Ventilator-Assisted Living©

Winter 2003, Vol. 17, No. 4


Noninvasive Ventilation: A History of My Life

Jim Costello, Chairperson, Post-Polio Support Group, Dublin, Ireland (

Frog breathing has always helped me, especially before ventilators became small and portable. Frog breathing (glossopharyngeal breathing) involves the use of the tongue and pharyngeal muscles to add to inspiratory efforts by "gulping" boluses of air.

Photo of Jim Costello in a meeting.As a respiratory polio survivor, I have used a ventilator in one form or another for 45 years. Initially, I used the iron lung and the cuirass (chest shell) which was powered by a Cape Engineering motor. Then I tried a Tunnicliffe jacket, like an anorak tied at the arms, neck and waist over a lightweight metal chest frame, and I also tried a rocking bed.

Currently I use the iron lung for sleeping. I am the only polio survivor in Ireland still using an iron lung.

I also now use a Nippy 1, a British pressure support ventilator (B & D Electromedical), and recently I acquired a BREAS 403, a Swedish pressure support ventilator (BREAS Medical AB). The interface for both is nasal pillows (Puritan Bennett,). I tried a mask but found it very claustrophobic and difficult to get a good seal.

I can walk with the assistance of a spinal brace (an adaptation of a Milwaukee brace), but have practically no use of my arms, just one hand that cannot grip to direct the computer mouse. I use my computer mainly by voice control. I need assistance with all the activities of daily living, and I set up the iron lung with various controls at my feet for the television, the radio, the heating within the lung, the telephone (using an external electric arm and headset) and other devices.

The original "fever" hospital — Cherry Orchard Hospital — which cared for me (free for people with infectious diseases in Ireland) when I originally contracted polio at age 15 continued to care for me whenever I needed treatment for various respiratory and other illnesses. The hospital now cares for me three to five days (my choice) per week. I use the BREAS in hospital in the early evening, but I usually sleep in the iron lung there — the British alligator model. When not in hospital, I am cared for at home by my partner.

Originally, I paid for the cuirass, but since I started using the Nippy (about the last eight years), my local Health Authority has paid for all my ventilatory equipment. I can breathe on my own throughout the day either sitting or standing, but whenever I lie down or get any form of respiratory infection, I need to use a ventilator.

I keep my Nippy at home to use when resting and sleeping. When I am travel-ling about town, I take my BREAS with its internal and external batteries. When I am on holiday either in Ireland or abroad, I always take both ventilators in case of breakdown. I use both set on pressure control ventilation (20 bpm, 22 cm H2O pressure).

Last year, I developed a severe mucus problem due to a sinus condition. I tried a coughing machine, but probably did not allow sufficient time to learn how to use it properly. For me, using the ventilator in combination with frog breathing clears my secretions.

Frog breathing has always helped me, especially before ventilators became small and portable. In pulmonary function tests with the spirometer, I can only blow 800 ml, but with frog breathing I can blow 2200/2400 ml.

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