U.S. patent application number 14/230037 was filed with the patent office on 2014-07-31 for apparatus and method for relieving dyspnoea.
This patent application is currently assigned to KONINKLIJKE PHILIPS N.V.. The applicant listed for this patent is KONINKLIJKE PHILIPS N.V.. Invention is credited to JOHN O'DEA.
Application Number | 20140209097 14/230037 |
Document ID | / |
Family ID | 34137779 |
Filed Date | 2014-07-31 |
United States Patent
Application |
20140209097 |
Kind Code |
A1 |
O'DEA; JOHN |
July 31, 2014 |
APPARATUS AND METHOD FOR RELIEVING DYSPNOEA
Abstract
Apparatus for relieving dyspnoea in an ambulatory exercising
subject comprises a housing to be worn on the subject, and within
which a variable speed air blower motor is located for delivering
an air supply to the subject through a mouthpiece at a pressure
similar to average intrinsic positive end-expiratory pressure of
the subject. A pressure transducer in the mouthpiece monitors the
pressure during breathing cycles of the subject, and a control
circuit determines the average intrinsic positive end-expiratory
pressure of the subject over five breathing cycles. The control
circuit operates the air blower motor for delivering the air supply
to the subject at a pressure similar to the determined average
intrinsic positive end-expiratory pressure.
Inventors: |
O'DEA; JOHN; (GALWAY,
IR) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
KONINKLIJKE PHILIPS N.V. |
EINDHOVEN |
|
NL |
|
|
Assignee: |
KONINKLIJKE PHILIPS N.V.
EINDHOVEN
NL
|
Family ID: |
34137779 |
Appl. No.: |
14/230037 |
Filed: |
March 31, 2014 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10796585 |
Mar 9, 2004 |
8701664 |
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14230037 |
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09831388 |
Aug 10, 2001 |
6705314 |
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PCT/IE99/00112 |
Nov 8, 1999 |
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10796585 |
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Current U.S.
Class: |
128/204.23 |
Current CPC
Class: |
A61M 16/0069 20140204;
A61M 16/205 20140204; A61M 16/202 20140204; A61M 16/20 20130101;
A61M 16/107 20140204 |
Class at
Publication: |
128/204.23 |
International
Class: |
A61M 16/20 20060101
A61M016/20 |
Foreign Application Data
Date |
Code |
Application Number |
Nov 6, 1998 |
IR |
S980914 |
Claims
1. Apparatus for providing pressure support to a subject, the
apparatus comprising: a gas flow generating system adapted to
provide a flow of gas monitoring means for monitoring a
characteristic associated with a breathing cycle of a subject;
controlling means for controlling the pressure of the flow of gas
provided by the gas flow generating system; a patient circuit
having a first end operatively connected to the gas flow generating
system and a second end; a patient interface operatively connected
to the second end of the patient circuit; and an exhaust valve
coupled to the patient interface so as to communicate an interior
of the patient interface to ambient atmosphere through at least a
portion of the patient interface, wherein the exhaust valve is
operable under control of the controlling means to control a
pressure of the flow of gas in the patient interface.
2. The apparatus as claimed in claim 1, wherein the valve is a
pressure regulating valve.
3. The apparatus as claimed in claim 1, wherein the gas flow
generating system includes a blower motor, and wherein the
controlling means controls the pressure provided by that gas flow
generating system by controlling an operating speed of the blower
motor.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a Divisional under 35 U.S.C. .sctn.121
of U.S. patent application Ser. No. 10/796,585, filed Mar. 9, 2004,
which is a Continuation under 35 U.S.C. .sctn.120 of U.S. patent
application Ser. No. 09/831,388, filed Aug. 10, 2001, entitled
"Apparatus and a Method for Relieving Dyspnoea," now U.S. Pat. No.
6,705,314, granted Mar. 16, 2004, which was a 35 U.S.C. .sctn.371
national phase of PCT/IE99/00112, filed on Nov. 8, 1999, which
claims priority to Irish Application Serial No. S980914, filed Nov.
6, 1998.
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] The present invention relates to apparatus and method for
relieving dyspnoea, and in particular, though not limited to
apparatus and method for relieving dyspnoea in an ambulatory
subject, and more particularly, though not limited to an exercising
ambulatory subject.
[0004] 2. Description of the Related Art
[0005] Subjects who suffer from respiratory disorders such as
chronic obstructive pulmonary disease often suffer from dyspnoea or
breathlessness. This is particularly so in exercising subjects. The
term "exercising" is used in this specification, in general, to
include activities beyond the resting state, for example, the act
of walking, ascending a stairs, or the like. Dyspnoea and the fear
of a spell of dyspnoea create great anxiety in such subjects, and
can severely limit their ability to perform even the most simple
tasks, such as walking a relatively short distance, or ascending a
stairs within a house. Apparatus for relieving dyspnoea in
ambulatory subjects are known, although they suffer from
limitations. Typically, such apparatus are portable and may be worn
or carried by the subject. Typically, they provide a supply of air
to a mouthpiece, a nasal mask or a face mask to be worn by the
subject, and the air pressure is at a pressure greater than ambient
pressure. In general, a housing which houses a blower motor is worn
or carried by the subject, and a communicating conduit delivers air
from the blower motor to the mouth piece or mask at the pressure
greater than ambient. Typically, a controller is provided within
the housing for controlling the air blower for varying the pressure
at which the air is supplied to the mouthpiece for the subject. A
control knob on the housing facilitates selection by the subject of
the pressure at which the air is to be supplied, similarly
controlled non-portable apparatus are also known.
[0006] While such apparatus are satisfactory for a subject who, for
example, is resting, or alternatively is exercising at a relatively
constant rate by, for example, walking at a constant rate, they are
unsatisfactory where the rate of exercising by the subject is
varying, for example, in the case of a subject walking from a
downstairs room to an upstairs room in a house. While the subject
is walking on level ground the exercise rate is at one level,
however, when ascending the stairs, the exercise rate significantly
increases. As the exercise rate increases the subject breathes
faster. Faster breathing shortens the breathing cycle, and in
particular, the expiratory part of the breathing cycle. By
shortening the expiratory part of the breathing cycle less time is
available for the lungs to empty. Since generally, ones lungs empty
exponentially the shortened expiratory part of the cycle leads to a
higher intrinsic positive end-expiratory pressure which is the
pressure in the breathing cycle at which expiration ends and the
subject commences the inspiratory part of the breathing cycle.
Breathing being under the control of the nervous system is
relatively oblivious to the mechanics of the operation of the lungs
and their state of emptiness during a breathing cycle. Thus, as the
intrinsic positive end-expiratory pressure increases over a number
of breathing cycles as a result of increase in the exercise rate,
known apparatus are unable to cope with the increased exercise
rate. Similar problems may arise in the case of a resting subject
should an event or crisis occur which causes an increase in the
breathing rate of the subject.
[0007] There is therefore a need for apparatus and a method for
relieving dyspnoea in a subject which overcomes these problems.
[0008] The present invention is directed towards providing such a
method and apparatus.
SUMMARY OF THE INVENTION
[0009] According to the invention there is provided apparatus for
relieving dyspnoea in a subject, the apparatus comprising an air
supply means for providing an air supply at a pressure greater than
ambient for delivery to the subject, wherein the apparatus further
comprises a monitoring means for monitoring at least a part of at
least one breathing cycle of the subject for determining the
intrinsic positive end-expiratory pressure of a breathing cycle of
the subject, and a control means responsive to the monitoring means
for controlling the pressure of the air supply delivered to the
subject at a pressure substantially matched to the intrinsic
positive end-expiratory pressure.
[0010] In one embodiment of the invention the control means
controls the pressure of the air supply delivered to the subject at
the pressure substantially matched to the intrinsic positive
end-expiratory pressure for a period at least at the end of the
expiratory part of each breathing cycle.
[0011] In another embodiment of the invention the control means
controls the pressure of the air supply delivered to the subject at
a pressure greater than the intrinsic positive end-expiratory
pressure during at least a part of the inspiratory part of each
breathing cycle.
[0012] In a further embodiment of the invention the control means
controls the pressure of the air supply delivered to the subject at
a pressure substantially matched to the intrinsic positive
end-expiratory pressure during the expiratory part of each
breathing cycle.
[0013] In a still further embodiment of the invention the control
means controls the pressure of the air supply delivered to the
subject at a pressure greater than the intrinsic positive
end-expiratory pressure during the inspiratory part of each
breathing cycle.
[0014] In one embodiment of the invention the monitoring means
monitors a plurality of breathing cycles, and a computing means is
provided for determining the average intrinsic positive
end-expiratory pressure over the said plurality of breathing
cycles.
[0015] In another embodiment of the invention the monitoring means
monitors each breathing cycle over the complete breathing
cycle.
[0016] Preferably, the monitoring means is adapted for locating
adjacent the mouth of the subject.
[0017] In one embodiment of the invention the monitoring means is
adapted for locating in a mouthpiece, a nasal mask or a face mask
or adjacent thereto through which the air supply is delivered to
the subject.
[0018] In another embodiment of the invention signals are relayed
from the monitoring means to the control means.
[0019] In one embodiment of the invention the monitoring means is
connected to the control means by hard wiring.
[0020] Alternatively, a means for transmitting an airborne signal
from the monitoring means to the control means is provided, and a
receiving means is provided in the control means for receiving the
airborne signal transmitted from the monitoring means.
[0021] Preferably, the monitoring means is a pressure transducer
for monitoring the pressure of air during the breathing cycles.
[0022] Advantageously, the apparatus comprises a mouthpiece, nasal
mask or a face mask, and a communicating means for communicating
the mouthpiece or mask with the air supply means.
[0023] In one embodiment of the invention an exhaust means is
provided in the mouthpiece or mask for exhausting exhaled air from
the subject, and preferably, a valving means is provided in the
exhaust means of the mouthpiece or mask, the valving means being
operable under the control of the control means in response to the
monitoring means for controlling the pressure of the air supply in
the mouthpiece.
[0024] In a still further embodiment of the invention the valving
means is a pressure regulating valving means.
[0025] In another embodiment of the invention the air supply means
is operable under the control of the control means in response to
the monitoring means for controlling the pressure of the air supply
delivered to the subject.
[0026] In one embodiment of the invention the apparatus is portable
and is adapted for use by an ambulatory exercising subject.
[0027] Ideally, the apparatus comprises a housing defining a hollow
interior region, the air supply means being located within the
hollow interior region. Preferably, the control means is located
within the hollow interior region of the housing. Advantageously, a
power source is located in the hollow interior region.
[0028] In one embodiment of the invention an air inlet and an air
outlet are provided to and from the hollow interior region and the
air supply means is located intermediate the air inlet and the air
outlet.
[0029] Preferably, a first air filtering means is located adjacent
the air inlet upstream of the air supply means, and preferably, a
second air filtering means is located adjacent the air outlet of
the air supply means.
[0030] Advantageously, the air outlet is adapted for receiving the
communicating means.
[0031] In one embodiment of the invention a strap is provided for
securing the housing to the subject.
[0032] In another embodiment of the invention a retaining means is
provided on the strap for retaining the mouthpiece or mask
releasably secured to the strap when not required.
[0033] In a further embodiment of the invention a receiving means
is provided on the strap for receiving the communicating means.
Preferably, the receiving means is a releasable receiving means for
releasably receiving the communicating means.
[0034] In a further embodiment of the invention the communicating
means comprises an elongated communicating conduit.
[0035] Advantageously, the communicating means comprises an
elongated flexible communicating conduit.
[0036] Ideally, the communicating conduit is of concertina time
construction for facilitating flexing of the conduit and storing of
the conduit.
[0037] In another embodiment of the invention the control means
comprises the computing means.
[0038] In a further embodiment of the invention the air supply
means comprises an air blower motor. Preferably, the air blower
motor is electrically powered. Advantageously, the air blower motor
comprises an impeller driver by a motor.
[0039] In one embodiment of the invention the pressure at which the
air supply is delivered to the subject when the pressure of the air
supply is matched to the intrinsic positive end-expiratory pressure
is substantially similar to the intrinsic positive end-expiratory
pressure of the subject monitored by the monitoring means.
[0040] Additionally the invention provides a method for relieving
dyspnoea in a subject, the method comprising the steps of providing
an air supply means for delivering an air supply to the subject at
a pressure greater than ambient, wherein the method further
comprises monitoring at least a part of at least one breathing
cycle of the subject for determining the intrinsic positive
end-expiratory pressure of the subject, and controlling the
pressure of the air supply to the subject so that the pressure of
the air supply delivered to the subject is substantially matched to
the intrinsic positive end-expiratory pressure.
[0041] In one embodiment of the invention the pressure of the air
supply delivered to the subject is controlled at the pressure
substantially matched to the intrinsic positive end-expiratory
pressure for a period at least at the end of the expiratory part of
each breathing cycle.
[0042] In another embodiment of the invention the pressure of the
air supply delivered to the subject is controlled at a pressure
greater than the intrinsic positive end-expiratory pressure during
at least a part of the inspiratory part of each breathing
cycle.
[0043] In a further embodiment of the invention the pressure of the
air supply delivered to the subject is controlled at the pressure
substantially matched to the intrinsic positive end-expiratory
pressure during the expiratory part of each breathing cycle.
[0044] In a still further embodiment of the invention the pressure
of the air supply delivered to the subject is controlled at a
pressure greater than the intrinsic positive end-expiratory
pressure during the inspiratory part of each breathing cycle.
[0045] In one embodiment of the invention a plurality of breathing
cycles of the subject are monitored for determining the average
intrinsic positive end-expiratory pressure over the said plurality
of breathing cycles.
[0046] In another embodiment of the invention the complete
breathing cycle of each monitored breathing cycle is monitored.
[0047] Preferably, the air pressure adjacent the mouth of the
subject is monitored for determining the intrinsic positive
end-expiratory pressure.
[0048] Advantageously, the air pressure is monitored in a
mouthpiece, nasal mask or a face mask attached to the subject for
determining the intrinsic positive end-expiratory pressure.
[0049] In one embodiment of the invention the pressure at which the
air supply is delivered to the subject is at a pressure
substantially similar to the determined intrinsic positive
end-expiratory pressure.
[0050] In another embodiment of the invention the method is for
relieving dyspnoea in an ambulatory exercising subject, and the
method comprises the step of providing the air supply means as a
portable air supply means.
[0051] The advantages of the invention are many. By virtue of the
fact that the apparatus and method control the pressure at which
the air supply is supplied to the subject at the end of the
expiratory part of each breathing cycle so that the pressure of the
air supply to the subject is matched to the intrinsic positive
end-expiratory pressure of the subject, the subject can effectively
commence inspiration immediately the expiratory part of the
breathing cycle has ended. This permits maximum intake of air by
the subject during the inspiration part of each breathing cycle. In
other words, by virtue of the fact that the subject can commence
inspiration immediately at the end of the expiratory part of the
breathing cycle air can be drawn into the lunge of the subject over
the entire inspiratory part of the breathing cycle. This, thus
maximizes the volume of air drawn into the lungs of the subject
during each breathing cycle. The matching of the pressure of the
air supply delivered to the subject with the intrinsic positive
end-expiratory pressure of the subject at the end of the expiratory
part of each breathing cycle removes the threshold load which
subjects typically encounter at the commencement of the inspiratory
part of a breathing cycle. This threshold load which would
otherwise be encountered by a subject is caused where the pressure
of the air supply delivered to the subject is below the intrinsic
positive end-expiratory pressure. Thus, by providing the air supply
to the subject at a pressure matched to the intrinsic positive
end-expiratory pressure at the end of the expiratory part of each
breathing cycle the threshold load is eliminated.
[0052] In embodiments of the invention where the pressure of the
air supply to the subject during part or all of the inspiratory
part of each breathing cycle is greater than the intrinsic positive
end-expiratory pressure, a further advantage is achieved in that a
greater volume of air can be drawn into the lungs of the subject
during the inspiratory part of the cycle.
BRIEF DESCRIPTION OF THE DRAWINGS
[0053] The invention will be more clearly understood from the
following description of some preferred embodiments thereof which
are given by way of example only with reference to the accompanying
drawings, in which:
[0054] FIG. 1 is a perspective view of apparatus according to the
invention for relieving dyspnoea in an ambulatory exercising
subject,
[0055] FIG. 2 is a perspective view of the apparatus of FIG. 1 in
use,
[0056] FIG. 3 is a block representation of a circuit of the
apparatus of FIG. 1,
[0057] FIG. 4 illustrates graphs of a number of consecutive
breathing cycles of an ambulatory subject during exercising,
[0058] FIG. 5 is a view similar to FIG. 3 of apparatus according to
another embodiment of the invention for relieving dyspnoea in an
ambulatory exercising subject, and
[0059] FIG. 6 is a side elevational view of a portion of the
apparatus of FIG. 5.
DETAILED DESCRIPTION OF THE EXEMPLARY EMBODIMENTS
[0060] Referring to the drawings and initially to FIGS. 1 to 4
there is illustrated apparatus according to the invention indicated
generally by the reference numeral 1 for relieving dyspnoea in a
subject, and in this embodiment of the invention in an ambulatory
exercising subject. The apparatus 1 is portable and is suitable for
wearing by the subject as illustrated in FIG. 2. The apparatus 1
comprises a housing 3 which defines a hollow interior region 4. An
air supply means, namely, a variable speed air blower motor 5
having an impeller 6 is located within the hollow interior region 4
for delivering an air supply to the subject at a pressure greater
than ambient pressure as will be described below. An air inlet port
7 in the housing 3 accommodates air into the hollow interior region
4 to be blown by the air blower motor 5 and the impeller 6 through
an outlet port 8 for delivery to the subject.
[0061] A communicating means, namely, a communicating conduit 9 of
flexible plastics material communicates the outlet port 8 with a
mouthpiece 10 to which the air supply is delivered to the subject.
The communicating conduit 9 is of concertina construction for
facilitating flexing of the conduit 9 and storing thereof. An
exhaust means, namely, an exhaust port 11 in the mouthpiece 10
assists in exhausting expired air from the subject. A first air
filtering means provided by a first air filter 12 located in the
air inlet port 7 filters air to the air blower motor and the
impeller 6, while a second air filtering means, namely, a second
air lifter 13 is located in the air outlet port 8 for filtering the
air supply to the subject, and also for filtering expired air which
may flow back through the conduit 9. A waist strap 15 and a
shoulder strap 16 secured to the housing 3 releasably secure the
housing 3 to the subject. A retaining means, namely, a retaining
clip 17 is provided on the shoulder strap 16 for releasably
retaining the mouthpiece 10 on the shoulder strap 16 when not in
use. A receiving means, namely, a receiving clip 18 on the shoulder
strap 16 releasably receives and secures the communicating conduit
9 to the shoulder strap 16.
[0062] A power supply means, namely, a DC power source provided by
a battery 20 is located in the housing 3 for powering the air
blower motor 5. The speed of the blower motor 5 is controlled by a
control means, namely, a control circuit 22 for varying the flow
rate of the air supply to the subject, for in turn varying the
pressure at which the air supply is delivered to the subject.
[0063] A monitoring means, in this embodiment of the invention
provided by a pressure transducer 25 is located in the mouth piece
10 for monitoring air pressure in the mouth piece 10 during a
plurality of complete breathing cycles so that the average
intrinsic positive end-expiratory pressure of the subject may be
determined.
[0064] Referring in particular to FIG. 4, the intrinsic pressure
and flow rate of air during the inspiratory part and the expiratory
part of the breathing cycle of an ambulatory exercising subject
during ten typical breathing cycles is illustrated. It should be
noted that the graphs A and B are not to scale, and are provided
solely for the purpose of illustrating typical breathing cycles.
Graph A illustrates the intrinsic pressure, which graph B
illustrates the intrinsic flow rate of air. During the first three
breathing cycles the subject is exercising at a relatively low
constant rate, for example, walking However, during the next seven
breathing cycles the exercise rate of the subject is increased, for
example, by changing from walking to running, or ascending a stairs
or the like. As can be seen from graph A as the exercise rate
increases the breathing cycle time is reduced. In other words, the
breathing cycle time for cycles four to ten is less than the
breathing cycle time for the first three breathing cycles. In
particular, as the breathing cycle time is reduced the time period
of the expiratory part of each breathing cycle from the positive
peak X to the point Y in each breathing cycle of graph A is
likewise reduced. As can be seen from graph B this, thus, reduces
the volume of air which can be exhaled by the subject, and in turn
raises the intrinsic positive end-expiratory pressure of each
breathing cycle. The intrinsic positive end-expiratory pressure of
each breathing cycle is the point Y where the graph Y cuts the
verticals C. In the first three breathing cycles the point Y lies
on the x-axis. Thus, in the first three breathing cycles the
subject can commence drawing air into his or her lungs at the very
beginning of the inspiratory part of each breathing cycle, in other
words, at the point Y. However, as the exercise rate increases the
point Y rises above the x-axis, and thereby, although expiration
has ceased at the point Y, inspiration cannot commence until the
intrinsic pressure has dropped to the x-axis, in other words, until
the point Z has been reached. Therefore, the subject is unable to
draw air into his or her lungs during the period Y to Z of each
breathing cycle, in other words, during the time period between the
adjacent verticals C and D.
[0065] The apparatus as will be described below by monitoring the
intrinsic pressure of the breathing cycles of the subject, and by
determining the average intrinsic positive end-expiratory pressure,
in other words, the average of the pressure values of the points Y
over a plurality of breathing cycles, in this case, five breathing
cycles, and then by increasing the pressure of the air supply to
the subject to the average of the pressure values of the points Y,
allows the subject to commence drawing in air immediately at the
commencement of the inspiratory part of each breathing cycle. In
other words, the subject can draw air into his or her lungs
immediately the point Y has been reached in each breathing
cycle.
[0066] The pressure transducer 25 monitors air pressure and may
also monitor air flow in the mouthpiece 10. Signals from the
pressure transducer 25 are relayed through hard wiring 27 to the
control circuit 22. A computing means provided by a microprocessor
28 in the control circuit 22 determines the average intrinsic
positive end-expiratory pressure of the subject from the signals
received from the pressure transducer 25 while using one or more
appropriate algorithms. Typically, signals from five consecutive
breathing cycles are read by the microprocessor 28, and the average
intrinsic positive end-expiratory pressure of the subject is
determined over the five breathing cycles. The determination of
intrinsic positive end-expiratory pressure in a subject will be
well known to those skilled in the art, and it is not intended to
describe the algorithms in detail. The microprocessor 28 in the
control circuit 22 controls the control circuit 22 for in turn
controlling the air blower motor 5 for delivering the air supply at
an appropriate flow rate to the mouthpiece 10 so that the air
supply delivered to the mouthpiece 10 is at a pressure matched to
the determined average intrinsic positive end-expiratory pressure.
In this embodiment of the invention the air supply is delivered to
the mouthpiece 10 at a pressure similar to the determined average
intrinsic positive end-expiratory pressure. The control circuit 22
controls the air blower motor 5 for maintaining the pressure of the
air supply at the appropriate pressure until signals received from
the pressure transducer 25 in the mouthpiece 10 indicate that a
further change in the average intrinsic positive end-expiratory
pressure has occurred. At which stage the control circuit 22 again
controls the blower motor 5 to again match the pressure of the air
supply to the newly determined average intrinsic positive
end-expiratory pressure.
[0067] A control knob 30 located exteriorly on the housing 3 is
operably connected to the control circuit 22 for providing manual
control of the control circuit 22 for in turn manually controlling
the pressure at which the air blower motor 5 delivers the air
supply to the mouth piece 10, should the subject decide to control
the air supply pressure manually. A button switch 32 also located
exteriorly on the housing 3 is operably connected to the control
circuit 2 for facilitating selection by the subject between an
automatic operation mode of the apparatus 1 and a manual operation
mode of the apparatus 1. When the apparatus 1 is operated in the
manual mode the pressure at which the air supply is delivered to
the mouth piece 10 is controlled by the control knob 30, and when
the apparatus 1 is operated in the automatic mode the pressure at
which the air supply is delivered to the mouth piece 10 is
determined by the control circuit 22 from signals received from the
pressure transducer 25 in the mouth piece 10. An indicator light 33
on the housing 3 indicates when the apparatus 1 is operating in the
automatic mode.
[0068] In use, a subject wears the apparatus 1 as illustrated in
FIG. 2, and when a supply of air at a pressure greater than ambient
is required the subject breaths through the mouth piece 10. If it
is desired to operate the apparatus 1 in the manual operating mode,
the button switch 32 is depressed and the control knob 30 is
rotated until the air supply to the subject is at the desired
pressure. When it is desired to operate the apparatus 1 in the
automatic operating mode the button switch 32 is again depressed
switching the apparatus 1 to operate in the automatic mode. In this
mode, signals from the pressure transducer 25 are read by the
microprocessor 28 in the control circuit 22 which continuously
determines the average intrinsic positive end-expiratory pressure.
The control circuit 22 sets the speed of the blower motor 5 at an
appropriate speed to deliver the air supply at a flow rate so that
the pressure of the air supply delivered to the mouthpiece 10 is
similar to the determined average intrinsic positive end-expiratory
pressure. The pressure transducer 25 continues to monitor the
intrinsic pressure of the breathing cycles of the subject, and the
microprocessor 28 continuously determines the average intrinsic
positive end-expiratory pressure from the signals received from the
pressure transducer 25. On a change in the average intrinsic
positive end-expiratory pressure being determined the control
circuit 22 resets the speed of the blower motor 5 for the air
supply in the mouthpiece 10 is matched to the new average intrinsic
positive end-expiratory pressure, and so operation of the apparatus
1 continues.
[0069] Referring now to FIGS. 5 and 6 there is illustrated
apparatus according to another embodiment of the invention
indicated generally by the reference numeral 40 also for relieving
dyspnoea in an ambulatory exercising subject. The apparatus 40 is
substantially similar to the apparatus 1 and similar components are
identified by the same reference numerals. The main difference
between the apparatus 40 and the apparatus 1 is that the blower
motor 5 is a constant speed motor, and thus, delivers the air
supply at a constant pressure. In this embodiment of the invention
the air supply is provided to the subject through a mouth and nasal
mask 41 within which the pressure transducer 25 is located. An
exhaust means provided by an exhaust port 42 from the mouth and
nasal mask 41 exhausts expired air from the subject. A valving
means, in this embodiment of the invention a variable pressure
regulating valve 44 is located in the exhaust port 42 for
controlling the pressure of the air supply in the mouth and nasal
mask 41. The valve 44 is hard wired to the control circuit 22 by a
cable 45, and the control circuit 22 controls the valve 44 for
maintaining the pressure in the mouth and nasal mask 41 at a
pressure similar to the average intrinsic positive end-expiratory
pressure determined by the microprocessor 28 in response to signals
received from the pressure transducer 25. In this embodiment of the
invention the only control exercised over the air blower motor 5 by
the control circuit 22 is to switch on and off the air blower motor
5 as the apparatus 40 is required to deliver an air supply to the
subject.
[0070] Operation of the apparatus 40 is substantially similar to
that of the apparatus 1. The average intrinsic positive
end-expiratory pressure of the subject is determined by the
microprocessor 28 of the control circuit 22 from signals read from
the pressure transducer 25. On determining the average intrinsic
positive end-expiratory pressure, the control circuit 22 then sets
the valve 44 appropriately so that the air supply in the mouth and
nasal mask 41 is at a pressure similar to the average intrinsic
positive end-expiratory pressure determined by the microprocessor
28. On the microprocessor 28 determining a change in the average
intrinsic positive end-expiratory pressure, the control circuit 22
resets the valve 44 appropriately, so that the air supply in the
mask 41 is again at a pressure similar to the new average intrinsic
positive end-expiratory pressure, and so operation of the apparatus
40 continues. Otherwise, operation of the apparatus 40 is similar
to that of the apparatus 1.
[0071] It is envisaged that the microprocessor 28 of the apparatus
1 and the apparatus 40 may be programmed so that the air supply is
delivered to the subject at a pressure similar to the average
intrinsic positive end-expiratory pressure during the expiratory
part of each breathing cycle, and just after the commencement of
the inspiratory part of each breathing cycle, the pressure of the
air supply to the subject would be raised to a pressure greater
than the average intrinsic positive end-expiratory pressure, and
the pressure of the air supply to the subject would be maintained
at that greater pressure until the end of the inspiratory part of
each breathing cycle, at which stage the pressure of the air supply
would be reduced to the average intrinsic positive end-expiratory
pressure. This would facilitate inspiration by the subject so that
the subject could draw in a greater volume of air during the
inspiratory part of the breathing cycle. At the end of the
inspiratory part of each breathing cycle the air blower motor or
the valve 44 would be operated to deliver the air supply to the
subject at a pressure similar to the average intrinsic positive
end-expiratory pressure until the expiratory part of each breathing
cycle had been completed.
[0072] Should the microprocessor be programmed in this way the
microprocessor would determine the beginning and end of the
respective expiratory and inspiratory parts of the breathing cycle
by reading the signals from the pressure transducer 25.
[0073] It is envisaged that an oxygen supply may be provided in the
housing for mixing with the air supply being delivered to the
subject. In the event of an oxygen supply being provided, the
control circuit would control the supply of oxygen into the air
supply so that the pressure at which the oxygen is being delivered
to the subject is similar to pressure at which the air supply is
being delivered.
[0074] While the air supply is described as being delivered to the
subject through a mouthpiece or mouth and nasal mask, the air
supply may be delivered to the subject through any other suitable
means, for example, a nasal mask, a face mask or the like.
[0075] It will be appreciated that while the air supply means has
been described as comprising a blower motor and impeller, any other
suitable air supply means may be provided, for example, an air
compressor, a diaphragm pump, a piston pump of an appropriate size
and with an adequate dynamic response.
[0076] While the pressure transducer has been described as being
hard wired to the control circuit, it will be appreciated that
signals from the pressure transducer may be relayed to the control
circuit by radio waves from a radio transmitter located adjacent
the pressure transducer to a radio receiver located in the control
circuit. Needless to say, any other airborne communicating waves
may be used to relaying signals from the pressure transducer to the
control circuit.
[0077] While the monitoring means has been described as being a
pressure transducer located adjacent to the mouth of the subject,
the monitoring means may be provided by a pressure transducer
located in the housing downstream of the air supply means. In which
case a flow meter would be provided for measuring the flow rate of
the air supply from the air supply means, and knowing the
resistance of the communicating means the intrinsic pressure during
each breathing cycle of the subject could be determined from
signals read from the pressure transducer and the flow meter.
[0078] While the average intrinsic positive end-expiratory pressure
has been described as being determined over five breathing cycles,
the average intrinsic positive end-expiratory pressure may be
determined over any other suitable number of breathing cycles.
Furthermore, in certain cases it is envisaged that instead of
determining the average intrinsic positive end-expiratory pressure,
intrinsic positive end-expiratory pressure may be used
directly.
* * * * *