Long-term comparative trial of positive expiratory pressure versus oscillating positive expiratory pressure (flutter) physiotherapy in the treatment of cystic fibrosis

McIlwaine, P.Maggie; Wong, L. T. K.; Peacock, Donlim; Davidson, A. G. F.

doi:10.1067/mpd.2001.114017

Cited by 87 publications

(85 citation statements)

References 18 publications

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“…Numerous studies come in agreement with our results and concluded that the reduction in CAT-score detects early health status improvement and chest wall vibration reduces dyspnea in COPD patients. 4,6,12,23 Our results also coincide with pilot study carried out by Chakravorty et al whom reported that patients with AECOPD and mucus hypersecretion are at increased risk of declining lung function, tolerated the HFCWO treatment well, leading to improvement in CAT-score and quality of life and reduced symptoms. 7 Moreover; our result is consistent with Mahajan et al, who stated that HFCWO is well tolerated in adults hospitalized for AECOPD or acute asthma and significantly improves dyspnea, also reported that patient with AECOPD use fewer antibiotics, due to fewer respiratory infections with less hospitalization.…”

Section: Discussionsupporting

confidence: 78%

“…27 Other two authors reported that the Flutter as an oscillating PEP device enhances movement of secretions from the peripheral to the central airways lumen, improving lung function and oxygenation. 5,6 Additionally, Zakerimoghadam et al, mentioned that chest physiotherapy whatever its types enhance MCC, increase ventilation and improve blood gases. 3 The improved spirometric-indices reported among our patients in HFCWO or Flutter with no improvement in control group (Table 3), was similar to the results reported by Nicolini et al, who concluded that, there was significant improvement in pulmonary function tests (FEV1 or FVC) in CPT and HFCWO treated patients in comparison to control group.…”

Section: Discussionmentioning

confidence: 99%

“…The oscillations induce vibrations within the airway wall to decrease the visco-elasticity of tenacious secretions, as well as, to accelerate airflow, enhance movement of secretions from the peripheral to the central airways lumen, improving lung function and oxygenation. 5,6 One of the oscillatory devices with High Frequency Chest Wall Oscillation (HFCWO) systems is the vest airway clearance system. HFCWO devices generate either positive or negative trans-respiratory pressure excursions to creates high velocity, low amplitude oscillatory airflows when applied through a pneumatic vest worn over the thorax, results in transient cephalad bias airflow spikes in the airways to loosen and moves trapped secretions from the peripheral to proximal airways, which can be removed through coughing or suctioning.…”

Section: Introductionmentioning

confidence: 99%

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Utility of vest high frequency chest wall oscillation device versus flutter device in acute exacerbation of chronic obstructive pulmonary disease

Farag

El-Syed

2017

Int J Res Med Sci

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Background: Objectives to assess the effectiveness of high frequency chest wall oscillation (HFCWO) vest system and Flutter devices in the treatment of patients with AECOPD, and to compare the efficacy of HFCWO vest system versus Flutter devices.Methods: We conducted an interventional study on 108 out of 129 patients presented with AECOPD, recruited from two-university hospitals. They were classified into three groups, HFCWO group (n=37), Flutter group (n=35), and control group (n=36). The HFCWO group and Flutter group were treated with AECOPD medications in addition to either HFCWO or Flutter physiotherapy, three sessions per week, for four weeks, while control group was treated by medications only. All patients were evaluated before and after treatment by spirometry, ABG, CAT score, and the BODE index.Results: Post treatment assessment for both HFCWO and Flutter groups demonstrated that most of spirometric indices (FEV1%, FVC%, FEV1/FVC %), oxygenations parameters (PaO2, SaO2 %) and CAT score, were significantly improved (p < 0.05). The level of perceived dyspnea decreased significantly, walking distance during 6-MWT was extended significantly, the BODE index and MMRC scale decreased significantly. While in control group only oxygenations parameters (PaO2, SaO2 %) was mildly improved. No statistical significant difference was found between vest HFCWO and Flutter device in all measured post treatment parameters (p > 0.05).Conclusions: Both vest HFCWO and Flutter device are highly effective in treatment of patients with AECOPD in terms of improvement in ventilatory function and oxygenation parameters with better exercise tolerance.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Utility of vest high frequency chest wall oscillation device versus flutter device in acute exacerbation of chronic obstructive pulmonary disease

Farag

El-Syed

2017

Int J Res Med Sci

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“…The proportions of the different airway clearance techniques recorded for people with CF in the UK are broadly comparable with Canada, except for a bias towards PEP over oscillating PEP in Canada. This difference may be explained by several Canadian studies which found that PEP therapy is more effective than flutter devices (a form of oscillating PEP) [28] and postural drainage [29].…”

Section: Variation By Countrymentioning

confidence: 84%

Airway clearance techniques used by people with cystic fibrosis in the UK

et al. 2015

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Please cite this article as: Hoo ZH, Daniels T, Wildman MJ, Teare MD, Bradley JM, Airway clearance techniques used by people with cystic fibrosis in the UK, Physiotherapy (2015), http://dx.doi.org/10.1016/j.physio. 2015.01.008 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Setting and participants All people with CF in the UK aged ≥11 years (n=6372). ResultsOf the 6372 people on the UK CF registry in 2011, 89% used airway clearance techniques.The most commonly used primary techniques were forced expiratory techniques (28%) and oscillating positive expiratory pressure (PEP) (23%). Postural drainage and high-frequency chest wall oscillation were used by 4% and 1% of people with CF, respectively. The male:female ratio of individuals who used exercise as their primary airway clearance technique was 2:1, compared with 1:1 for other techniques. Individuals with more severe lung disease tended to use devices such as non-invasive ventilation or high-frequency chest wall oscillation.Conclusions Forced expiratory techniques and oscillating PEP are the most common airway clearance techniques used by people with CF in the UK, and postural drainage and high-frequency chest wall oscillation are the least common techniques. This is significant in terms of planning airway clearance technique trials, where postural drainage has been used traditionally as the comparator. The use of airway clearance techniques varies between countries, but the reasons for these differences are unknown.

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“…A study comparing autogenous drainage with Flutter® reported no differences in the amount of sputum produced by application of either of the two methods [4]; however, the Flutter® device was reported to be more effective in reducing viscoelasticity of the secretion. The positive expiratory pres-DOI: 10.5152/TurkThoracJ.2018.17050 Bilge Üzmezoğlu 1 sure was shown to be more effective than Flutter® in terms of preserving pulmonary function, hospital admissions, and antibiotic use in patients, who were followed up for 1 year [5]. Daily use of the Flutter® device at home was as effective as ACBT in patients with non-CF bronchiectasis, and it leads to higher levels of adherence by patients [3].…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Flutter® and Active Cycle of Breathing Techniques in Patients with Bronchiectasis: A Prospective, Randomized, Comparative Study

Üzmezoğlu¹,

Altıay

Özdemır³

et al. 2018

Turk Thorac J

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OBJECTIVES:The objective of the study was to compare the efficacy of an oscillating positive expiratory device and the active cycle of breathing techniques (ACBT) in patients with bronchiectasis. MATERIALS AND METHODS:A home-based study that lasted for 4 weeks was designed to compare the oscillating physiotherapy device Flutter ® and the ACBT in 40 patients, who were randomly assigned into two groups containing 20 patients each. The effect of the two methods of physiotherapy on sputum production, pulmonary functions, and the quality of life was compared. RESULTS:The results of the present study indicate that both the methods were associated with a reduced number of patients complaining of cough and fatigue and increased sputum production (p=0.000, p=0.004, and p=0.002, respectively). In addition, statistically significant reductions were determined by the Medical Research Council and Borg Dyspnea scores (p=0.001 and 0.002, respectively). The Flutter® device caused a more significant effect on the perception of dyspnea. Overall, there was an improvement in the physical sub-scale of the Short Form (SF)-36 Quality of Life Questionnaire scores of 36 patients who completed the study (p=0.001). During the physiotherapy period, no changes in pulmonary functions were observed. Exacerbations were recorded in 3 patients in the ACBT group and in 1 patient in the Flutter® group. CONCLUSION:The Flutter® device and ACBT represent effective home-based physiotherapeutic methods. The Flutter® device appears to be more effective with regard to sputum production.

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Long-term comparative trial of positive expiratory pressure versus oscillating positive expiratory pressure (flutter) physiotherapy in the treatment of cystic fibrosis

Cited by 87 publications

References 18 publications

Utility of vest high frequency chest wall oscillation device versus flutter device in acute exacerbation of chronic obstructive pulmonary disease

Utility of vest high frequency chest wall oscillation device versus flutter device in acute exacerbation of chronic obstructive pulmonary disease

Airway clearance techniques used by people with cystic fibrosis in the UK

The Efficacy of Flutter® and Active Cycle of Breathing Techniques in Patients with Bronchiectasis: A Prospective, Randomized, Comparative Study

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