TY - JOUR T1 - Positive Expiratory Pressure Physiotherapy for Airway Clearance in People With Cystic Fibrosis: A Cochrane Review Summary With Commentary JF - Respiratory Care SP - 370 LP - 372 DO - 10.4187/respcare.09306 VL - 67 IS - 3 AU - Daniel F Fisher Y1 - 2022/03/01 UR - http://rc.rcjournal.com/content/67/3/370.abstract N2 - Cystic fibrosis (CF) is an inherited disorder that involves several organs; however, 85% of mortality from this disorder is related directly to lung disease. CF results in an overproduction of thick, tenacious secretions that obstruct airways, making them prone to infection. The trapped airway secretions are a suitable media for bacterial growth because of the sugar content, high humidity, and warm environment. The infected secretions often lead to inflammation of the airways and atelectasis. Trapped secretions can lead to occluded distal airways that may act as a ball-valve mechanism producing hyperinflation of the lung. The associated air trapping results in ventilation-perfusion mismatching by increasing the dead-space-to-tidal-volume ratioTechniques used to augment airway clearance traditionally have included percussion, vibration, and postural drainage (PVPD), also referred to as chest physiotherapy (CPT), followed by a series of both forced exhalations and coughing. CPT is a time-consuming process and can also be uncomfortable for the patient who is receiving the therapy.1 CPT requires assistance either from another practitioner or a family member, which can have an effect on the adherence to prescribed therapy.2 Alternative techniques have been described that are more patient-initiated including thoracic oscillating devices such as the vest or positive expiratory pressure (PEP) therapy. PEP can be provided either with a face mask or by using a mouthpiece.PEP involves exhaling against a spring-loaded valve or through a flow resistor.1-4 The expiratory impedance generates back pressure that has been hypothesized to stent open flaccid airways, thus delaying dynamic airway collapse.3,4 With the airway supported against premature closure, secretion clearance is enhanced by 2 mechanisms: improved aeration resulting from a more complete exhalation and an increase in flow distal to the mucus. With the resulting back pressure created during this procedure, there is a temporary … Correspondence: Daniel F Fisher MSc RRT, Department of Respiratory Care, Milford Regional Medical Center, Milford MA 01757. E-mail: dafisher{at}milreg.org ER -