Chest
Volume 105, Issue 6, June 1994, Pages 1789-1793
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Physio-Therapy: Clinical Investigations
Comparison of Intrapulmonary Percussive Ventilation and Chest Physiotherapy: A Pilot Study in Patients With Cystic Fibrosis

https://doi.org/10.1378/chest.105.6.1789Get rights and content

Study objective

To compare the intrapulmonary percussive ventilator (IPV) to chest physiotherapy (P&PD) with respect to acute changes in (1) pulmonary function and (2) sputum physical properties in patients with cystic fibrosis (CF).

Design

Randomized crossover.

Setting

Community-based CF referral center.

Participants

Nine nonhospitalized persons (range, 7 to 40 years; median, 12.4 years) with moderate to excellent Shwachman scores.

Interventions

Three treatment regimens: (1) 2.5 mg albuterol delivered via IPV (internal percussive component activated); (2) 2.5 mg albuterol delivered via IPV (internal percussive component inactivated), followed by P&PD; and (3) 2.5 mg albuterol delivered via updraft nebulizer, followed by P&PD.

Measurements and results

Outcome measures included pulmonary function testing (PFTs) and quantitative and qualitative sputum analysis. Among the three treatment groups, there were no significant differences in the change in predicted PFTs 1 h or 4 h after treatment, nor in the volume of sputum expectorated in the first 4 or in the subsequent 20 h. Among patients receiving IPV, more serious disease was associated with greater improvement in FEF25-75 1 h after treatment, but these differences disappeared by 4 h. There were no meaningful differences in viscoelastic characteristics of sputum expectorated after each treatments. Participants reported general satisfaction with no adverse effects while using IPV.

Conclusions

This initial pilot study suggests (1) stable patients with CF tolerated one treatment of IPV without adverse sequelae, and (2) IPV was as effective as standard aerosol and P&PD in improving short-term PFT results and enhancing sputum expectoration.

Section snippets

METHODS AND MATERIALS

The study was approved by the Human Use Committee of Bronson Methodist Hospital. Informed consent was obtained from all participants and the parents/guardians of those patients under 18 years old.

Participants with CF diagnosed by clinical history, physical examination, and standard pilocarpine ionotophoresis16 were recruited from the Cystic Fibrosis Center at Michigan State University/Kalamazoo Center for Medical Studies. Patients with a history of pneumothorax, pulmonary surgery, or with

RESULTS

Characteristics of the nine participants, including their severity of CF, are indicated in Table 1. The participants in this pilot study represented a wide range of ages from 7.4 years to 40.1 years old, with moderate to excellent disease severity. Participants tolerated all respiratory treatment without adverse consequences. Subjectively, participants reported no discomfort with use of IPV compared with conventional P&PD therapy.

Pulmonary function data for the three treatment regimens are

DISCUSSION

This pilot study compared a novel mechanical device, the IPV-1, with standard chest physiotherapy in ambulatory patients with CF. The IPV-1 is a lightweight, self-contained instrument that simultaneously combines two effective methods of tracheal-bronchial secretion mobilization: chest percussion and the delivery of an aerosolized bronchodilator solution. Facilitating clearance of mucus may allow greater small airway patency and increased expiratory flow rate, with more effective removal of

ACKNOWLEDGMENT

The authors are grateful to Mark Durren, R.R.T., and the Respiratory Care Department of Bronson Methodist Hospital for providing space for the study, the spirometer, and supplies for respiratory treatments. Special thanks to Terry Dennany, R.R.T., for superb technical assistance and to Bruce Rubin, M.D., and Oscar Ramirez, M.D., of the Division of Pulmonary Medicine at Cardinal Glennon Children's Hospital, St. Louis, for performing the sputum analyses. In addition, the authors thank the Bronson

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