Chest physiotherapy in cystic fibrosis: a comparative study of autogenic drainage and the active cycle of breathing techniques with postural drainage.

Abstract

Background -Autogenic drainage has been suggested as an alternative method of chest physiotherapy in patients with cystic fibrosis. In this study autogenic drainage was compared with the active cycle of breathing techniques (ACBT) together with postural drainage. Methods -Eighteen patients with cystic fibrosis took part in a randomised two-day crossover trial. There were two sessions of one method of physiotherapy on each day, either autogenic drainage or ACBT. The study days were one week apart. On each day the patients were monitored for six hours. Mucus movement was quantified by a radioaerosol technique. Airway clearance was studied qualitatively using xenon-133 scintigraphic studies at the start and end ofeach day. Expectorated sputum was collected during and for one hour after each session of physiotherapy. Pulmonary functions tests were performed before and after each session. Oxygen saturation (Sao,) and heart rate were measured before, during, and after each session. Results -Autogenic drainage cleared mucus from the lungs faster than ACBT over the whole day. Both methods improved ventilation, as assessed by the xenon-133 ventilation studies. No overall differences were found in the pulmonary function test results, but more patients had an improved forced expiratory flow from 25% to 75% with autogenic drainage, while more showed an improved forced vital capacity with ACBT. No differences were found in sputum weight and heart rate, nor in mean Sao, over the series, but four patients desaturated during ACBT. Conclusions -Autogenic drainage was found to be as good as ACBT at clearing mucus in patients with cystic fibrosis and is therefore an effective method of home physiotherapy. Patients with cystic fibrosis should be assessed as to which method suits them best. (Thorax 1995;5O:165-169)

Efficacy of Pursed Lips Breathing with Forced Expiration Techniques and Active Cycle of Breathing Technique on Pulmonary Mucus Clearance in Healthy Subjects

“…Also, there was no significant deterioration in PEFR during and immediately after each intervention period. This contradicts Miller et al 31) , who reported in 1995 that pulmonary function was decreased after inhalation of aerosol, presumably due to bronchoconstriction. In our study, all subjects seemed to be in stable conditions throughout the study period of three study days and d i d n o t h a v e a n y a d v e r s e e f f e c t d u e t o bronchoconstriction.…”

Chest Physiotherapy in Cystic Fibrosis: Improved Tolerance With Nasal Pressure Support Ventilation

“…Desaturation has been described during CPT. 5,29 It has been suggested that desaturation can be prevented by allowing sufficiently long periods of quiet breathing between the FET maneuvers. 7 In our study, desaturation occurred immediately after the FET maneuvers during the control session, consistent with a role of bronchial collapse and prolonged expiration.…”

Physiotherapy for airway clearance in adults

“…One group has compared AD and the ACBT [64] and concluded that AD increased the rate of clearance of mucus, although there was no overall difference in the weight of sputum expectorated. There is debate, however, as to whether it was the ACBT which was used in the study in practice [65,66].…”