Chest physiotherapy in infants with cystic fibrosis: To tip or not? A five‐year study

Abstract

There is controversy about the need for postural drainage physiotherapy in asymptomatic infants with cystic fibrosis (CF). We aimed to compare the effectiveness of standard postural drainage chest physiotherapy (SPT) with a modified physiotherapy regimen without head-down tilt (MPT) in young infants with CF. Twenty newly diagnosed infants with CF (mean age, 2.1 months; range, 1-4) were randomized to SPT or MPT. Parents kept a detailed symptom and treatment diary for the following 12 months. Serial chest radiographs, taken at diagnosis, 12 months, 2(1/2) years, and 5 years after diagnosis, were assessed using the Brasfield score. Pulmonary function tests were compared between groups after 5 years. Of the 20 infants, 16 (80%) completed the review at 12 months, and 14 (70%) at 2(1/2) and 5 years. Patients receiving SPT had more days with upper respiratory tract symptoms than those on MPT (70 +/- 32.8 vs. 37 +/- 24.9 days; P = 0.04) and required longer courses of antibiotics (23 +/- 28.5 vs. 14 +/- 11.2 days; P = 0.05). Chest x-ray scores were similar at diagnosis but were worse at 2(1/2) years for those receiving SPT (P = 0.03). Forced vital capacity and forced expired volume in 1 sec (FEV(1)) at 5-6 years was lower for SPT than for MPT (P < 0.05). In conclusion, MPT was associated with fewer respiratory complications than SPT in infants with CF.

Chest physiotherapy, gastro-oesophageal reflux, and arousal in infants with cystic fibrosis

“…1 2 The detection of CF by screening methods carried out in all neonates has led to the earlier use of chest physiotherapy in this presymptomatic population. Previous studies carried out by our group have shown that in some children, head-down postural drainage chest physiotherapy exacerbates GOR 3 and may contribute to a more rapid deterioration in lung function [2][3][4][5] compared to a modified regimen without head-down tilt. This has led to a change in the recommendations for standard chest physiotherapy in infants with CF.…”

Physiotherapy in cystic fibrosis: optimising techniques to improve outcomes

“…44,45 ACTs currently used in infants are poorly evidence based and in general have been adapted from techniques developed for older patients with chronic sputum retention. 20 The main types of ACTs which can be used for young infants with CF are infant PEP, modified postural drainage 46 with percussion and assisted autogenic drainage (AAD) with or without bouncing on a gym ball. 47 In the toddler years blowing games, bubbles and bubble PEP with more structured forced expiratory techniques (FETs) can be introduced.…”

Structure and Function of the Mucus Clearance System of the Lung

“…This study indicates that gravity results in increased ventilation in the dependent regions in positions commonly used during airway clearance, thus effecting increased sputum clearance from the dependent regions. Numerous side effects have been reported in head-down positions, including headaches, sinus pain (Cecins et al 1999), desaturation of oxygen (Falk et al 1984), symptomatic and silent gastroesophageal reflux (Button et al 1997(Button et al , 1998(Button et al , 2003Orenstein 2003), and poor adherence (Myers and Horn 2006). Another relevant study compared the effects of body position on mean expiratory pressure (MEP) and peak expiratory flow rate (PEFR), surrogate markers of huff, and cough strength in adults with stable CF.…”