Chest physiotherapy with positive airway pressure: a pilot study of short-term effects on sputum clearance in patients with cystic fibrosis and severe airway obstruction.
Study design (if review, criteria of inclusion for studies)
Randomised, cross-over trial.
Participants
17 participants with CF. Severe lung disease. Acute participants. Mean (SD) age 27 (7) years; mean (SD) FEV1% predicted 25 (6); mean (SD) BMI 18 (3) kg/m2; mean (SD) MIP% predicted 87 (17); mean (SD) wet weight sputum 5 (5) g.
Interventions
Order of intervention randomised. Treatment twice daily for 70 mins for 2 days per intervention. Intervention 1 directed cough; Intervention 2 mask PEP; Intervention 3 mask CPAP; Intervention for NIV with IPAP 8 - 12 cmH20; EPAP 4 cmH20.
Outcome measures
Sputum wet and dry weight; number spontaneous coughs; FEV1; mean SpO2; participants subjective impression of the effectiveness and fatigue induced by each treatment.
Main results
There was no statistically significant difference in the dry weight of sputum collected: mask PEP 0.9 +/- 0.6 g, CPAP 0.8 +/- 0.4 g, NPPV 0.9 +/- 0.6 g, control treatment 1.0 +/- 0.8 g. There was a statistically significant difference in the wet weight of sputum collected: mask PEP 15.8 +/- 5.5 g, CPAP 13.7 +/- 5.5 g, NPPV 13.2 +/- 5.0 g, control treatment 14.0 +/- 5.0 g (p < 0.05), but that difference became nonsignificant the number of spontaneous coughs were considered. There were no statistically significant changes in the spirometry and pulse-oximetry values. The patients' subjective efficacy scores were similar for mask PEP, CPAP, and NPPV. Less fatigue was reported after NPPV and CPAP than after mask PEP.
Authors' conclusions
There were no differences in sputum clearance or pulmonary-function measures between mask PEP and short-term administration of either CPAP or NPPV combined with directed cough. After mask PEP these patients felt more tired than after CPAP or NPPV secretion-clearance therapy.