Acute effects of combined exercise and oscillatory positive expiratory pressure therapy on sputum properties and lung diffusing capacity in cystic fibrosis: a randomized, controlled, crossover trial

Abstract

Background: Regular airway clearance by chest physiotherapy and/or exercise is critical to lung health in cystic fibrosis (CF). Combination of cycling exercise and chest physiotherapy using the Flutter® device on sputum properties has not yet been investigated. Methods: This prospective, randomized crossover study compared a single bout of continuous cycling exercise at moderate intensity (experiment A, control condition) vs a combination of interval cycling exercise plus Flutter® (experiment B). Sputum properties (viscoelasticity, yield stress, solids content, spinnability, and ease of sputum expectoration), pulmonary diffusing capacity for nitric oxide (DLNO) and carbon monoxide (DLCO) were assessed at rest, directly and 45 min post-exercise (recovery) at 2 consecutive visits. Primary outcome was change in sputum viscoelasticity (G', storage modulus; G", loss modulus) over a broad frequency range (0.1-100 rad.s − 1). Results: 15 adults with CF (FEV 1 range 24-94% predicted) completed all experiments. No consistent differences between experiments were observed for G' and G" and other sputum properties, except for ease of sputum expectoration during recovery favoring experiment A. DLNO, DLCO, alveolar volume (V A) and pulmonary capillary blood volume (V cap) increased during experiment A, while DLCO and V cap increased during experiment B (all P < 0.05). We found no differences in absolute changes in pulmonary diffusing capacity and its components between experiments, except a higher V A immediately post-exercise favoring experiment A (P = 0.032). Conclusions: The additional use of the Flutter® to moderate intensity interval cycling exercise has no measurable effect on the viscoelastic properties of sputum compared to moderate intensity continuous cycling alone. Elevations in diffusing capacity represent an acute exercise-induced effect not sustained post-exercise.

The effect of acute maximal exercise on the regional distribution of ventilation using ventilation MRI in CF

“…There is increasing interest in and awareness of the effects of exercise on patients with CF (9,10,27,28). Patients with reduced aerobic capacity have a greater risk of morbidity and mortality(2-4) and a greater risk of hospitalisation (5).…”

Short‐term effects of a novel bronchial drainage device: A pilot cohort study in subjects with cystic fibrosis

“…Dwyer et al 31 found a reduction of mechanical impedance upon both the use of flutter and treadmill exercise. In contrast, in another study aiming at the effect of flutter and cycling exercise, sputum viscoelasticity was not affected by any intervention 32 . It should be noted that flutter or OPEP apply positive expiratory pressure at variable frequencies, 32 whereas the BDD used in our study applies negative pressure impulses, set at 12 and 6 Hz (personal communication with Physio Assist GmbH).…”

“…For instance, the diaphragm thickening ratio increased upon inspiratory muscle training in subjects with CF. 29 Recently, an 32 It should be noted that flutter or OPEP apply positive expiratory pressure at variable frequencies, 32 whereas the BDD used in our study applies negative pressure impulses, set at 12 and 6 Hz (personal communication with Physio Assist GmbH). In the present study, we quantified the diffusion of FITC-dextrans in mucus samples using FRAP.…”

Effectiveness of positive expiratory pressure on patients over 16 years of age with cystic fibrosis: systematic review and meta-analysis

“…25,27,28,30 Seven trials registered the presence or not of adverse effects during the study. 21,22,24–26,28,29 Most studies reported that the treatment was well tolerated and with no adverse effects in any group, except for Radtke et al , 21 since during this study, one female patient required oral antibiotic therapy for the treatment of a pulmonary exacerbation and was excluded from the analyses.…”