2024
2025
Module inwendige
aandoeningen
RESPIRATOIRE
,TABLE OF CONTENTS
1 Inleiding ........................................................................................................ 4
1.1 Respiratoir systeem .............................................................................................4
1.2 Structuur van de longen ....................................................................................4
1.3 Ademhalingsspieren ............................................................................................4
1.4 Bronchiale boom of luchtwegen ...........................................................................5
1.4.1 Funnel ................................................................................................................................. 6
1.5 Alveoli connecties en collaterale ventilatie...........................................................6
1.6 Alveoli en terminale bronchionli ..........................................................................7
1.7 Ciliary beat frequency ..........................................................................................7
1.8 Obstructie en compressie ....................................................................................8
1.9 Equal pressure point ............................................................................................9
1.9.1 De equall pressure point beweegt ....................................................................................... 9
1.10 Longfunctie ..................................................................................................... 10
1.10.1 Normale waarden VS. pathologische waarden .................................................................. 11
1.11 Maximaal flow-volume curve ........................................................................... 12
2 Principes en beoordeling Patiënt.................................................................... 13
2.1 Verwachte problemen bij obtructieve longaandoeningen .................................... 13
2.2 Voornaamste doelen van bronchiale drainage .................................................... 13
2.3 Effecten van de lineaire luchtsnelheid ................................................................ 14
2.4 Diagnose............................................................................................................ 14
2.5 Onderzoek ......................................................................................................... 15
2.5.1 Klinische aspecten ............................................................................................................ 15
2.5.2 Thorax vorm ...................................................................................................................... 16
2.5.3 Ademhalingsgeluiden........................................................................................................ 16
2.5.4 Hoest- en hijstechnieken .................................................................................................. 17
2.5.5 Oefencapaciteit ................................................................................................................ 17
2.5.6 Spierkracht ....................................................................................................................... 17
2.6 Additionele diagnostische informatie ................................................................. 18
3 Autogene drainage ......................................................................................... 20
3.1 Hoe inademen bij autogene drainage? ................................................................ 20
3.2 Uitademen bij autogene drainage ....................................................................... 21
3.2.1 Hoe uitademen bij autogene drainage? ............................................................................. 21
3.3 Bronchiale funnel ............................................................................................... 21
3.4 Modulatie van het ademhalingsniveau vanuit de periferie ................................... 22
1
, 3.5 Flow-volume curve ............................................................................................. 22
3.6 Drainage houdingen ........................................................................................... 23
3.7 De vereisten in drainage ..................................................................................... 23
3.8 Verschillend drainage technieken ...................................................................... 24
3.8.1 Neus snuiten ..................................................................................................................... 24
3.8.2 Posturale drainage ............................................................................................................ 25
3.8.3 HFCWO............................................................................................................................. 25
3.8.4 ELTGOL ............................................................................................................................. 25
3.8.5 ACBT ................................................................................................................................. 25
3.8.6 PEP ................................................................................................................................... 25
3.8.7 Therapep ........................................................................................................................... 27
3.8.8 Flutter ............................................................................................................................... 27
3.8.9 RC cornet .......................................................................................................................... 27
3.8.10 Acapella ............................................................................................................................ 27
3.8.11 Aerobika............................................................................................................................ 27
4 Luchtwegen vrijmaken bij kinderen ................................................................ 27
4.1 Baby’s ................................................................................................................ 27
4.1.1 Longen en thorax ............................................................................................................... 27
4.2 Geassisteerde autogene drainage ...................................................................... 28
4.3 Verschil AD en AAD ............................................................................................ 29
4.4 Technieken ........................................................................................................ 29
5 Inhalatie therapie........................................................................................... 30
5.1 Doel van inhalatie therapie ................................................................................. 30
5.2 Inhalatie therapie: Gunstig? ............................................................................... 31
5.3 Aerosol gedrag en depositie ............................................................................... 31
5.3.1 Optimalisatie .................................................................................................................... 32
5.4 Kinderen: ademhalingspatroon .......................................................................... 33
5.5 Ziekte................................................................................................................. 34
5.6 Apparaten .......................................................................................................... 34
5.6.1 Van compressor tot geperforeerde mesh nebuliser ........................................................... 34
5.6.2 eFlow ................................................................................................................................ 34
5.6.3 I-neb ................................................................................................................................. 34
5.6.4 Aeroneb Go ....................................................................................................................... 34
5.6.5 PMDI ................................................................................................................................. 35
5.6.6 Babyhaler .......................................................................................................................... 36
5.6.7 DPI .................................................................................................................................... 36
5.7 Combinatie inhalatie met ACT ............................................................................ 37
5.8 Geïnhaleerde drugs en de timing ........................................................................ 37
6 Inspiratoire oefeningen: niet-invasieve ventilatie ........................................... 38
2
, 6.1 Respiratoire kinesitherapie na operatie .............................................................. 38
6.2 Incentieve spirometrie ....................................................................................... 38
6.2.1 TriFlow .............................................................................................................................. 38
6.2.2 Coach ............................................................................................................................... 39
6.3 Intermittent positieve pressure breathing (IPPB) ................................................. 39
6.3.1 Definitie ............................................................................................................................ 39
6.3.2 Indicaties IPPB .................................................................................................................. 39
6.4 Continuous positive airway pressure (CPAP) ....................................................... 39
6.4.1 Doelstellingen CPAP ......................................................................................................... 40
6.4.2 Indicaties CPAP................................................................................................................. 40
6.4.3 Contra-indicaties CPAP..................................................................................................... 40
6.4.4 EZPAP ............................................................................................................................... 40
6.5 Bilevel positive airway pressure (BIPAP).............................................................. 41
6.5.1 Indicaties BIPAP ................................................................................................................ 41
6.5.2 Contra-indicaties BIPAP .................................................................................................... 41
6.6 Intrapulmonary percussive ventilation (IPV)........................................................ 41
6.6.1 De aerosol generator ......................................................................................................... 42
6.6.2 Doel bij obstructieve patiënten ......................................................................................... 42
6.6.3 Doelen bij restrictieve patiënten ........................................................................................ 42
6.6.4 Contra-indicaties IPV ........................................................................................................ 43
6.6.5 Indicaties .......................................................................................................................... 43
7 Mobilisatie oefentherapie .............................................................................. 43
7.1 Preventie doelen ................................................................................................ 43
7.2 Curatieve doelen ................................................................................................ 43
7.3 Patiënt evaluatie ................................................................................................ 44
7.4 Respiratoire ismoetrische spierkracht testing .................................................... 44
7.5 Perifere isometrische spierkracht testing ........................................................... 44
7.6 Oefentherapie .................................................................................................... 44
7.6.1 Cardio-circulatoire beperking ........................................................................................... 45
7.6.2 Ventilatoire beperking ....................................................................................................... 45
7.6.3 Zuurstof opname beperking .............................................................................................. 46
7.6.4 Musculaire beperking ........................................................................................................ 46
7.7 Respiratoire en perifere spiertraining ................................................................. 46
7.7.1 Respiratoire ...................................................................................................................... 46
7.7.2 Perifere ............................................................................................................................. 47
7.8 Thuis sporten ..................................................................................................... 47
3
2025
Module inwendige
aandoeningen
RESPIRATOIRE
,TABLE OF CONTENTS
1 Inleiding ........................................................................................................ 4
1.1 Respiratoir systeem .............................................................................................4
1.2 Structuur van de longen ....................................................................................4
1.3 Ademhalingsspieren ............................................................................................4
1.4 Bronchiale boom of luchtwegen ...........................................................................5
1.4.1 Funnel ................................................................................................................................. 6
1.5 Alveoli connecties en collaterale ventilatie...........................................................6
1.6 Alveoli en terminale bronchionli ..........................................................................7
1.7 Ciliary beat frequency ..........................................................................................7
1.8 Obstructie en compressie ....................................................................................8
1.9 Equal pressure point ............................................................................................9
1.9.1 De equall pressure point beweegt ....................................................................................... 9
1.10 Longfunctie ..................................................................................................... 10
1.10.1 Normale waarden VS. pathologische waarden .................................................................. 11
1.11 Maximaal flow-volume curve ........................................................................... 12
2 Principes en beoordeling Patiënt.................................................................... 13
2.1 Verwachte problemen bij obtructieve longaandoeningen .................................... 13
2.2 Voornaamste doelen van bronchiale drainage .................................................... 13
2.3 Effecten van de lineaire luchtsnelheid ................................................................ 14
2.4 Diagnose............................................................................................................ 14
2.5 Onderzoek ......................................................................................................... 15
2.5.1 Klinische aspecten ............................................................................................................ 15
2.5.2 Thorax vorm ...................................................................................................................... 16
2.5.3 Ademhalingsgeluiden........................................................................................................ 16
2.5.4 Hoest- en hijstechnieken .................................................................................................. 17
2.5.5 Oefencapaciteit ................................................................................................................ 17
2.5.6 Spierkracht ....................................................................................................................... 17
2.6 Additionele diagnostische informatie ................................................................. 18
3 Autogene drainage ......................................................................................... 20
3.1 Hoe inademen bij autogene drainage? ................................................................ 20
3.2 Uitademen bij autogene drainage ....................................................................... 21
3.2.1 Hoe uitademen bij autogene drainage? ............................................................................. 21
3.3 Bronchiale funnel ............................................................................................... 21
3.4 Modulatie van het ademhalingsniveau vanuit de periferie ................................... 22
1
, 3.5 Flow-volume curve ............................................................................................. 22
3.6 Drainage houdingen ........................................................................................... 23
3.7 De vereisten in drainage ..................................................................................... 23
3.8 Verschillend drainage technieken ...................................................................... 24
3.8.1 Neus snuiten ..................................................................................................................... 24
3.8.2 Posturale drainage ............................................................................................................ 25
3.8.3 HFCWO............................................................................................................................. 25
3.8.4 ELTGOL ............................................................................................................................. 25
3.8.5 ACBT ................................................................................................................................. 25
3.8.6 PEP ................................................................................................................................... 25
3.8.7 Therapep ........................................................................................................................... 27
3.8.8 Flutter ............................................................................................................................... 27
3.8.9 RC cornet .......................................................................................................................... 27
3.8.10 Acapella ............................................................................................................................ 27
3.8.11 Aerobika............................................................................................................................ 27
4 Luchtwegen vrijmaken bij kinderen ................................................................ 27
4.1 Baby’s ................................................................................................................ 27
4.1.1 Longen en thorax ............................................................................................................... 27
4.2 Geassisteerde autogene drainage ...................................................................... 28
4.3 Verschil AD en AAD ............................................................................................ 29
4.4 Technieken ........................................................................................................ 29
5 Inhalatie therapie........................................................................................... 30
5.1 Doel van inhalatie therapie ................................................................................. 30
5.2 Inhalatie therapie: Gunstig? ............................................................................... 31
5.3 Aerosol gedrag en depositie ............................................................................... 31
5.3.1 Optimalisatie .................................................................................................................... 32
5.4 Kinderen: ademhalingspatroon .......................................................................... 33
5.5 Ziekte................................................................................................................. 34
5.6 Apparaten .......................................................................................................... 34
5.6.1 Van compressor tot geperforeerde mesh nebuliser ........................................................... 34
5.6.2 eFlow ................................................................................................................................ 34
5.6.3 I-neb ................................................................................................................................. 34
5.6.4 Aeroneb Go ....................................................................................................................... 34
5.6.5 PMDI ................................................................................................................................. 35
5.6.6 Babyhaler .......................................................................................................................... 36
5.6.7 DPI .................................................................................................................................... 36
5.7 Combinatie inhalatie met ACT ............................................................................ 37
5.8 Geïnhaleerde drugs en de timing ........................................................................ 37
6 Inspiratoire oefeningen: niet-invasieve ventilatie ........................................... 38
2
, 6.1 Respiratoire kinesitherapie na operatie .............................................................. 38
6.2 Incentieve spirometrie ....................................................................................... 38
6.2.1 TriFlow .............................................................................................................................. 38
6.2.2 Coach ............................................................................................................................... 39
6.3 Intermittent positieve pressure breathing (IPPB) ................................................. 39
6.3.1 Definitie ............................................................................................................................ 39
6.3.2 Indicaties IPPB .................................................................................................................. 39
6.4 Continuous positive airway pressure (CPAP) ....................................................... 39
6.4.1 Doelstellingen CPAP ......................................................................................................... 40
6.4.2 Indicaties CPAP................................................................................................................. 40
6.4.3 Contra-indicaties CPAP..................................................................................................... 40
6.4.4 EZPAP ............................................................................................................................... 40
6.5 Bilevel positive airway pressure (BIPAP).............................................................. 41
6.5.1 Indicaties BIPAP ................................................................................................................ 41
6.5.2 Contra-indicaties BIPAP .................................................................................................... 41
6.6 Intrapulmonary percussive ventilation (IPV)........................................................ 41
6.6.1 De aerosol generator ......................................................................................................... 42
6.6.2 Doel bij obstructieve patiënten ......................................................................................... 42
6.6.3 Doelen bij restrictieve patiënten ........................................................................................ 42
6.6.4 Contra-indicaties IPV ........................................................................................................ 43
6.6.5 Indicaties .......................................................................................................................... 43
7 Mobilisatie oefentherapie .............................................................................. 43
7.1 Preventie doelen ................................................................................................ 43
7.2 Curatieve doelen ................................................................................................ 43
7.3 Patiënt evaluatie ................................................................................................ 44
7.4 Respiratoire ismoetrische spierkracht testing .................................................... 44
7.5 Perifere isometrische spierkracht testing ........................................................... 44
7.6 Oefentherapie .................................................................................................... 44
7.6.1 Cardio-circulatoire beperking ........................................................................................... 45
7.6.2 Ventilatoire beperking ....................................................................................................... 45
7.6.3 Zuurstof opname beperking .............................................................................................. 46
7.6.4 Musculaire beperking ........................................................................................................ 46
7.7 Respiratoire en perifere spiertraining ................................................................. 46
7.7.1 Respiratoire ...................................................................................................................... 46
7.7.2 Perifere ............................................................................................................................. 47
7.8 Thuis sporten ..................................................................................................... 47
3
