Positive pressure – analysing the effect of the addition of non-invasive ventilation (NIV) to home airway clearance techniques (ACT) in adult cystic fibrosis (CF) patients

Stanford, Gemma; Parrott, H.; Bilton, Diana; Agent, Penny

doi:10.3109/09593985.2014.994151

Cited by 11 publications

(20 citation statements)

References 16 publications

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“…There were trends for lower reported levels of breathlessness and fatigue with the use of NIV, but these did not reach significance. This differs from our previously reported results where subjects did subjectively rate NIV-supported ACT significantly higher for EoC and reduced effort13; however, those results were from a more severe patient group (median FEV 1 26%) over a 1-year period. Several of the participants of the current study commented that they felt NIV would be useful for them if they were more unwell, breathless or unable to expectorate, as they felt it would be more supportive at that time, which may then provide more comparable data.…”

Section: Discussioncontrasting

confidence: 99%

“…The research question stemmed from previously published research interviews completed with CF patient users of NIV for ACT,13 which on further discussion with these patients the authors felt was important to try and answer objectively. Patients with CF from the Royal Brompton Hospital were involved in designing the methodology to try and answer the question of whether sputum clearance changed with the addition of NIV.…”

Section: Methodsmentioning

confidence: 99%

“…To date, no research has reported an increase in sputum expectorated with the addition of positive pressure; however, the ability to augment greater tidal volumes through positive pressure is thought to be a mechanism which could improve sputum clearance. We have previously reported the subjective viewpoints of patients using NIV to support ACT, in which they felt their sputum clearance had increased 13. The aim of the present study was to investigate this observation objectively by assessing sputum cleared in 24 hours in a randomised cross-over trial of usual ACT versus NIV-supported ACT.…”

Section: Introductionmentioning

confidence: 90%

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Randomised cross-over trial evaluating the short-term effects of non-invasive ventilation as an adjunct to airway clearance techniques in adults with cystic fibrosis

et al. 2019

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IntroductionNon-invasive ventilation (NIV) is used in cystic fibrosis (CF) to support airway clearance techniques (ACTs) by augmenting tidal volumes and reducing patient effort. However, the evidence base for this is limited. We hypothesised that NIV, in addition to usual ACT, would increase sputum clearance. In addition, we investigated ease of sputum clearance (EoC), work of breathing (WoB) and NIV tolerability.MethodsAdults with CF (16+ years) at the end of hospitalisation for a pulmonary exacerbation were randomised to a cross-over trial of NIV-supported ACT or ACT alone in two consecutive days. No other changes to standard care were made. The primary outcome was the total 24-hour expectorated sputum wet weight after the intervention. Spirometry was completed pre-treatment and post-treatment. Oxygen saturations were measured pre-treatment, during treatment and post-treatment. EoC and WoB were assessed using Visual Analogue Scale.Results14 subjects completed the study (7 male, mean age 35 [SD 17] years, mean forced expiratory volume in 1 s [FEV1] 49 [20] % predicted). The difference between treatment regimens was −0.98 g sputum (95% CI −11.5 to 9.6, p=0.84) over 24 hours. During treatment oxygen saturations were significantly higher with NIV-supported ACT (mean difference 2.0, 95% CI 0.9 to 2.6, p=0.0004). No other significant differences were found in post-treatment FEV1, EoC, WoB, oxygen saturations or subject preference.ConclusionsThere was no difference in treatment effect between NIV-supported ACT and ACT alone, although the study was underpowered. Oxygen saturations were significantly higher during NIV-supported ACT, but with no effect on post-treatment saturations. NIV was well tolerated.Trial registration numberNCT01885650.

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Section: Discussioncontrasting

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 90%

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Randomised cross-over trial evaluating the short-term effects of non-invasive ventilation as an adjunct to airway clearance techniques in adults with cystic fibrosis

et al. 2019

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“…24 Standford et al looked at a one-year period following the addition of NIV to airway clearance techniques (ACT) and demonstrated statistically significant improvements in ease of patient report of airway clearance and reduced effort during ACT. 28 This study analyzed objective measures such as lung function and frequency of use of IV antibiotics, as well as patient reported measures of fatigue and breathlessness. 28 Patients reported significant improvement in fatigue and breathlessness, which would lead to improved quality of life.…”

Section: Benefits Of Niv For Cf Patientsmentioning

confidence: 99%

An Overview of Noninvasive Ventilation in Cystic Fibrosis

Jobanputra

Jagpal

Marulanda

et al. 2021

Preprint

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Noninvasive ventilation (NIV) use was initially reported in cystic fibrosis (CF) in 1991 as a bridge to lung transplantation, and over the decades the use of NIV has increased in the CF population. Individuals with CF are prone to various physiologic changes as lung function worsens, and they may benefit from NIV for advanced lung disease. As life expectancy in CF has been increasing due to advances such as highly effective modulator therapy, people with CF are now subject to the same co-morbidities that may benefit from NIV as their age matched cohorts. NIV can improve gas exchange, quality of sleep, exercise tolerance and augment airway clearance in CF, and it is important that CF providers are comfortable with this therapeutic modality. In this review, we will summarize the physiologic basis for NIV use in CF, describe indications for initiation of NIV, and postulate a practical approach for CF clinicians to take fin monitoring patients on NIV. We will discuss aspects unique to people with CF and the use of NIV. We hope that this serves as a resource for CF providers, especially those of us who do not have dedicated training in sleep medicine, as we continue to care for our patient population.

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“…In stable CF patients with awake hypercapnia, a six week trial of nocturnal noninvasive ventilation showed improved nocturnal hypoventilation and peak exercise capacity without improving lung function or awake hypercapnia 64 . Noninvasive ventilation has also been evaluated in cystic fibrosis patients as an adjunct to airway clearance techniques, 65,66 particularly in patients having trouble expectorating sputum. 65 The rationale is that in patients with severe lung disease, airway clearance therapy results in energy expenditure and use of noninvasive ventilation could allow for decreased work of breathing and fatigue.…”

Section: Treatmentmentioning

confidence: 99%

Sleep- Disordered Breathing in Cystic Fibrosis

Jobanputra

Jagpal

Ahmed

et al. 2020

Preprint

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Sleep-disordered breathing is an underrecognized comorbidity in the cystic fibrosis (CF) population across the lifespan. Nocturnal hypoxia, obstructive sleep apnea (OSA), and nocturnal hypoventilation are respiratory abnormalities that occur commonly during sleep, and have deleterious consequences to quality of life in people with CF. Effective screening for these abnormalities is needed to allow for the timely initiation of treatment. Lack of treatment leads to worse pulmonary, cardiovascular, and metabolic outcomes in patients. In this review, we give an overview of sleep-disordered breathing for the CF clinician, including definitions, treatment, and suggestions for future research. We strongly encourage the CF community to incorporate evaluation for sleep-disordered breathing, so that outcomes for the subset of the patients with coexisting sleep-disordered breathing improve.

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Positive pressure – analysing the effect of the addition of non-invasive ventilation (NIV) to home airway clearance techniques (ACT) in adult cystic fibrosis (CF) patients

Abstract: This study is limited by small numbers; however, trends towards less hospital admissions and greater patient ease while using NIV with ACT warrant further investigation.

Cited by 11 publications

References 16 publications

Randomised cross-over trial evaluating the short-term effects of non-invasive ventilation as an adjunct to airway clearance techniques in adults with cystic fibrosis

Randomised cross-over trial evaluating the short-term effects of non-invasive ventilation as an adjunct to airway clearance techniques in adults with cystic fibrosis

An Overview of Noninvasive Ventilation in Cystic Fibrosis

Sleep- Disordered Breathing in Cystic Fibrosis

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