Evaluation of the PEP Mask in Cystic Fibrosis

Abstract

Twenty-eight patients suffering from cystic fibrosis, with an age range of 8-21 years entered a randomised cross-over trial to study the efficacy of the Positive Expiratory Pressure (PEP) mask as a method of chest physiotherapy, both on its own and in conjunction with other physiotherapy techniques. Twenty-four of these patients completed the trial consisting of 4 treatment programmes each lasting one month and with no wash-out period between them. Five of these patients went on to a fifth programme of Forced Expiratory Technique (FET) alone. At the end of the trial, no significant difference was found between the programmes as regards growth, Shwachman score, Chrispin-Norman score or pulmonary function tests. Twenty-three patients chose to continue using the PEP mask in conjunction with FET long-term as their chest physiotherapy programme as they felt it was an effective treatment allowing increased independence, with postural drainage being kept to a minimum.

Effects of flutter and PEP mask physiotherapy on symptoms and lung function in children with cystic fibrosis

“…Widely varying methodologies in patients with varying severity of lung disease could well explain the different outcomes. Regarding the PEP mask, several studies failed to show an improvement in forced expiratory flows or lung volumes after several weeks of daily treatment [5,20]. In contrast, others showed a significant improvement in lung volumes and expiratory flows after 15 days of PEP mask physiotherapy by CF patients hospitalized for a pulmonary exacerbation [21].…”

“…Also, improvement in lung function after 14 days of physiotherapy with the use of the flutter was reported in adult patients with chronic obstructive bronchitis [16] and preliminary data suggest the same for patients with CF [17,18]. In contrast, most studies with the PEP mask failed to show short-term benefit or improvement in lung function or symptoms [5,19,20] or were inconclusive because other aspects of the treatment may have been responsible for an observed effect [21]. It seems, therefore, that the flutter might have advantages over the more commonly used PEP mask.…”

High frequency chest compression and PEP

“…Small clinical studies have reported improved tracheobronchial clearance and patient comfort with PEP devices compared to standard CPT. [2][3][4][5][6][7][8][9] There is also reported reduction in pulmonary infections/antibiotic courses and improved bronchodilation. 9,[10][11][12] In addition, there has also been reported improvement in compliance and shorter hospital stays.…”

Cystic fibrosis

“…The forced expiration technique consists of one or two forced exhalations (huffs) from middle to low lung volume, followed by a period of relaxed, controlled diaphragmatic breathing. Although one study has demonstrated superior sputum production over CPT in the short term [112], a 3-year prospective study found it to be less effective than conventional CPT [133]. Other more recently introduced techniques include the use of a positive expiratory pressure mask and autogenic drainage.…”

“…Other more recently introduced techniques include the use of a positive expiratory pressure mask and autogenic drainage. It is unclear whether these techniques offer any therapeutic advantage over CPT [133].…”