Innovative approaches and techniques to improve respiratory health and quality of life for individuals with Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease (COPD) is a group of lung diseases that block airflow to the lungs, causing breathing difficulties. This disease is the fifth leading cause of death worldwide, requiring special efforts to maintain airway clearance to improve patients' quality of life 4 .
The human respiratory system consists of various organs working together to ensure the body receives oxygen while removing carbon dioxide. In adults, normal breathing frequency ranges between 12-20 times per minute 1 .
In people with COPD, there is damage to the airways (bronchi) and lung sacs (alveoli). The two conditions that most often develop into COPD are chronic bronchitis and emphysema 2 .
In COPD patients, excessive mucus or phlegm becomes a major problem as it can block the airways. This condition not only hinders airflow but also facilitates infection development and worsens symptoms.
This damage causes excessive mucus production while reducing the lungs' natural self-cleaning ability, leading to symptoms such as shortness of breath, persistent cough with phlegm, and wheezing 2 .
Traditional approaches to COPD management often follow a "one-size-fits-all" model with limited effectiveness. The "Treatable Traits" (TT) approach is a breakthrough in precision medicine that targets specific identifiable and modifiable characteristics in each individual, regardless of diagnostic labels 3 .
Researchers have developed a framework categorizing treatable traits into three main domains 3 :
| Treatable Trait Category | Example Management Strategies |
|---|---|
| Airflow Limitation | LABA/LAMA as maintenance therapy |
| Eosinophilic Inflammation | Inhaled corticosteroids |
| Adherence Issues | Education, regimen simplification, regular follow-up |
| Incorrect Inhaler Technique | Education including demonstration and periodic reassessment |
| Smoking Habits | Smoking cessation counseling ± pharmacological therapy |
| Anxiety & Depression | Pharmacological therapy, breathing exercises, cognitive behavioral therapy |
| Low BMI/Obesity | Nutritional counseling and interventions (diet, exercise) |
One of the most fundamental efforts to improve airway clearance effectiveness is teaching patients effective coughing exercises. Effective coughing is a proper coughing method where patients conserve energy and can expel phlegm maximally, facilitating secretion mobilization 4 .
By expelling phlegm, the patient's airways are not blocked by secretions, making the airways effective again. Airway patency will prevent patients from ineffective airway clearance problems 4 . This technique is often taught in chest physiotherapy sessions proven highly effective for COPD patients with airway clearance disorders 4 .
A recent study published in The Open Respiratory Medicine Journal in July 2025 evaluated the effectiveness of Focused Pulse High-Frequency Chest Wall Oscillation (FP-HFCWO) therapy using the Respin 11 device for mucus management in COPD and asthma patients 6 .
This retrospective cohort study was conducted at the Pulmonology Clinic of San Carlo Hospital in Nancy, Rome between September 2023 and January 2025. The study involved 27 patients (17 with COPD and 10 with asthma) who experienced chronic mucus hypersecretion and persistent symptoms despite maximal pharmacological treatment 6 .
Recruited COPD patients were undergoing maximal pharmacological treatment including ICS (Inhaled Corticosteroids), LABA (Long-Acting Beta-Agonists), and LAMA (Long-Acting Muscarinic Antagonists), along with daily mucolytic therapy (N-acetylcysteine 600 mg) 6 .
FP-HFCWO therapy showed significant results in improving clinical outcomes for COPD patients. CAT scores decreased by an average of 7.5 points after intervention, indicating statistically significant symptom improvement (p<0.001) 6 .
Even more impressive, the number of moderate to severe exacerbations decreased by 73.0% in the COPD group, equivalent to Δ-1.11 events (p<0.001) 6 . This reduction in exacerbation frequency is clinically relevant as recurrent exacerbations can accelerate lung function decline and reduce quality of life for COPD patients.
| FP-HFCWO Study Results on COPD and Asthma Patients | |
|---|---|
| Outcome Parameter | COPD (n=17) |
| Average Age | 78.0 years |
| FEV1% Predicted | 64.7% |
| CAT Score Change | Decrease of 7.5 points |
| Exacerbation Reduction | 73.0% (Δ-1.11 events) |
| Tools and Materials in FP-HFCWO Study | |
|---|---|
| Tool/Material | Function in Research |
| Respin 11 (VitalAire®) | FP-HFCWO device for focused high-frequency oscillation on chest wall |
| N-acetylcysteine 600 mg | Daily mucolytic agent to thin mucus |
| Triple Therapy (ICS/LABA/LAMA) | Maximal pharmacological therapy for COPD |
| CAT Questionnaire | Tool to measure COPD impact on health status |
| HRCT | Imaging to detect tree-in-bud patterns, mucus plugs, or bronchiectasis |
In addition to specific interventions to improve airway clearance, COPD management requires a comprehensive approach that includes:
The best way to prevent COPD as smoking is the primary cause of this disease 5 .
Avoid exposure to cigarette smoke, air pollution, and chemical fumes or dust from workplaces whenever possible 5 .
Recurrent lower respiratory tract infections can cause lung scarring that contributes to COPD development 5 .
Recent findings on the treatable traits approach and technologies like FP-HFCWO provide new hope in COPD management. Integration between emerging therapies and the TT approach promises better personalization of COPD management, improved outcomes, and development of more targeted medications 3 .
Nevertheless, basic techniques such as effective coughing and chest physiotherapy remain important foundations in COPD management, particularly in efforts to improve airway clearance effectiveness 4 .
With a combination of traditional approaches and recent innovations, it is hoped that the quality of life for COPD patients can be increasingly improved, reducing exacerbation frequency and slowing disease progression. It is important for COPD patients to consult regularly with doctors to get a care plan tailored to their individual conditions and needs.