Immediate and long-term effects of chest physiotherapy in patients with cystic fibrosis

Desmond, Katharine J.; Schwenk, W.; Thomas, Eli; Beaudry, Pierre H.; Coates, Allan L.

doi:10.1016/s0022-3476(83)80579-4

Cited by 111 publications

(45 citation statements)

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“…Although this was an adequately powered study to address a change in FEV 1 , the patients who participated in the study were in the milder range of disease severity and the results may not be generalized to patients with more severe disease. It is interesting that there were a number of patients (3 of 8 who responded in both treatment orders) who had a baseline FEV 1 between 80% and 90% predicted and demonstrated Ͼ10% increase in FEV 1 . This group with milder lung disease may be considered by some clinicians to be "too mild" to justify a trial of dornase alfa, yet some patients in the present study with an FEV 1 Ͼ80% predicted demonstrated Ͼ10% improvement in their FEV 1 .…”

Section: E552mentioning

confidence: 99%

“…Intention-to-treat analysis was used. Nonsignificant mean (95% confidence interval) differences in FEV 1 ABBREVIATIONS. CF, cystic fibrosis; FEV 1 , forced expiratory volume in 1 second; PEP, positive expiratory pressure; VO 2max , maximal oxygen consumption; QWB, quality of well-being score; CI, confidence interval; FEF , mid expiratory flow rate.…”

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confidence: 99%

“…CF, cystic fibrosis; FEV 1 , forced expiratory volume in 1 second; PEP, positive expiratory pressure; VO 2max , maximal oxygen consumption; QWB, quality of well-being score; CI, confidence interval; FEF , mid expiratory flow rate. P hysiotherapy and systemic and nebulized antibiotics have been the cornerstones of treatment in cystic fibrosis (CF) for many years.…”

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confidence: 99%

“…P hysiotherapy and systemic and nebulized antibiotics have been the cornerstones of treatment in cystic fibrosis (CF) for many years. [1][2][3] The introduction of the nebulized mucolytic agent dornase alfa (Pulmozyme [Hoffman-La Roche, Dee Why, Sydney, Australia]) in the 1990s proved to be an innovative adjunct to the management of lung disease in terms of reduced pulmonary exacerbations, improved lung function, and quality-of-life measures. [3][4][5] Dornase alfa use varies from country to country, on the basis of patient preference, physician prescribing practices, measured benefit in an individual, and health funding arrangements.…”

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confidence: 99%

“…13 Previous work has documented a 4% to 6% improvement in FEV 1 after 6 months of treatment with dornase alfa for schoolaged children who complied with therapy. 4 For this study, a change in percentage of predicted FEV 1 of 5% (ϳ0.08 L at 10 years of age), equivalent to a 0.5 SD change over baseline, was chosen as a clinically significant improvement in FEV 1 . Using an ␣ of .05 and 99% power, we needed to recruit a total of 49 participants.…”

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confidence: 99%

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A Crossover, Randomized, Controlled Trial of Dornase Alfa Before Versus After Physiotherapy in Cystic Fibrosis

et al. 2005

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ABSTRACT. Objective. Although dornase alfa is a widely used, aerosolized, mucolytic agent in patients with cystic fibrosis (CF), its efficacy in relation to the timing of physiotherapy has not been tested. We sought to determine whether dornase alfa is more efficacious when it is administered 30 minutes before versus 30 minutes after physiotherapy/positive expiratory pressure (PEP) therapy in clinically stable children.Methods. Using a crossover, randomized, doubleblind, and placebo-controlled trial, we undertook a 6-week study of the efficacy of dornase alfa in relation to the timing of physiotherapy at home. There were 2 treatment orders. Dornase alfa before ؉ placebo after physiotherapy/PEP for 2 weeks was followed by a 2-week washout and then the reverse order placebo before and dornase alfa after physiotherapy/PEP for the final 2 weeks. The second treatment order reversed the placebo and dornase alfa therapy for the first and last 2-week blocks. The main outcome measures used included the change in predicted percentage of forced expiratory volume in 1 second (FEV 1 ), a composite quality of wellbeing score (QWB), and a measure of aerobic fitness (maximal oxygen consumption, [VO 2max ]), determined using shuttle testing.Results. Fifty-two patients who had CF (27 female) with mild to moderate suppurative lung disease, were a mean ؎ SD age of 10.7 ؎ 3.2 years, had Shwachman scores of 86 ؎ 11.8, had predicted FEV 1 of 83% ؎ 18%, had quality of well-being score of 0.76 ؎ 0.08, and had VO 2max of 42.6 ؎ 6.3 ml/kg per min were enrolled. Fifty patients completed the study. Intention-to-treat analysis was used. Nonsignificant mean (95% confidence interval) differences in FEV 1 ABBREVIATIONS. CF, cystic fibrosis; FEV 1 , forced expiratory volume in 1 second; PEP, positive expiratory pressure; VO 2max , maximal oxygen consumption; QWB, quality of well-being score; CI, confidence interval; FEF , mid expiratory flow rate. P hysiotherapy and systemic and nebulized antibiotics have been the cornerstones of treatment in cystic fibrosis (CF) for many years. [1][2][3] The introduction of the nebulized mucolytic agent dornase alfa (Pulmozyme [Hoffman-La Roche, Dee Why, Sydney, Australia]) in the 1990s proved to be an innovative adjunct to the management of lung disease in terms of reduced pulmonary exacerbations, improved lung function, and quality-of-life measures. 3-5 Dornase alfa use varies from country to country, on the basis of patient preference, physician prescribing practices, measured benefit in an individual, and health funding arrangements. In Australia, most recent figures indicate that dornase alfa is used by 22.1% of school-aged children (5-18 years), all of whom have demonstrated a Ͼ10% improvement in forced expiratory volume in 1 second (FEV 1 ) after 4 weeks of therapy. 6 However, despite the evaluation of dornase alfa in Ͼ15 years of clinical trials, there is no evidence as to whether dornase alfa is more efficacious when delivered before or after physiotherapy. As has been shown in adults who are prescri...

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confidence: 99%

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