To determine whether sputum clearance is increased by using nebulised saline or terbutaline as an adjunct to chest physiotherapy, a radioaerosol method (using technetium-99m labelled human albumin millimicrospheres) was employed in eight patients with stable bronchiectasis on four occasions, for comparison of sputum clearance with four different regimens. These were: control, with the patient resting in an upright position; chest physiotherapy, by the forced expiration technique with postural drainage; and chest physiotherapy following five minutes' inhalation of either nebulised normal saline or nebulised terbutaline 5 mg. Use of both nebulised saline and nebulised terbutaline immediately before chest physiotherapy gave a significantly greater yield of sputum than did physiotherapy alone, and terbutaline also significantly increased radioaerosol clearance from the whole lung and from regions of interest. The mechanism is unclear, but this method may provide a simple way of increasing the efficacy of conventional chest physiotherapy.Chest physiotherapy is widely used in hospital practice but there is little objective assessment of its value in different settings. A central function of chest physiotherapy in acute conditions is to mobilise excess secretions and enhance expectoration.' The use of an inhaled radio aerosol that is deposited on the tracheobronchial tree allows such secretions to be "labelled" and their subsequent clearance monitored. Use of this method has shown the contribution of cough,2 vibration, or percussion3 to clearance to be limited; greater clearance of airways secretions is obtained by the forced expiration technique in conjunction with postural drainage.45 We have evaluated the use of nebulised saline and nebulised terbutaline as an adjunct to this optimal chest physiotherapy to determine whether sputum clearance is increased further. MethodsWe studied eight patients (six of them women), aged 36-71 years, with stable bronchiectasis on four occasions. Their mean daily sputum production was 36 (range 10-120) g. The results of spirometry before Address for reprint requests: Dr P P Sutton, Hartlepool General Hospital, Hartlepool, Cleveland TS24 9RH. Accepted 10 July 1987 and after each of the four treatment days are shown in the table. No patient smoked, and bronchodilators and domiciliary physiotherapy were withheld on the morning of each study day. PHYSIOTHERAPYThe treatment schedules, given in randomised order, were: (1) control, patient resting upright; (2) chest physiotherapy; (3) chest physiotherapy following five minutes' inhalation of nebulised normal saline; (4) chest physiotherapy following five minutes' inhalation of nebulised terbutaline (5 mg).Chest physiotherapy included the forced expiration technique and postural drainage and lasted for 20 minutes. For treatment 3, 4 ml normal saline was nebulised for five minutes immediately before physiotherapy by a Unicorn jet nebuliser with a mouthpiece and driven by oxygen at 8 1 m-'. For treatment 4, terbutaline respirator solut...

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creased from 100-600 bpm. The two machines behaved s i m i l a r l y i n terms of I : E and q u i t e d i f f e r e n t l y i n terms of r a t e . As I : E i ncreased, both v e n t i l a t o r s maintained normal pH and PC0 values u n t i l 1 :2, then hypercarbia and acidemia developed. ~g r a t e s i ncreased, t h e VS600 maintained normal pH and PC02 values u n t i l 250 bpm; t h e BLP d i d so u n t i l 600 bpm. Above these r a t e s , hypercarbia and acidemia developed. A t a l l r a t e s and I :E r a t i o s , AaDO were h i g h e r w i t h t h e BLP; Paw was h i g h e r w i t h the VS600, b u t no? s i gn i f i c a n t l y so.d i f f e r e n c e s between e i t h e r group f o r a g e , s e x , h e i g h t , w e i g h t o r a g e a t o n s e t of m e c h a n i c a l v e n t i l a t i o n . The MCH p o s i t i v e g r o u p BLP -200 bpm -VS600 BLP -600 bpm -VS600 had r e c e i v e d a s i g n i f i c a n t l y l o n g e r d u r a t i o n o f IPPB d u r i n g t h e pH 7 . 4 7 2 0 . 1 4 7 . 3 3 L 0 . 1 7 . 3 8 + 0 . 1 2 7 . 0 4 2 0 . 0 9 * c o u r s e of t h e n e o n a t a l r e s p i r a t o r y f a i l u r e . Thus, e v e n i n Pan 3 . 6 t 3 . 7 7 . 5 T 3 . 2 4 . 3 2 3 . 1 7 . 5 2 3 . 3 *D ,n nT We c o n s i d e r t h i s i n c r e a s e d a i r w a y r e a c t i v i t y and r e d u c e d A ."."A pulmonary f u n c t i o n t o b e one of t h e r i s k f a c t o r s i n t h e Conclusions: 1) The VS600 produced b e t t e r a r t e r i a l oxygenation development o f c h r o n i c o b s t r u c t i v e pulmonary d i s e a s e l a t e r i n and somewhat h i g h e r &. 2) The BLP produced b e t t e r v e n t i l a t i o n l i f e .over a w i d e r range of rates. 3 ) D i f f e r e n t h i g h frequency j e t v e n t i l a t o r s perform d i f f e r e n t l y . The conclusions from t h e studi e s o f one system cannot, and should n o t , be a p p l i e d t o any o t h e r . v a t i o n s s u g g e s t t h a t i n a c u t e asthma, t h e d u r a t i o n o f t h i s peak e f f e c t i s s h o r t e r . The a i m o f t h i s s t u d y was t o examine t h e e f f e c t of f r e q u e n t a d m i n i s t r a t i o n of low d o s e s of s a l b u t a m o l d u r i n g t h e i n i t i a l management o f a c u t e a s t h m a . 22 c h i l d r e n aged 6-17 y e a r s who p r e s e n t e d t o t h e Emergency Department w i t h a c u t e asthma w e r e a s s e s s e d by measurement o f FEV i n i t i a l l y and a t 20 m i n u t e i n t e r v a l s f o r 2% h o u r s .A l l c h i l d r A n r e c e i v e d a n i n i t i a l d o s e of 0.15 mg/kg s a l b u t a m o l i n 2 ml o f normal s a l i n e v i a a n e b u l i z e r .T h e r e a f t e r , t h o s e i n g r o u p A ( 8 p a t i e n t s ) r e c e i v e d t h e same d o s e a t 60 min. . --. - 1983; 3 8 : 6 1 6 ) . Maximal e x p i r a t o r y and i n s p i r a t o r y p r e s s u r e s were measured u s i n g t h e t e c h n i q u e d e s c r i b e d by Black and H y a t t (ARRD 1969; 99:696) and w e r e e x p r e s s e d a s p e r c e n t a g e of p r e d i c t e d (...