Short‐term effects of three chest physiotherapy regimens in patients hospitalized for pulmonary exacerbations of cystic fibrosis: A cross‐over randomized study

Abstract

The aim of our study was to compare the short-term efficacy of three different chest physiotherapy (CPT) regimens (PD, postural drainage; PEP, positive expiratory pressure physiotherapy; HFCC, high-frequency chest compression physiotherapy) on patients with cystic fibrosis (CF) hospitalized for an acute pulmonary exacerbation. Sixteen patients with CF, 8 males, 8 females, aged 15-27 years (mean, 20.3 +/- 4), met the inclusion criteria: 1) age over 14 years; 2) mild or moderate airway obstruction; 3) sputum volume > 30 mL/day; 4) being proficient in PD and PEP CPT. Patients at admission had (mean +/- SD) forced volume in 1 second (FEV1) 52.2 +/- 21.9 percent predicted; Shwachman-Kulczycki clinical score 65.1 +/- 11 points; Chrispin-Norman chest radiography score 18.6 +/- 4.3 points. The three CPT regimens and a control-treatment (CONT) were administered in a random sequence, each patient receiving each treatment twice a day (in 50 minute sessions) for 2 consecutive days. During CONT and for 30 minutes after each session only spontaneous coughing was allowed. Wet and dry weight of sputum were recorded during the 50-minute sessions and 30 minutes afterward. Lung function was measured before and 30 minutes after each session. For each treatment a score was given by the patient for efficacy, and by both the patient and the physiotherapist for tolerance. Wet and dry weights of sputum collected during the sessions were greater for all CPT regimens than for CONT (P < 0.001, P < 0.0001). No significant differences between the three CPT regimens for both wet and dry weights were found when the number of coughs was taken into account.(ABSTRACT TRUNCATED AT 250 WORDS)

Physiologic Evidence for the Efficacy of Positive Expiratory Pressure as an Airway Clearance Technique in Patients With Cystic Fibrosis

“…Similarly, most reports of small, yet measurable, improvements in lung function generally showed no differences after low PEP compared with after traditional interventions for a single treatment 14,17 or after multiple treatments. 13 Beneficial effects on lung function have been documented following the use of high PEP in individuals with CF. Oberwaldner et al 15 reported that 10 months of high PEP resulted in improvements in lung function and higher mean daily sputum volumes cleared compared with 2 months of CPT interventions.…”

“…12 Positive expiratory pressure breathing has been shown to be effective in secretion removal for patients with CF. [13][14][15] Additionally, patient-administered PEP breathing is well accepted by patients, 14 -16 easy to use, 14 -16 time efficient, 14,16 and inexpensive 14 compared with postural drainage, manual percussion, and vibration.…”

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

“…Several studies have tried to measure lung function changes as a result of expectoration methods, some with negative results [5,19] and some with significant changes even after a single session [11]. Widely varying methodologies in patients with varying severity of lung disease could well explain the different outcomes.…”

“…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.…”

Structure and Function of the Mucus Clearance System of the Lung

“…Precautions include endstage disease (end expiratory volume may fall below closing capacity), port under the vest (not currently accessed), recent esophageal surgery, distended abdomen, bronchospasm, osteoporosis, and coagulopathy (AARC 1991). HFCWO therapy has been compared with other airway clearance techniques in CF and other disease groups with pulmonary problems (Arens et al 1994;Braggion et al 1995;Kluft et al 1996;Scherer et al 1998;Oermann et al 2001;Phillips et al 2004;Yuan et al 2010;Fainardi et al 2011). A simulation tool to study high-frequency compression energy transfer mechanisms and waveforms has been developed for applications in pulmonary disease (O'Clock et al 2010).…”