | SG | national |
Number | Date | Country | |
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Parent | 16768958 | Jun 2020 | US |
Child | 18800435 | US |