WO2020221872A1 - Breathing training device - Google Patents

Abstract

According to one aspect of the invention, a breathing training device is provided which includes an air guidance arrangement having a mouthpiece (21) and a branched air channel connected to the mouthpiece. Said air channel forms a mouthpiece branch (11), to which the mouthpiece is attached, a first branch (12) and a second branch (13). The first branch (12) has an inlet/outlet opening (45) and is used for the entry of fresh air and the discharge of used air. The second branch (13) has a flexible air container (31), for example a flexible air bag, which is used to store exhaled air for the purpose of inhalation of said air again by the user. The device has a first electrically controlled valve (41) and a second electrically controlled valve (42), with the first valve and the second valve being arranged such that the air path between the mouthpiece (21) and the inlet/outlet opening (45) and the air path between the mouthpiece (21) and the air container (31) can each be opened or closed independently of one another and a flow resistance at least between the mouthpiece (21) and the inlet/outlet opening (45) can be adjusted.

Description

BREATHING MACHINE

The invention relates to a device for training the respiratory function.

Respiratory training devices are used in particular to train the respiratory muscles, in particular for therapeutic purposes or to increase respiratory performance, for example for competitive sports.

A respiratory training device of this type is known from WO 02/081034. It has a branched air duct starting from a mouthpiece. A first branch has a piston valve and is used to suck in fresh air or to discharge stale air. A second branch is connected to a flexible air bag. When you exhale, the air bag is first filled with exhaled air. Only when this is full and a certain overpressure, which can be set on the piston valve, has been reached inside the device, the piston valve opens and more air flows outside via the first branch. Conversely, when inhaling, the air from the air bag is inhaled first, and only when there is a negative pressure in the device does the piston valve open, whereby ambient air is sucked in. In an embodiment described in WO 02/081034, the first branch has two piston valves, one of which is used to control the amount of fresh air entering the air duct, and one is used to control the amount of stale air exiting the air duct.

The design of the breathing training device with an air bag serves to prevent the CCh concentration in the blood of the person exercising from decreasing too much during endurance training (hyperventilation). Adaptation to the characteristics of the exercising person - in particular the capacity of the lungs of the exercising person - is determined by the choice of the size of the air bag.

This breathing exercise machine works very well. However, it would be desirable to have a breathing training device available which is even more flexible in use and handling.

US 2018/0120245 relates to a sensor for breathing air with which a CCL content of the air can be measured, among other things, by measuring thermal conductivities. One application mentioned is a breathing training device of the type taught in WO 02/081034, in which a first branch is open to the atmosphere and a second branch is provided with an air bag. In each branch there is a sensor for measuring the carbon dioxide concentration, and a processor module can adjust the concentration of the carbon dioxide content of the inhaled air by measurements on both branches in order to avoid hyperventilation.

Document EP 3 141 289 also shows a respiratory training device. In one embodiment, this has two channels following a mouthpiece, one of which can only be flown through by exhaled air and the other only by air that is inhaled, for which there are check valves. The channel for the air to be inhaled is provided with a connection for a breathing air mixture, for example with special substances, and an outlet into a breathing air bag. The channel for the air to be inhaled is provided with an outlet to the atmosphere and an inlet from the breathing air bag. A plurality of sensors can be present in each of the channels, for example pressure sensors, gas composition sensors, flow sensors. This allows the flow mixtures of the inhaled and exhaled air to be regulated individually. The devices presented in US 2018/0120245 and in EP 3 141 289 are potentially complex in terms of construction and control.

It is therefore an object of the present invention to provide a respiratory training device which overcomes the disadvantages of the prior art and which is structurally simple, variable in use and powerful.

According to one aspect of the invention, a respiratory training device is provided which has an air guiding arrangement with a mouthpiece and a branched air duct adjoining the mouthpiece with a mouthpiece branch to which the mouthpiece is attached, a first branch and a second branch. The first branch has an inlet / outlet opening and is used for the entry of fresh air and the discharge of used air. The second branch has a flexible air container, for example a flexible air bag, which is used to store exhaled air so that the user can inhale it again. According to one aspect of the invention, the respiratory training device is characterized in that it has a first electrically controlled valve and a second electrically controlled valve, the first and the second valve being arranged so that the airway between the mouthpiece and the inlet / outlet opening and the air path between the mouthpiece and the air container can each be opened or closed independently of one another and a flow resistance can be set at least between the mouthpiece and the inlet / outlet opening.

For this purpose, at least one of the two valves is an adjustable valve. In particular, both valves can be adjustable. In the present text, the term “adjustable valve” generally refers to a control element through which the volume flow of a fluid, that is to say a liquid or a gas, can be controlled. The term “adjustable valve” is therefore to be understood in accordance with the English meaning “control valve” and does not mean a restriction to a specific design of the control element. In particular, the adjustable valve can also be manufactured in one of the types that are sometimes referred to as “flap”, “slide”, “cock” or “valve in the narrower sense of the word” etc. The divisibility can be continuous in the narrower sense of the word or approximately continuous by making available many levels. An example of an approximately continuously adjustable valve is a valve with a flap or another control element that is moved between two extreme positions by a stepper motor.

Adjustable valves differ from “on / off” valves, which only allow a setting between two switching states, for example “open” and “closed”. ¹

The mouthpiece branch means a part of the air ducting arrangement that is not branched in itself and forms a coherent volume that extends to the branch between the first and the second branch. The mouthpiece branch is so designed and arranged that all exhaled air flows through the mouthpiece branch and from there into the first and / or second branch, and that all air to be inhaled coming from the first and / or second branch through the Mouthpiece branch goes. As a result, all of the air to be inhaled and, in particular, all of the exhaled air necessarily passes through the volume which the sensors present in or on the mouthpiece are present. The first and second valves are controlled by a control unit which, in addition to controlling the valves, can also have other functions and which in particular also reads out the sensors, etc. The control unit is to be understood as a functional unit in this text. It can be a physical entity, for example a chip or a circuit board with several chips and / or other electronic components. However, it can also be designed to be physically distributed over different devices, for example by a sensor chip (or similar) partially assuming functions that are assigned to the control unit here.

In particular, the following arrangements of the first and second adjustable io valve are conceivable: According to a first possible arrangement, the first adjustable valve is in the first branch and the second adjustable valve (or possibly a second valve, which is not adjustable but an "on / off") Valve is) arranged in the second branch, ie Both valves are arranged on the far side of the branching of the air guide arrangement as seen from the mouthpiece. Both adjustable valves 15 can then be controlled in a simple manner by increasing or decreasing the flow cross-section - up to a closed state with a flow cross-section 0.

According to a second possible arrangement, a first adjustable valve is located in front of the branch in relation to the mouthpiece and can control a total st) flow cross section. A second adjustable valve is then designed as a directional valve and, in a state in which it releases a connection between the first branch and the mouthpiece branch and blocks a connection between the second branch and the mouthpiece branch, a state in which it allows both connections, in a state in which it blocks a connection between the first branch and the mouthpiece branch 25 and releases a connection between the second branch and mouthpiece branch, as well as being brought into states lying in between. According to a third possibility, the first adjustable valve is such a directional control valve and the second adjustable valve is a valve in one of the two branches that controls the flow cross section. Such an arrangement also ultimately allows the two airways mentioned to be opened or closed independently through the interaction of the two adjustable valves.

It is also not excluded that in addition to the two valves mentioned, there is at least one further controllable valve. In particular, a pressure relief valve can be present, for example. This makes particular sense in the second branch, for example, because external pressure on the flexible container can greatly increase the pressure in the interior of the air duct arrangement in a desired or undesired manner. A pressure relief valve protects the components used from damage.

The breathing training device can be operated in various operating modes by the valves that can be controlled by the control unit. This can be particularly advantageous in combination with a CCh sensor, a flow sensor and / or a pressure sensor.

In general, it applies to the operating modes mentioned in this text that the respiratory training device can be set up to operate them. This means that in addition to suitability for such an operation, the breathing training device also has means to carry out this operation. Such means include programming of the respiratory training device and specifically of its control unit, either permanently or in the form of a loadable software module.

For example, in an endurance training operation, the airway between the mouthpiece and flexible container can be at least partially open, while the airway between the mouthpiece and the inlet / outlet opening is partially closed (ie the flow resistance is high and / or this airway is completely closed at times). In this mode of operation, the user is enabled to inhale and exhale at a high breathing rate without hypocapnia occurring, since in this mode of operation a large part of the exhaled air is inhaled again. The proportion of this air and the fresh air can be controlled by setting at least the flow resistance on the air path between the mouthpiece and the inlet / outlet opening and, for example, in particular by individually setting the flow resistance through both branches. It is particularly favorable if a control loop is formed via the control unit in which the measured CCh content (for example expiratory, in particular end expiratory, see also the comments below) is used as the controlled variable.

In a strength training and / or force measurement operation, however, the airway between the mouthpiece and the flexible container is closed, and the airway between the mouthpiece and the inlet / outlet opening is either completely closed until a certain pressure is reached (threshold value), or partially closed so that the Flow resistance is significant.

In both operating modes as well as in the further operating modes described below (with the exception of spirometry, where there is no need), training and / or measurements can relate to both expiration and inspiration. The flow resistances during expiration and inspiration can also be selected differently.

The control unit is therefore set up in particular to control the valves mentioned both during an inspiration phase and during an expiration phase. This can be done in particular on the basis of values measured only during the inspiration phase, especially on the basis of CO2 concentration determined only during the inspiration phase.

A special way of using the advantages of the procedure according to the invention with the at least one valve that can be controlled and adjusted by the control unit is to provide a vibration mode. It has been shown that vibration breathing training is particularly advantageous when releasing mucus in the airways. In vibration mode, the adjustable valve or at least one of the adjustable valves or both adjustable valves are operated in a vibration mode in which the flow resistance is periodically changed in a vibration frequency, for example between a very high value (flow cross-section 0 or close to 0) and a moderate value. This enables an oscillating pressure amplitude during exhalation or inhalation with a corresponding vibration frequency, which brings the mentioned advantageous properties with it. Frequencies below 50 Hz but above 5 Hz have proven to be favorable vibration frequencies; Frequencies around 20 Hz to 25 Hz are particularly favorable.

If - which is the case in many embodiments of the invention - both valves are adjustable, in particular both valves can vibrate in the vibration training mode, preferably in unison.

Other operating modes are possible. E.g. If a flow sensor is present, a total volume of the air exhaled during a single expiratory phase or also over several expiratory phases can be determined and a spirometric measurement can be carried out. In addition or as an alternative, the procedure according to the invention with the at least one valve controllable and adjustable by the control unit also enables operating modes as required, for example the “interval training” operating mode with operating parameters changing at adjustable intervals, or user-defined operating modes.

The adjustable valve or at least one of the adjustable valves can be a flap valve; in particular, both valves (i.e. the first and the second controllable valve) can be flap valves. Flap valves of the type described here have a flap which can be pivoted about an axis of rotation within the air guide arrangement and in this way can close the flow cross-section of airways or continuously / gradually increase or decrease it.

Flap valves have been found to be particularly favorable, the axis of rotation of which leads approximately through the center of gravity of the flap, which is thus arranged approximately in the middle of the flap. With these no inertial mass has to be shifted for actuation of the respective valve, so that they run particularly smoothly and are particularly suitable for very quick adjustments of the flow cross-section or for very quick opening / closing of the airway. Such flap valves with an axis of rotation through the center of gravity are particularly suitable for arrangements in which they are each arranged in a tube section - with a round or non-circular cross section of the lumen in the tube, the tube cross section, for example, immediately in front of and immediately behind the flap, for example constant is.

Such flap valves are particularly suitable for embodiments which, among other things, provide operating modes in which the flow cross-sections change very quickly and / or very often, for example the vibration training mode mentioned. In particular, such flap valves with an axis of rotation due to the center of gravity are particularly suitable for designs in which the first valve is arranged in the first branch and the second valve is arranged in the second branch.

The flap valve is driven in particular electrically, via a suitable motor. Stepper motors have proven to be particularly suitable.

As already indicated, the respiratory training device according to the invention has, for example, a CCk sensor. Such a device should in particular be set up and arranged accordingly to measure the CCk content of the exhaled and / or possibly the inhaled air. The measurement does not have to result in a numerical value for the percentage CCk content. It is sufficient if a measured value is determined which clearly correlates with the C0 ₂ content and which enables the adjustable valve (s _{) to be} regulated so that the C0 ₂ content can be regulated within a certain range. In this text, measurements that produce a value that correlates with the C0 ₂ content, also not necessarily a numerical value for the percentage of C0 ₂ in the air, are also referred to as measurements of the C0 ₂ content.

C0 ₂ sensors are known per se, and the present invention is suitable for the use of C0 ₂ sensors of various types. According to special embodiments, however, the invention makes use of a relationship existing for devices of the type according to the invention and proposes using the device with a CO ₂ sensor of a particularly economical, newly developed type. These embodiments are based firstly on the knowledge that the thermal conductivity of air saturated with moisture depends on the CCh concentration in this air. Second, it is based on the knowledge that the exhaled air (especially, but not only end-expiratory) has both a known humidity (of 100%) and a known temperature (body temperature). If all other parameters are kept constant, the heat dissipated from or supplied to a heated or cooled body will therefore depend on the CCL content of the air. In particular, the heat dissipated by a heating wire will depend on this CCL content. Against this background, it is proposed for embodiments to divert a portion of the exhaled air with a constant flow. A measuring cell then contains a heating element, for example a heating wire. The heating element is heated during the measurement.

The required heating power in relation to the temperature reached in a steady state is a measure of the convection cooling to which the heating element is subjected when the exhaled air flows through it at a constant flow. The temperature of the heating element can be measured directly or regulated to a specific desired value, or also indirectly, for example by the electrical resistance being a measure of the cooling. The result of the measurement can be used as a measure of the C0 ₂ content. For example, the power can be kept constant and the electrical resistance (measure for the temperature) used as a measured variable, or conversely, the current flow through the heating element can be regulated so that after a short start ramp the electrical resistance as a measure for the temperature is constant is maintained and the required power (measure for the heat transfer) is used as a measured variable. Other configurations are also conceivable, for example with a constant current through the heating element (voltage as a measured variable), constant voltage (current or power or resistance as a measured variable), etc. From the respective measured variable, based on the stored results of calibration measurements, a C0 ₂ - Salary can be calculated and this can then be used as the controlled variable. Alternatively - more simply - the measured variable or another variable derived therefrom can also be used directly as the controlled variable.

As mentioned, this method of measuring the CC content requires that the flow of the diverted air portion is constant - otherwise the required power also depends - critically - on the flow through the measuring cell. This is achieved by firstly keeping a flow opening through which the air enters the side branch with the measuring cell so that pressure fluctuations in the relevant branch (e.g. mouthpiece branch) of the air duct arrangement are not reflected in flow changes. On the other hand, this can be done by additionally conveying the air through the side branch by a pump, the pump having a constant pumping capacity.

Such a pump runs, for example, constantly or only during a measurement phase. Such a measurement phase is selected in particular so that the CCh content is measured in each case in the end expiratory phase. This point in time can be determined by the control unit, in particular using the results of the flow measurement, which will be explained below. The flow measurement firstly allows a clear differentiation between the inspiration and expiration phase and secondly it enables the determination of the point in time at which the expired air flow decreases at the end of the expiration phase.

Regardless of the physical measuring principle, the C0 ₂ sensor can in particular be arranged in the mouthpiece branch (or mouthpiece); an arrangement on the mouthpiece branch or mouthpiece, for example via a branched-off side branch with constant flow that functions as mentioned, is also meant. It turns out that the arrangement of the CC sensor in the mouthpiece branch / mouthpiece as the only CC sensor enables a particularly efficient and simple structure. It has been shown in particular that a single CC sensor in the mouthpiece is sufficient to regulate the device in such a way that hypocapnia can be prevented.

In general, the CCh concentration of the inhaled air in the mouthpiece branch is not easy to determine because neither the humidity nor the temperature are known, as the mixing ratio is also not known. The prior art therefore suggests measuring the C0 ₂ concentration where it is known exactly where the air is coming from, and then adjusting the mixing ratio to a desired value. In contrast to such approaches, embodiments of the present invention are based on the knowledge that, firstly, the C0 ₂ concentration of the exhaled air in the mouthpiece branch can be better determined in contrast to the inhaled air and, secondly, that this is suitable as a control variable, even if the concentration is ultimately in the inhaled air determines what the user breathes. The CCL concentration of the exhaled air is meaningful in this regard.

The arrangement in the mouthpiece branch is based on the above-mentioned approach of taking the measurements expiratory, for which the device can be appropriately equipped and programmed. This is in contrast, for example, to the approach according to US 2018/0120245. This requires two C0 ₂ sensors, one in each branch, in order to regulate the C0 ₂ content of the inhaled air by setting a desired milk ratio. In contrast, it is proposed here to use only a single C0 ₂ sensor, as mentioned in or on the mouthpiece. The controlled variable is then the C0 ₂ content of the exhaled air or another variable that is dependent on it and also takes other values into account. It has been shown that this indirect procedure using the exhaled air is just as suitable as a regulation directly from the CC content of the air to be inhaled, which requires more complex sensors.

The device preferably also has a flow sensor. Such a device can be based on any of the many known measuring principles for measuring the gas flow. According to one embodiment, the flow sensor corresponds to a principle similar to the aforementioned C0 ₂ sensor (whereby the measuring principles of the flow sensor and the C0 ₂ sensor can be selected independently of one another, that is, for example, both sensors do not have to be based on this measuring principle, but that can also be the case for only one or the other of the two or for none at all.

According to the embodiment mentioned, the flow sensor has a heating element, for example a heating wire, which is heated with a known, predetermined or measured power. With constant air humidity and air temperature, the heating power required to maintain a known (directly or indirectly measured or controlled) temperature depends primarily on the flow, provided the flow is laminar. An additional dependence on the CO2 concentration, which can be used in the possible CCL sensor, can be viewed as negligible according to a first option, since changes in the heating power caused by flow changes in relation to the temperature are much more significant than those caused by changes in the C0 ₂ concentration in the area of interest. According to a second option, this dependency can be compensated arithmetically, in embodiments in which a value characteristic of the C0 ₂ concentration is known from the C0 ₂ measurement. As with all flow measurements, the result of this measurement is pressure-dependent; this dependency can be compensated mathematically with the measured pressure (see the description of the pressure measurement below). Together with the flow sensor, the device has, for example, a laminarization device connected upstream of it, which laminarizes the air flow as it flows through the flow sensor by preventing any vortex formation. Such laminarization devices can, in particular, have structures made up of many parallel tubular elements, for example in the form of a honeycomb.

Furthermore, the device according to the invention has, for example, a pressure sensor in embodiments. Such a device can be designed in a manner known per se and, for example, be arranged in the mouthpiece branch or in a (further) side branch branched off from it.

In addition to the functions already described, the control unit can in particular also have or enable a user interface. For this purpose it has, for example, an interface via which you can communicate with an external device - typically a computer (server, desktop, laptop, tablet, smartphone, etc.) - and / or with a dedicated user interface, for example a screen for the Display of user feedback, can communicate.

In the following, the subject matter of the invention is explained in more detail using exemplary embodiments and the accompanying drawings. In the drawings, the same reference symbols denote the same or analogous elements. Show it:

1 shows a view of a device according to the invention; 2 shows a schematic cross-sectional illustration of a

Device; 3 and 4 show the device according to FIG. 2 in different states during the expiratory phase and during the inspiration phase;

Fig. 5 is a block diagram of a device; 6-8 schematically each an alternative device; 9 schematically shows a detail of a C0 ₂ sensor; 10 shows a detail of a pressure sensor; and FIG. 11 shows a feedback display for force measurements.

FIG. 1 shows a respiratory training device 1 of the type according to the invention in a view. An air duct assembly 10 is a system of branched pipes. The tubes form a mouthpiece branch 11, which starts from a mouthpiece 21, a first branch 12 and a second branch 13. The second branch opens into a flexible air reservoir 31. Inside a housing 20, elements of a control system, which are described in greater detail below, and possibly also elements of the sensor system also described below are arranged.

As can be seen in particular in the schematic representation in FIG. 2, the first branch 12 forms an inlet / outlet opening 45 which can also be provided with a filter (not shown in the figures) or similar. Both in the first branch 12 and in the second branch 13 there is a first and a second adjustable valve 41 and 42, respectively.

The adjustable valves are designed as flap valves, ie they each have a flap 48 which is rotated around an axis of rotation 49 between a corresponding branch releasing state and a locking state is pivotable. It is also possible to adopt states between these two extremes, so that the cross section available for the air flow can be set, which enables the volume flow to be set (with a given pressure difference). In the embodiment of FIG. 2, the flap valves are designed such that the axis of rotation lies on the center of gravity of the flaps, which brings the advantages explained above with it.

In Fig. 2, the first adjustable valve 41 is shown in the release position, while the second adjustable valve 42 blocks. FIG. 3 shows a configuration in which the first flap valve opens only slightly and thus only allows a small flow, while the second flap valve 42 is fully open. Shown is the configuration while the user is exhaling, whereby the exhaled air for the most part flows into the flexible container 31 and a small part flows out of the device through the inlet / outlet opening 45. Figure 4 shows a configuration in which both adjustable valves 41, 42 are partially open during the process of inhalation by the user. The two partially open flap valves ensure a certain ratio between used and fresh inhaled air, which can be adjusted by the position of the flaps, whereby, as described in more detail below, the C0 ₂ content in the air can be regulated using a suitable sensor.

A CCk sensor 51, a pressure sensor 52 and a flow sensor 53 are also shown schematically in FIG.

In addition, one sees in Fig. 2 - also schematically - a lamination arrangement 57 in the mouthpiece. Such a device can, for example, have an arrangement of walls running parallel to the flow direction, which have a honeycomb structure form, ie form a pattern of hexagonal cells in a section perpendicular to the direction of flow (ie also perpendicular to the plane of the drawing in FIG. 2). The laminarization device - which can also have a physical structure other than a honeycomb structure - laminarizes the flow of the exhaled air, which, as described in this text, contributes to the measurability of the gas flow. An optional bacteria filter 56 is also visible in FIG. 2.

The sensors mentioned are connected to a control unit of the device and they are read out via this. This can be done by feeding the sensor signal into the control unit with or without prior A / D conversion and evaluating it there. This includes the possibility that electronic components are assigned to the sensors, which steps carry out this evaluation themselves and which are therefore assigned to the control unit 60 in terms of their function.

FIG. 5 shows a schematic structure of the control and regulation components. The control unit 60 is to be understood as a functional unit. It can be a physical entity, for example a chip or a circuit board with several chips and / or other electronic components. However, it can also be designed to be physically distributed over different devices, for example by a sensor chip (or similar) forming part of the control unit by producing a control signal directly, for example. The control unit controls stepper motors 47, by means of which the flaps 48 of the flap valves 41, 42 are moved. In addition, the control unit has an interface 61 for communication with an external device, for example a computer 63 (desktop, laptop, tablet, smartphone, etc.) with appropriate software, a dedicated operating console or a user interface. In the exemplary embodiment shown, there is also a user display 64 which, for example, via the computer (or the operating console) or also directly from the control unit coming from, a feedback for the user of the breathing training device can be presented.

The procedure with two independently controllable valves enables different operating modes. Some of these are briefly discussed below.

Endurance training: In this operating mode, the adjustable valves (flap valves 41, 42 in the example shown) are set during exhalation in such a way that a large part of the exhaled air (initially all of the exhaled air) is collected in the flexible container 31. If the flexible container 31 is filled - also depending on the container size - an overpressure and underpressure valve 71, which is attached between the flexible container 31 and the valve 41 of the corresponding arm, opens, and the further exhaled air flows out, as in FIG. 3 shown. When inhaling, conversely, due to the setting of the adjustable valves, the air present in the container is at least for the most part inhaled again, supplemented by fresh air from the inlet / outlet opening 45 (FIG. 4). The adjustable valves are set in such a way that the measured end-expiratory CCh concentration is set to a value that is, for example, in the normocapnic range (4.5-6% CO2 end-expiratory). If the air in the flexible bag is insufficient for inhalation, the overpressure and underpressure valve 71 opens so as not to change the flow resistance. The device thus forms a control loop in which the controlled variable is the CCL concentration, the setting of the first adjustable valve (first flap valve 41 in the example shown) or the settings of both adjustable valves that form the manipulated variable (s). Depending on the desired parameters and depending on the size of the flexible container 31, the second valve 42 can also be constantly open in the “endurance training” operating mode and therefore does not have to be an adjustable valve. Preferably, however, the second valve is also an adjustable valve, which makes it easier to adjust the proportions of used and fresh air during an entire breath is made possible. In this embodiment, feedback displayed in real time via the user display 64 can moreover be particularly valuable in order to regulate the breathing depth, breathing rate and the duration of the training.

The functions of the overpressure valve and the underpressure valve are implemented in the described embodiment in a single element, the overpressure and underpressure valve 71 mentioned. But they can also be implemented by an independent pressure relief or vacuum valve.

Strength training: In the "strength training" operating mode, the second adjustable valve (second flap valve 42) is closed. The first adjustable valve is set, for example, in such a way that it offers a certain, relatively large flow resistance at least during exhalation. The first adjustable valve can in particular also be operated in such a way that it closes completely during strength training and only opens a little when the measured pressure exceeds a threshold value (threshold value training). In this embodiment, feedback displayed in real time via user display 64 can also be particularly valuable. E.g. the pressure reached can be displayed in relation to the threshold pressure to be achieved via a suitable bar symbol with a bar that grows or shrinks according to the pressure, so that the user can see when he is getting close to the threshold pressure to be reached. Or if the flow resistance is high, the pressure to be achieved and the current pressure can be displayed.

Spirometry: In the "Spirometry" operating mode, at least the first adjustable valve is open. The second adjustable valve can be closed. The flow of the Exhaled air is recorded by the flow sensor and the volume of exhaled air is determined through integration.

Maximum respiratory muscle strength: In this operating mode, the maximum inspiratory and expiratory strength can be measured. Both adjustable valves are completely closed. Through explosive exhalation or inhalation with completely full or empty lungs, the maximum strength of the respiratory muscles can be measured by the pressure sensor.

Vibration: Based on the "Endurance training" operating mode and / or the "Strength training" operating mode and / or the "Interval training" operating mode (see below), at least one of the adjustable valves, for example both adjustable valves (for endurance vibration training), is operated to vibrate. The vibration frequency can be between 5 Hz and 50 Hz, for example between 15 Hz and 35 Hz, in particular between approx. 20 Hz and approx. 30 Hz. It has been shown that vibration breathing training is particularly beneficial when releasing mucus from the airways. The approach according to the invention with the two valves enables vibration training by the same device, which can also be used for endurance training and also protection against hyperventilation (via the CCL measurement and a corresponding control), the ability to set various parameters (respiratory volume resistance, etc. .) and the feedback function also apply to the "Vibration" operating mode.

Interval training: In particular in combination with feedback via the user display 64, interval training can also be provided. A specification (a level displayed via the user display, for example in relation to the current performance and / or force) and / or the resistances imposed on the user (by Settings of the adjustable valves) change at specified intervals. CC regulation takes place in the same way as the 'endurance training' operating mode.

Step test: In the 'step test' operating mode, the endurance strength of the respiratory muscles is tested. For the test, the breathing depth and the breathing rate are regulated via the user display 64. In addition, the flow resistance is regulated using the two valves so that, in combination with the respiratory volume and the respiratory frequency, the work of breathing can be gradually increased until the respiratory muscles tire (analogous to a bicycle step test of the known type). A typical protocol could be as follows: The breathing depth is a constant 60% of the vital capacity measured previously (see operating mode, spirometry ⁴ ), and the breathing frequency is increased by two breaths per minute every two minutes, starting with 16 breaths per minute. By setting the breathing resistance with the two valves 41, 42 and, for example, also setting the breathing rate, the work of breathing is increased by 10% every two minutes until the breathing muscles get tired. Of course, other step test protocols can also be implemented. During the entire test, the CCh regulation takes place as in the operating mode, endurance training.

Customized Training: Any profiles and sequences of training and / or measuring steps useful for the current user can be programmed via the interface.

The embodiment of FIGS. 2-4 has a particularly favorable arrangement of the at least two adjustable valves. Other arrangements are shown schematically in Figures 6-8. Fig. 6 shows an arrangement that is easy to handle in the control, like the embodiment of Figs. 2-4, with the first adjustable valve 41 in the mouthpiece branch 11. This first adjustable valve makes the overall Flow cross-section controllable, ie the first adjustable valve alone sets the resistance (inspiratory and expiratory) against which the user has to breathe. The first valve 41 can also close completely, particularly in the “strength training” operating mode. In the "Vibration" operating mode, it may be sufficient if only the first valve vibrates. The second adjustable valve 42 is designed as an adjustable directional valve and can switch between a state in which it releases a connection between the first branch and mouthpiece branch and blocks a connection between the second branch and mouthpiece branch, and a state in which there is a connection between first branch and mouthpiece branch blocks and a connection between the second branch and mouthpiece branch releases, movable. Conditions in between enable one

Communication between the mouthpiece branch, first branch and second branch. In Fig. 6 the second adjustable valve is illustrated schematically as a pivotable flap.

Arrangements with such a directional valve as explained with reference to FIG. 6 as a first adjustable valve 41 and a second valve 42 controlling the flow cross section in the first branch (FIG. 8) or second branch (FIG. 7) are possible and allow all of them

Operating modes as mentioned above, in that in both cases both the flow cross-section between the mouthpiece and the air container and the flow cross-section between the mouthpiece and the inlet / outlet opening can each be set between 0 and a maximum value and can be selected independently of one another. A C0 ₂ regulation as described above with reference to the operating mode, endurance training is also possible in this way.

The CC sensor 51 can be based on a principle known for CCh sensors. For example, CC sensors are known which function as infrared sensors and use the known fact that CO2 is an efficient IR absorber. Such sensors are reliable and can be placed directly in the respiratory flow however, the disadvantage that they are relatively complex to manufacture and operate and correspondingly expensive.

According to an alternative embodiment, the CCh sensor 51 can also be based on the new, alternative functional principle mentioned, according to which a portion of the exhaled air is branched off with a constant flow. A measuring cell 83 then contains a heating element, for example a heating wire. The heating element is heated during the measurement. The required heating power in relation to the temperature reached in a steady state is, as explained above, a measure for the convection cooling and thus, given constant other parameters, a measure for the CCL content.

FIG. 9 schematically illustrates the principle of such a possible CCh sensor. In a CC sensor side branch 82 branched off particularly from the mouthpiece branch or 11, possibly directly from the mouthpiece, air is sucked in via a connection opening 81 with a small cross section during expiration, in particular at the end of the expiratory phase, for example by a small pump 84 constant delivery rate. The side branch, for example, also has a small cross section of, for example, between 0.7 mm and 1.5 mm. The branched off air reaches the measuring cell 83 before or after passing through the pump 84, where measurement is carried out according to the principle explained above. During the measurement, the control unit will, for example, use the flow measurement to determine the time of the CCh measurement. In particular, the control unit can initiate the CCh measurement towards the end of the expiratory phase, when the flow caused by expiration through the mouthpiece branch decreases again. The pump 84 can deliver constantly or at the mentioned times of the CO2 measurement; the same applies to the heating of the heating element. The pressure measurement - with, for example, a conventional pressure sensor element 92 - can optionally take place on a branch 91 branched off from the mouthpiece branch 11 or possibly from the mouthpiece, as shown in FIG.

The flow measurement can be done with any suitable flow sensor. There are flow sensors of various types on the market for this purpose, and the present invention does not exclude any of the various measuring principles.

The flow sensor 53 in the embodiment illustrated here is based on the following measuring principle, which is analogous to the CC sensor described above: A heating element, for example a heating wire, is heated with a known heating power. The heating power required to maintain a certain temperature is a measure of the heat dissipated by the flow air, which in turn is a measure of the flow at constant (defined) air temperature and humidity and with laminar flow. As discussed above, the amount of heat dissipated per unit of time also depends on the CCL content. However, if the CCL content is kept approximately constant by the control, this influence is small compared to the influence of the flow, i.e. a possible measurement error would not be great. Second, if a particularly precise measurement is required, it can also be corrected mathematically, since the CCL content is known from the CCL measurement carried out in parallel.

The measurement of the flow through the flow sensor is carried out by the control unit during expiration. Exhaled air has a known temperature and humidity. In addition, the air flow of the exhaled is laminar due to the laminarization device. In addition, the flow can be corrected mathematically based on the measured pressure. Therefore, the measurement described above gives meaningful measured values. Through appropriate calibration and / or test measurements a value for the flow can be determined from the measurement and a value for the exhaled volume can be determined through integration over time. As described above for the CC sensor, the relationship between temperature (or electrical resistance) on the one hand and heating power in the steady state on the other hand can be used for this purpose. -

FIG. 11 illustrates another optional feature of the feedback display for the user via the user display 64, which is also optionally available. If the user is to reach a pressure threshold during strength training or during force measurement, a threshold value display 101 is activated. This shows the current pressure reached by the user in relation to a threshold 103 to be reached via a display element, for example a bar 102 or similar, and thus gives the user an immediate impression of the goal still to be reached. Other feedback displays are of course also possible.

Claims

PATENT CLAIMS 1. Breathing training device, comprising an air duct arrangement with a mouthpiece (21) and a branched air duct adjoining the mouthpiece with a mouthpiece branch (11) to which the mouthpiece is attached, a first branch (12) and a second branch (13) , where the first branch is an / Outlet opening (45) for the entry of fresh air and for the discharge of stale air, and wherein the second branch has a flexible air container (31) for storing exhaled air for the purpose of re-breathing this exhaled air by the user, characterized by a control unit (60), a first valve controllable by the control unit (41) and a second valve (42) controllable by the control unit, the first valve (41) and / or the second valve (42) being an adjustable valve and the first and second valves being arranged so that the airway between the mouthpiece (21) and the inlet / outlet opening (41) and the air path between the mouthpiece (21) and the air container (31) can each be opened or closed independently of one another and a flow resistance at least between the mouthpiece (21) and inlet / Outlet opening is adjustable. 2. Breathing training device according to claim 1, wherein both the first valve (41) and the second valve (42) are adjustable. 3. Breathing training device according to claim 1 or 2, wherein the first valve (41) is arranged in the first branch (11) and is set up to adjust the flow resistance through the first branch between an open state and a closed state, and the second valve (42 ) is arranged in the second branch (12). 4. Respiratory training device according to one of the preceding claims, wherein the first valve (41) and / or the second valve (42) is a flap valve which has a flap (48) which can be pivoted by an electric drive about an axis of rotation (49). 5. breathing training device according to claim 4, wherein the axis of rotation (49) is guided at least approximately through a center of gravity of the flap (48). 6. Breathing training device according to one of the preceding claims, comprising a C0 ₂ sensor (51) for measuring a measured value characteristic of the CCh concentration of air present in the air duct arrangement, the control unit (60) being set up in at least one operating mode To regulate the setting of the first valve (41) and / or the second valve (42) based on the measured value. 7. Breathing training device according to claim 6, wherein the CCh sensor has a CCL sensor side branch (82) of the air guide arrangement and an air conveying means for conveying air with a constant flow through the CCL sensor side branch (82), and wherein the CCL -Sensor also has a sensor element with a heating element, which can be heated with a preset and / or measurable heating power, wherein the measured value can be obtained from a relation between the heating power and a temperature of the heating element. 8. breathing training device according to claim 7, wherein o the control unit is set up to regulate the heating power so that an electrical resistance through the heating element is constant, and is set up to determine the measured value from the required power, o or wherein the control unit is set up to regulate the heating power so, that an electrical current through the heating element is constant and is set up to determine the measured value from the required voltage or the control unit is set up to apply a constant voltage to the heating element and is set up to determine the measured value from the resulting current. 9. breathing training device according to any one of claims 6-8, wherein the control unit is set up to determine the measured value during an expiratory phase, in particular at the end of the expiratory phase. 10. Respiratory training device according to claim 9, wherein the control unit is set up to use the measured value as a controlled variable, whereby the control unit is able to adjust the setting of the first valve (41) and / or the second valve (42) based on the CCh concentration to regulate the exhaled air. 1 1. Breathing training device according to one of claims 6-10, wherein the CCh sensor (51) is arranged in the mouthpiece branch (1 1) or mouthpiece or a branch directly from these branches different from the first and second branch. 12. Breathing training device according to one of claims 6-11, wherein the control unit (60) forms a control loop, the measured value or a variable derived therefrom being used as the controlled variable. 13. Breathing training device according to one of the preceding claims, comprising a flow sensor (53) for measuring the air flow in the air guide arrangement. 14. Breathing training device according to claim 13, wherein the flow sensor (53) is arranged in the mouthpiece branch (11) or mouthpiece. 15. Breathing training device according to claim 13 or 14, wherein the flow sensor has a heating element which can be heated with a preset and / or measurable heating power, wherein the one characteristic of the air flow can be obtained from a relation between the heating power and a temperature of the heating element. 16. Breathing training device according to one of the preceding claims, further comprising a pressure sensor (52). 17. Breathing training device according to claim 16, wherein the pressure sensor in the mouthpiece branch (11) or mouthpiece or a branch branched off from these is arranged. 18. Breathing training device according to one of the preceding claims, comprising a laminarization device (57) in the mouthpiece (21) and / or mouthpiece branch (11). 19. Respiratory training device according to one of the preceding claims, further comprising a user display (64) and / or an interface to a user display, wherein the control unit is set up to graphically display a measured pressure, a measured flow and / or at least one variable derived therefrom to the user . 20. Breathing training device according to one of the preceding claims, wherein the control unit (60) is set up to set the first and second valve optionally in endurance training mode or interval training mode so that the airway between the mouthpiece (21) and the air reservoir ( 31) is at least partially open and the airway between the mouthpiece and the inlet / Outlet opening (41) is partially open, or in a strength training and / or force measurement mode so that the airway between the mouthpiece (21) and the air container (31) is closed and the airway between the inlet / outlet opening (41) is at most partially and / or temporarily open. 21. Breathing training device according to one of the preceding claims, wherein the control unit (60) is set up to optionally vibrate the first and / or second valve in a vibration training mode. 22. Breathing training device according to claim 21, wherein a vibration frequency of the first and / or second valve is between 5 Flz and 50 Hz. 23. Breathing training device according to one of the preceding claims, wherein the Control unit (60) is set up to optionally determine a total volume of the air exhaled during an expiratory phase in a spirometry operation.