Note: Descriptions are shown in the official language in which they were submitted.
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CLC is a device that can measure the volume of air inhaled or exhaled
(Spirometer) and selectively regulate the resistance against breathing in
or out (Resistor). It can be used as an Spirometer only or Resistor only,
CLC is very easy to learn, does not allow the option of making a mistake,
can be washed and used again and again that makes it very economical
and gives the opportunity of doing a lot of different research (the
reason that I came up with the idea of making CLC device is the same).
CLC provicles the best possible lung care. CLC functions similar to
devices like Inspiratory Muscle Trainer, Positive Expiratory Pressure
device and Incentive Spirometer, and still has a lot of other advantages
like bigger range, more accuracy and is more economic.
NVe have rrrany options while breathing into or out of the CLC
device:
A mask that covers mouth and nose or nose only, with air bag around
the edge of it or a floppy plastic (like the one used for nose mask in
BiPAP or CP,AP) to seal it to the skin and avoid any air leakage. ( A lot of
patients with chronic obstructive pulmonary disease are claustrophobic,
so the size and shape of the mask should suit their needs). These
masks can bE~ fixed on the face by head straps. These masks can have
3 special one way valves (breathing in only) and one outlet for the
Resistor or the Spirometer. These valves are for connection to: 1.
Oxygen pipe (via valve P). 2. A big pipe carrying humidified oxygen or
humidified air (via valve M that can be closed selectively). 3.One way
valve for breathing air in (via valve A). This valve can be changed for
breathing out only.
For patients wvho still need additional oxygen or humidified oxygen or
humidified air, there is another option of having a reserve bag ( as big as
500 to 5000 cc) that can be connected to the oxygen pipe or humidified
oxygen (or humidified air) from one side, to fill up , and from another side
to the mask via valve M or to the Resistor via opening A or to the
Spirometer vi<~ opening L.
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The mask can be made in a simpler way and have valve A and outlet R
only.
Alternatively, a mouth piece may be used instead of a mask. The
subject seals his lips around the mouth piece or a mouth piece like the
one used for snorkeling that may be easier to use. The mouth piece can
have a floppy plastic around, that goes under lips and cheeks, so the
subject doe sn't have to worry about sealing his lips around the mouth
piece. Another option is a strap with special room for the Resistor to be
fixed in, for sportsperson when exercising or for weak or lazy subjects.
This mouth piece can be flexible at the base to decrease bouncing
movements of the mouth piece inside the mouth when body in motion
e.g. when exercising.
The mouth piece or mask can be connected to the Resistor or the
Spirometer through a long and flexible pipe (mouth piece can rotate
freely at the connection site to the pipe) that subject can watch what he
is performing for encouragement.
Resistor:
The mask or mouth piece or flexible pipe is connected to a pressure
regulated resistor(Resistor) that can have a range e.g. from zero to forty
cm of H20. Since an accurate pressure regulator for low pressure might
be very expensive to manufacture and considering the fact that different
groups of subjects have different expiratory volume and muscle strength
and need different pressure ranges, the Resistor could be made in
different sizes with different pressure ranges e.g., 0 to 20 or 5 to 40 cm
of H20. (These ranges can vary based on the cost of manufacturing
them and the needs of the subjects). The Resistor can have the option
of opening and closing gradually (by using different limitor tubes) at the
selectively chosen starting resistance.
The limitor tube can be made in different shapes and sizes. As the
valve moves backward in limitor tube the leakage space (open space
between the valve and the limitor tube) changes. When the valve is
moving backward under the pressure of area A and inside the limitor
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tube, the spring is squeezing, so the back pressure of the spring is
gradually increasing.
The opening and the closing resistance is selected by the pressure
indicator. The distance that the valve has moved backward represents
an extra amount of resistance made, that can be measured in cm of
H20, on the control knob. The sum of these two numbers makes the
optimum resistance. (The optimum resistance is equal to the distance,
the valve has moved in the limitor tube, converted to resistance in cm of
H20 plus opening/closing resistance selected on the control knob at the
start).
The size of the variable opening should be equal to the leakage space in
the point selected as optimum pressure. Moving the valve further
backward from this point will be more difficult.
The opening A can be connected to the reserve bag (for oxygen or
humidified oxygen or humidified air).
When the Resistor is used as an inspiratory muscle trainer, a filter (e.g.
a piece of sponge) can be placed on the opening A to filter the air
breathed in.
All openings in the Resistor and the Spirometer should have the same
shape and size, so that the mouth piece or mask or flexible pipe or
reserve bag can be affixed to either opening.
Break clips stop the pressure indicator from moving, so that we can limit
the range, for the subject's safety. Since the Resistor should be
dismantleable to wash, it may get damaged or worn, so every now and
then checking the accuracy of pressure shown on the control knob is
necessary. This checking can be done by connecting monitoringloxygen
adaptor on opening A and to a manometer, and using the Resistor as a
positive expiratory pressure device, the monitoring/oxygen adaptor can
be removed at other times.
With connecting the monitoringloxygen adaptor to opening B we can
check the accuracy of the Resistor by manometer, when used as an
inspiratory muscle trainer.
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When monitoringloxygen adaptor is connected to opening A) the oxygen
tube can be connected to it and the Resistor can be used as an
inspiratory muscle trainer (for people who need extra oxygen).
The Resistor can stand on a base in an upright or horizontal position.
The Resistor can be made in different colors, sizes, shapes and
resistance ranges. With the created pressure due to air flow, subject
could be amused and motivated by connecting the Resistor to a doll or
dummy to inflate or deflate it (figure 4).
The Resistor can be made a simpler way while keeping the basic quality.
In this case the Resistor comprises of:
1. a chamber that can be opened in side B or the middle, and a scale in
cm of H20. (Scale can be on control knob as before)
2. a spring can create a range of resistance e.g. 0 to 20 cm of H20.
3. pressure indicator that can be moved by turning the control knob or on
the inner side of the chamber.
4. a valve.
5. Resistor can stand on a base in upright or horizontal position.
Spirometer:
Spirometer measures the volume of air inhaled or exhaled and can be
comprised of:
1. A big tube that measures 250 to 600 cc and is limited between the
starting and the end point of the Floating disc.
2. Floating disc, that flies up when sucked up in inspiratory spirometer or
pushed (blown) up in expiratory spirometer. The Floating disc can have
a diaphragm in the middle that tends to be normally open unless sucked
up or pushed up with inspiration or expiration.
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The Floating disc is very light.
3. There can be a one way diaphragm that is for slowing down the speed
that the Floating disc goes down after being pushed or blown up.
The best way of achieving the maximum breathing into or out of the
spirometer is with a short rest in between. This is usually missed by the
subject and takes time to teach. But in the Spirometer because of the
action of the one way diaphragm the subject learns this quickly and
properly, since he must wait and have a short rest until floating disc falls,
then blow again.
4. Opening L is a multiple of opening S, e.g. 9 times. Opening L in
inspiratory Spirometer can be connected to the reserve bag.
5. A filter (e.g. a piece of sponge) can be placed onto the opening L
when used as an inspiratory spirometer.
6. Opening A of the expiratory Spirometer can be connected to opening
B of the Resistor, and the opening B of the inspiratory Spirometer can
be connected to the opening A of the Resistor. Opening A or B in the
Spirometer can be connected to the mouth piece, mask or flexible pipe
directly.
When one CLC device is used for different subjects, a one way
diaphragm can be placed in the end of the flexible pipe that connects to
mouth piece or mask, to make sure that, that single device is used only
for inspiration or only for expiration, so chances of transferring infection
from one subject to another is nil. The one way diaphragm must be
changed from time to time to ensure it works properly. A one way
diaphragm can be fixed on the Resistor or the Spirometer too.
The Resistor and the Spirometer can be used separately or while
connected to each other, and they can be placed on a base. The
Resistor can be made in a small size, so that the subject can carry it
easily.
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The advantages of CLC over previously manufactured. ones:
1. CLC does three jobs. It is an inspiratory muscle trainer and a positive
exspiratory pressure device and an incentive spirometer. As an
inspiratory muscle trainer, it works much better than those currently in
use like "threshold device", since you can change the size of the leakage
space so keep a high pressure for longer time. And as a positive
exspiratory pressure device, it has quite a big range of resistance that
can be regulated selectively. And as an incentive spirometer, can
measure the volume of air breathed in or out.
2. Since opening and closing resistance in the Resistor can be different
from maximum resistance, and increase in resistance can be gradual, it
can be much safer than previous models with abrupt changes in
resistance and can avoid potential damages that can occur as with
previous models.
3. CLC as an incentive spirometer) as well as measuring accurately the
amount of the air transferred, has many more options and since it can be
washed and used again, in the long run it is more economical than the
devices currently in use, and works more effectively.
4. With the help of CLC, a lot of research on effects of different
resistance on the lungs in different diseases or studies on relationships
between resistance and volume of air inhaled or exhaled could be done.
And yet a lot more than these.
5.As a positive expiratory pressure device, since the resistance can be
regulated, teaching time will be appreciably less or nil, simply by going
through the manual. Though for the previous positive expiratory
pressure devices teaching often takes 2 or 3, 30 minutes sessions,
before the subject could create the prescribed pressure properly. It
seems difficult for a subject to create a specific pressure without having
a monitor, especially when the respiratory condition of the subject is
changing over time.
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6. With very low expiratory pressure (from zero to ten) we can improve
ventilation, shortness of breath, severity of asthma attacks, atelectasis,
secretion clearance and exacerbation of chronic obstructive pulmonary
disease. Currently, there is no device to make this range of resistance.
7. Since the resistance can be regulated, when used as an incentive
spirometer, CLC can be much more effective. Devices currently in use
do not make any resistance.
8. When CLC is customized can have different colors, sizes, shapes,
and a lot of fun and amusement can be created with pressure of air flow.
9. The flexible pipe in CLC, can rotate freely at both ends, where
connected to the Resistor or the Spirometer (or the base) and where
connected to the mask or mouth piece or flexible pipe, so the subject
does not have to worry about his position.
10. All openings in CLC) regarding size and shape, can be standardized
so that, the same mouthpiece or mask or flexible pipe or reserve bag
can be connected to each other or Resistor or Spirometer.
11. In the subjects with tracheostomy, inspiratory and expiratory muscles
get very weak so secretion clearance is difficult for them and need
suctioning several times, though by strengthening of these muscles with
CLC, the subject can clear secretions easily and ventilate better and
need less supplementary oxygen.
12. In general with CLC training, respiratory muscle strength and lung
volume improves, and because it can be used again and again, will be
very economical and can decrease the number of days patient remains
in hospital and reduces expenses of the patient's respiratory care.
13. A deficiency of the Threshold (inspiratory muscle trainer), presently
in use, is a too big leakage space so that the subject can not keep the
pressure for a long time) but in the CLC (the Resistor), since the
leakage space is variable there is no such a problem.
14. CLC can be used for subjects who are receiving extra oxygen,
humidified oxygen or humidified air, without any interruption. Devices
currently in use do not have this option.
