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Systemic causes Diabetes Obesity Hypothyroidism Pregnancy Menopause Systemic lupus erythematosus Scleroderma Dermatomyositis Renal failure Long-term hemodialysis Acromegaly Multiple myeloma Sarcoidosis Leukaemia Alcoholism Haemophilia PATHOPHYSIOLOGY The most popular ones are mechanical compression, micro-vascular insufficiency, and vibration theories

It reduces matrix metalloproteinase MMP-9 levels and sustains the expression of tight junction proteins such as occludin, ZO-1, and claudin-5, preserving BBB integrity [160]

3.3.2 Nonpharmacological methods Nonpharmacological methods of airway clearance include active recirculation breathing techniques, autogenic drainage (which involves a controlled expiration rate and depth to facilitate secretion mobilization), slow expiration with the glottis open in the lateral decubitus position, and the application of positive expiratory pressure

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