Respiratory exacerbations in children with cystic fibrosis: Physiotherapy treatment outcomes

Abstract

Treatment efficacy is crucial in cystic fibrosis (CF) as it impacts directly upon life expectancy, with its evaluation contributing to the evidence base for physiotherapy practice. This study assesses whether respiratory outcomes changed at the Royal Children's Hospital, Brisbane (RCH) over a period when physiotherapy airways clearance techniques altered All 1998 and 2000 admissions of children over two years of age to RCH for CF related respiratory exacerbations were included, totalling 248 admissions, 125 in 1998 and 123 in 2000. Data for respiratory effort, cough quality, sputum volume/weight, sputum colour and sputum stickiness were analysed. Respiratory function test (RFT) results included: forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and forced expiratory flow (FEF25-75%) and % of predicted values. Repeated measures ANOVA and appropriate post hoc tests evaluated changes occurring during the admissions. Independent-samples t-tests allowed comparison of the improvement in the two years. During hospital admission in both 1998 and 2000, a significant improvement in RFT results occurred. Similar improvements in 1998 and 2000 suggested no change in treatment efficacy had occurred. Significant changes during hospitalisation, in cough quality, sputum volume/weight, and sputum colour suggest that these variables are appropriate and simple physiotherapy outcome measures.

The active cycle of breathing technique: A systematic review and meta-analysis

“…6 Despite the potential for measurement inaccuracy, sputum wet weight has been shown to be as reliable as dry sputum, 1,48 and a common and clinically useful outcome of airway clearance techniques. 11 The lung function variables of FVC and FEV 1 were commonly evaluated but it could be argued that these outcomes are of limited value in assessing the efficacy of airway clearance techniques given the short-term duration of the majority of studies and the documented day to day variance in these measures. Such great variability in these outcomes could mean that only massive changes would reach statistical significance.…”

“…Clinicians have been shown to commonly use sputum production in patient assessment, and patients commonly consider sputum production in their own assessment of the efficacy of airway clearance techniques such as the ACBT. 9,10 The outcome of sputum volume has been identified as a relevant, inexpensive, minimally invasive, easily accessible and clinically useful marker to monitor response to therapy in people with cystic fibrosis 11 and bronchiectasis. 12 In people with bronchiectasis, daily sputum volume has been identified as an important prognostic indicator, with people with higher daily sputum volume having poorer quality of life.…”

Outcomes and endpoints reported in studies of pulmonary exacerbations in people with cystic fibrosis: A systematic review

“…The two points in time varied across the studies. The baseline FEV1 was either the FEV1 at initiation of intensive therapy or the 'best' value within the preceding 3-12 months, compared to the FEV1 at 7, 10-14 days or 1-3 months after treatment cessation [12,29,31,42,71,75,[87][88][89][90][91]. A pre-defined minimum clinically important difference (e.g.…”

“…A pre-defined minimum clinically important difference (e.g. 10% improvement in FEV1) was sometimes used to define treatment success [29,42,71]. The number of pulmonary exacerbations or the time to the next exacerbation during a defined period were alternative endpoints applied, including in studies of young children incapable of performing spirometry [90].…”