Long-term comparative trial of conventional postural drainage and percussion versus positive expiratory pressure physiotherapy in the treatment of cystic fibrosis☆,☆☆,★
Section snippets
Subjects
Forty patients with CF, aged 6 to 17 years, were enrolled in the study after informed consent was obtained as approved by the University of British Columbia Ethical Review Committee. The diagnosis of CF was confirmed by sweat test with the Gibson-Cooke method. 21 At entry to the study all patients were judged to be competent and compliant in performing daily conventional PD&P physiotherapy at home. This was based on the clinical impression from long-term follow-up at the CF clinic, repeated
Results
Between January and April of 1994, 40 patients (22 boys), aged 6 to 17 years, were enrolled in the study and randomly assigned to either group A or B (Table I) . The patients in both groups were evenly matched for pulmonary function and age. A broad range of pulmonary dysfunction was represented (FEV 1 , 37% to 115% of predicted value). Thirty-six patients completed the 1-year study period. Two from each group dropped out because of noncompliance with treatment (performance of prescribed
Discussion
Our results indicate that physiotherapy with the PEP technique was significantly superior to PD&P in maintaining or improving pulmonary function in patients with CF. In the group performing PD&P, the annual rate of decline in pulmonary function (FEV 1 of –2.28% predicted per year) was similar to the reported North American rate of decline (FEV 1 of –2% predicted per year [S. Fitzsimmons, The American CF Registry; personal communication, July 1996). Reisman et al. 6 also reported a similar rate
Acknowledgements
We acknowledge with thanks the help of Joyce Schmidt, Anna Gravelle, and Sharon Gyorgy from the Division of Biochemical Diseases and Cystic Fibrosis Clinic and the assistance of the Physiotherapy staff at B.C.’s Children’s Hospital.
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2020, Brazilian Journal of Physical TherapyCitation Excerpt :But, in the last systematic review that analyzed the use of different devices and techniques of respiratory physical therapy in patients with CF, no superiority of any therapeutic approach was identified.11 Despite the results of that review, there is evidence to suggest that the use of PEP may be more effective than conventional techniques, slowing-down the long-term decline in lung function,18 and reducing pulmonary exacerbations compared to HFCWO use.19 Another study suggests that the beneficial effects of HFOO techniques are more apparent in the short term compared to PEP20 and, the use of Flutter may improve lung function of patients who are hospitalized.21
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2015, Respiratory MedicineCitation Excerpt :The latter is performed by the forced expiration technique (FET), huffing and/or coughing while the expiratory resistor is temporarily put aside [1,2,60–63]. PEP with FET has been shown to be an effective airway clearance technique [5,6,14,64,65] and better maintenance of lung function over time and improved physical function in patients with cystic fibrosis [6,22,66,67]. Several studies have reported its effect to be equal to other airway clearance techniques such as positioning and postural drainage [5,59,64,68–77] or superior to chest wall oscillation, postural draining with percussions and OscPEP [22,66,67].
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Supported by Telethon Funds, B.C.’s Children’s Hospital, Vancouver, B.C., Canada.
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Reprint requests: A. George F. Davidson, BSc, MD, FRCPC, Cystic Fibrosis Clinic, B.C.’s Children’s Hospital, 4480 Oak St., Room 2C66, Vancouver, B.C. V6H 3V4, Canada.
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