Let’s make respiratory therapy fun!
The Canadian Academy for the Knowledge Economy is proud to be the fiscal sponsor of Breathing Games, a project which aims to:
- increase treatment adherence
- ensure proper home therapy
- relieve concerned family
- reduce hospitalisation costs
- gather data for research
Have you ever been snorkelling and suddenly went out of air ?
People with cystic fibrosis (mucoviscidosis) feel there is water in their lungs.
Between 3 and 7 years old, they begin a lifelong daily therapy to improve their life quality.
This tedious one hour routine results in medium to low adherence for 60 % of the patients.
What is Cystic Fibrosis ?
Cystic fibrosis, also known as Mucoviscidosis, is a so-called genetic disease that primarily affects the respiratory and digestive systems. It affects between 70 000 and 100 000 people worldwide [CFWW], of which 30 000 in the USA [CFF], 9 000 in United Kingdom [CF Trust] and 4 000 in Canada [CF Canada].
Usually, the epithelial cells from the lungs and digestive tract release a layer of slippery mucus that traps particles and germs and acts as a lubricant. In the case of cystic fibrosis, the cells produce a defective protein that leads to the formation of a thick and viscous mucus. This mucus obstructs the bronchial pipes, which make breathing and the absorption of nutrients difficult [CHUV].
In 90 % of the cases, a diagnostic is made before the age of ten years old [Passeport santé]. Common symptoms are a persistent cough, poor weight, bulky stools and a very salty skin for infants [CHUV].
What is the medical treatment ?
The treatment varies depending on the stage of the disease. The treatment of airways aims to clear them from mucus, to prevent or treat infections and to support optimal breathing. Different approaches exist [Association Muco] :
- aerosol therapy – which liquefies mucus in the lungs and spreads antibiotics if necessary
- respiratory physiotherapy – which allows through movements to expel the mucus from the lungs
- taking antibiotics – which prevents infections and chronic lung inflammations
- rinsing the nose – which clears the nose and prevents infections
- sports – which strengthens the immune system and a balanced psychological state
- transplant – used when respiratory failure is too high and threatens the life
The treatment of digestive problems aims to allow better assimilation of food and normal growth. A good nutritional status enhances immunity. These are [Association Muco] :
- taking pancreatic enzymes – which compensates for the dysfunction of these enzymes
- hypercaloric diet – which offsets the partial assimilation of food
- prescription vitamins – which also compensates for a deficiency at this level
Which is the Public Health challenge ?
According to different studies, about 60 % of the people with cystic fibrosis have a low or medium adherence to their PEP therapy. Therapy exercises may be tedious and boring, especially for young people [Modi 2010].
This is due [CHU Sainte Justine] to
- no treatment at all – some children have no symptoms such as visible secretions, and forget that practicing PEP from an early age increases life expectancy
- poorly executed treatment – while some children may do an activity simultaneously to their PEP, they may forget that breathing in slowly and deeply is important to enable the air to reach the least accessible spaces behind secretions for example
However, the adherence of young patients with cystic fibrosis to their to PEP therapy may increase when therapy is presented as a game [Wardini 2013, Oikonomou 2012, Bingham 2012, AAP 2011, Levitt 2008].