System and method for treating lung disease using positive pressure airway support

• US 9,901,692 B2
• Filed: 11/21/2009
• Issued: 02/27/2018
• Est. Priority Date: 12/19/2008
• Status: Active Grant

• Current Assignee: Koninklijke Philips N.V.
• Original Assignee: Koninklijke Philips N.V.
• Inventors: Mechlenburg, Douglas, Coldren, Richard J.
• Primary Examiner(s): Stuart, Colin W
• Application Number:
  US13/131,902
• Publication Number:
  US 20110232643A1
• Time in Patent Office: 3,020 Days
• Field of Search: 12820423, 12820024, 12820312, 12820314, 12820315, 12820418, 12820421
• CPC Class Codes: A61B 5/085 Measuring impedance of respiratory organs or lung elasticity
• CPC Class Codes: A61M 11/00 Sprayers or atomisers specially adapted for therapeutic purposes in general B05B; aerosol containers B65D83/14
• CPC Class Codes: A61M 15/00 Inhalators drug delivery in endotracheal tubes A61M16/04
• CPC Class Codes: A61M 16/0003 Accessories therefor, e.g. sensors, vibrators, negative pressure
• CPC Class Codes: A61M 16/0006 with means for creating vibrations in patients' airways
• CPC Class Codes: A61M 16/0069 the speed thereof being controlled by respiratory parameters, e.g. by inhalation
• CPC Class Codes: A61M 16/021 operated by electrical means A61M16/202 – A61M16/205 take precedence
• CPC Class Codes: A61M 16/022 Control means therefor
• CPC Class Codes: A61M 16/024 including calculation means, e.g. using a processor
• CPC Class Codes: A61M 16/026 specially adapted for predicting, e.g. for determining an information representative of a flow limitation during a ventilation cycle by using a root square technique or a regression analysis
• CPC Class Codes: A61M 16/202 electrically actuated
• CPC Class Codes: A61M 2016/0027 pressure meter
• CPC Class Codes: A61M 2016/003 with a flowmeter
• CPC Class Codes: A61M 2016/0039 in the inspiratory circuit
• CPC Class Codes: A61M 2230/46 Resistance or compliance of the lungs

Abstract

A method of treating lung disease, such as asthma or COPD, is provided that includes determining a parameter indicative of a patient'"'"'s pulmonary mechanics (such as, without limitation, airway resistance or lung compliance), and delivering positive pressure support to the airway of the patient, wherein the pressure level (which may be constant or variable) of the positive pressure support during at least a portion of the inspiratory phase of the patient is determined based on the determined parameter.

Claims

1. A method of treating lung disease in a patient, comprising:

determining, with a controller, a parameter indicative of the patient'"'"'s pulmonary mechanics, the parameter determination comprising;

(1) measuring, with one or more sensors, flow responses produced by two different parameter determination inspiratory positive airway pressure (IPAP) levels delivered to the patient during two successive breaths, subtracting the flow responses from one another, and performing a least squares error fit on flow data that results from the subtraction;

or

(2) randomly varying a level of parameter determination pressure support delivered to the patient during the two successive breaths, determining a differential volume signal by subtracting volume responses measured during the two successive breaths from one another, and estimating a steady-state response of the differential volume signal;

generating, with a pressure support system, therapy positive pressure support for delivery to an airway of the patient, wherein a pressure level of the therapy positive pressure support during at least a portion of an inspiratory phase of the patient is determined based on the determined parameter,

wherein the pressure level of the therapy positive pressure support during at least a portion of the inspiratory phase includes a peak pressure, and

determining a second pressure level that is below the peak pressure of the therapy positive pressure support, the second pressure level being determined during an expiratory phase of the patient, the second pressure level determined based on the determined parameter.

2. The method according to claim 1, wherein generating the therapy positive pressure support for delivery to an airway of the patient comprises delivering bi-level positive pressure support to an airway of the patient, the bi-level positive pressure support having an IPAP level and an expiratory positive airway pressure (EPAP) level, wherein the IPAP level and the EPAP level of the bi-level positive pressure support are determined based on the determined parameter.

3. The method according to claim 1, wherein the determining a parameter step is performed prior to the generating therapy positive pressure support step.

4. The method according to claim 1, wherein the lung disease is asthma.

5. The method according to claim 1, wherein the lung disease is COPD.

6. The method according to claim 1, wherein the parameter is upper airway resistance.

7. The method according to claim 1, wherein the parameter is lung compliance.

8. The method according to claim 1, wherein the generating is performed by the pressure support system and wherein the determining the parameter indicative of the patient'"'"'s pulmonary mechanics comprises determining the parameter with a device external to the pressure support system and providing the parameter to the pressure support system.

9. The method according to claim 1, wherein the generating is performed by the pressure support system and wherein the determining the parameter indicative of the patient'"'"'s pulmonary mechanics comprises determining the parameter external to the pressure support system and manually inputting the parameter into the pressure support system.

10. The method according to claim 1, further comprising repeating the method one or more times a day regardless of whether the patient is suffering acute symptoms of lung disease to reduce the patient'"'"'s reliance on medication.

11. A pressure support system for treating lung disease, comprising:

a pressure generating system adapted to produce a flow of breathing gas;

a patient circuit operatively coupled to the pressure generating system to deliver the flow of breathing gas to an airway of a patient; and

a controller operatively coupled to the pressure generating system, the controller being adapted to;

determine a parameter indicative of the patient'"'"'s pulmonary mechanics, the parameter determination comprising;

(1) measuring, with one or more sensors, flow responses produced by two different parameter determination inspiratory positive airway pressure (IPAP) levels delivered to the patient during two successive breaths, subtracting the flow responses from one another, and performing a least squares error fit on flow data that results from the subtraction;

or

(2) randomly varying a level of parameter determination pressure support delivered to the patient during the two successive breaths, determining a differential volume signal by subtracting volume responses measured during the two successive breaths from one another, and estimating a steady-state response of the differential volume signal; and

control the pressure generating system to deliver the flow of breathing gas to the patient at a therapy pressure level during at least a portion of an inspiratory phase of the patient, wherein the therapy pressure level is determined based on the determined parameter,

wherein the therapy pressure level of the flow of breathing gas during the portion of the inspiratory phase includes a peak pressure, and

the controller is adapted to control the pressure generating system to deliver the flow of breathing gas to the patient at a second therapy pressure level that is below the peak pressure, the second therapy pressure level being determined during an expiratory phase of the patient, the second therapy pressure level determined based on the determined parameter.

12. The system according to claim 11, wherein the controller is adapted to control the pressure generating system to deliver the flow of breathing gas to the patient at a therapy bi-level pressure support IPAP level during the portion of the inspiratory phase of the patient and deliver the flow of breathing gas to the patient at a therapy bi-level pressure support expiratory positive airway pressure (EPAP) level during at least a portion of an expiratory phase of the patient, wherein the therapy bi-level pressure support IPAP level and EPAP level are determined based on the determined parameter.

13. The system according to claim 11, wherein the controller is adapted to determine the parameter prior to the controlling of the pressure generating system.

14. The system according to claim 11, wherein the parameter is upper airway resistance.

15. The system according to claim 11, wherein the parameter is lung compliance.

16. The system according to claim 11, wherein the lung disease is asthma or COPD.

17. The system according to claim 11, wherein the one or more sensors are operatively coupled to the controller, the one or more sensors being adapted to measure one or more characteristics associated with the flow of breathing gas and to generate one or more signals indicative thereof, wherein the controller is adapted to determine the parameter using the one or more signals.

18. A method of treating lung disease, comprising:

(a) generating, with a pressure support system, a first bi-level positive pressure support for delivery to an airway of a patient at an IPAP/EPAP differential for a first number of respiratory cycles wherein the IPAP/EPAP differential is a pressure determined by subtracting an expiratory positive airway pressure (EPAP) from an inspiratory positive airway pressure (IPAP) for a given respiratory cycle, the IPAP/EPAP differential of the first bi-level positive pressure support being a baseline level based on a predetermined baseline IPAP level and a predetermined baseline EPAP level;

(b) determining, with a controller, a parameter indicative of the patent'"'"'s pulmonary mechanics, the parameter determination comprising;

(1) measuring, with one or more sensors, flow responses produced by two different parameter determination IPAP levels delivered to the patient during two successive breaths, subtracting the flow responses from one another, and performing a least squares error fit on flow data that results from the subtraction;

or

(2) randomly varying a level of parameter determination IPAP/EPAP differential delivered to the patient during the two successive breaths, determining a differential volume signal by subtracting volume responses measured during the two successive breaths from one another, and estimating a steady-state response of the differential volume signal;

(c) determining, with the controller, that the determined parameter is outside of a predetermined baseline range;

(d) determining, with the controller, an increase of a predetermined magnitude in the baseline IPAP/EPAP differential to a current IPAP/EPAP differential, wherein the predetermined magnitude of the IPAP/EPAP differential is based on the determined parameter that is indicative of the patient'"'"'s pulmonary mechanics;

(e) generating, with the pressure support system, a second bi-level positive pressure support for delivery to the airway of the patient at the then current IPAP/EPAP differential for a second number of respiratory cycles;

(f) re-determining, with the controller, the parameter; and

(g) repeating, with the controller and the pressure support system, (d), (e) and (f) one or more times until either it is determined that the then current re-determined parameter is within the baseline range or that the then current IPAP/EPAP differential is equal to a predetermined maximum differential.

19. The method according to claim 18, wherein if it is determined in (g) that the then current IPAP/EPAP differential is equal to the predetermined maximum differential, the method further comprises notifying the patient to begin using asthma medication and continuing to provide the second bi-level positive pressure support at the then current IPAP/EPAP differential.

20. The method according to claim 18, wherein if it is determined in (g) that the then current IPAP/EPAP differential is equal to the predetermined maximum differential, the method further comprises automatically providing asthma medication to the patient while continuing to provide the second bi-level positive pressure support at the then current IPAP/EPAP differential.

21. The method according to claim 18, wherein if it is determined in (g) that the then current re-determined parameter is within the baseline range, the method further comprises:

(h) decreasing the then current IPAP/EPAP differential to a decreased level;

(i) delivering a third bi-level positive pressure support at the decreased level for a third number of respiratory cycles;

(j) re-determining the parameter; and

(k) repeating (h), (i) and (j) one or more times until either it is determined that the then current re-determined parameter is outside the baseline range or that the then current decreased level is equal to the baseline level.

22. The method according to claim 21, wherein if it is determined in (k) that the then current re-determined parameter is outside of the baseline range, the method repeats (d), (e), (f) and (g).

23. The method according to claim 21, wherein if it is determined in (k) that the then current re-determined parameter is not outside the baseline range and the then current decreased level is equal to the baseline level, the method further comprises continuing to provide the third bi-level positive pressure support at the baseline level.

24. The method according to claim 18, wherein the lung disease is asthma or COPD.

25. The method according to claim 18, wherein the pressure support system notifies the patient to begin using a medication or automatically provides a medication when the then current IPAP/EPAP differential is equal to a predetermined maximum differential.