BackgroundCystic fibrosis patients require daily airway clearance therapies. The primary objective of this study was to compare the short-term efficacy of high-frequency chest compression and positive expiratory pressure mask on expectorated sputum, pulmonary function, and oxygen saturation in patients with CF hospitalized for an acute pulmonary exacerbation.MethodsA controlled randomized cross-over trial with 24 hours between treatments was used. Thirty-four CF patients (26 ± 6.5 years) were included in the study. Before and 30 minutes after each treatment were recorded: pulmonary function testing, oxygen saturation, and perceived dyspnea. Preference for the two devices was assessed.ResultsNo statistically significant difference between high-frequency chest compression and positive expiratory pressure mask was found in sputum production and in lung function testing. A reduction in SpO2 was found after positive expiratory pressure mask (98 ± 1.0% versus 97 ± 1.2%; P < 0.001). Both treatments induced a statistically significant increase in Borg scale for dyspnea without differences between them. Patients reported greater satisfaction with positive expiratory pressure mask than with high-frequency chest compression (P < 0.001).ConclusionHigh-frequency chest compression and positive expiratory pressure mask have comparable short-term effects on expectorated sputum and lung function. Although positive expiratory pressure mask was associated with a lower SpO2, it was better tolerated than high-frequency chest compression.KeywordsAirway clearance therapies; High-frequency chest compression; Sputum; Cystic fibrosis

Background: The appropriate criteria for patient selection are still a key issue in the clinical management of patients referred to pulmonary rehabilitation (PR). Methods: We retrospectively analyzed the records of a wide population of 1470 outpatient or inpatients with chronic obstructive pulmonary disease (COPD) referred to standard PR at two specialized Italian centers. Two models of multivariate logistic regression were developed to test the predictive powers of baseline exercise tolerance, namely the distance walked in 6 mins (6MWD), and of baseline dyspnea on exertion, measured by the modified Medical Research Council scale (mMRC), versus the minimal clinically important difference (MCID) for the same outcomes. Results: Compared to the category of individuals with 6MWD >350 meters, those patients with 201-350 meters and ≤200 meters showed a higher probability (p<0.001) of predicting a MCID change. Compared to the category of individuals with mMRC 0-1point, all the other categories (2, 3, and 4) also showed a higher probability (p<0.001) of predicting a MCID change. The incorporation of baseline categories of 6MWD and mMRC in a risk chart showed that the percentage of patients reaching MCID in both variables increased as the baseline level of 6MWD decreased and of mMRC increased. Conclusion: This study demonstrates that lower levels of exercise tolerance and greater perceived dyspnea on exertion predict achieving clinically meaningful changes for both these treatment outcomes following PR. A specific risk chart that integrates these two variables may help clinicians to select ideal candidates and best responders to PR.

Dyspnea is a common symptom in Systemic Sclerosis (SSc) that considerably decreases patients’ quality of life (QoL). Pulmonary Rehabilitation (PR) mitigates dyspnea impact on daily activities. The aim of this study is to evaluate the effect on respiratory disability of home-based PR in SSc patients with dyspnea. In this observational prospective monocentric study, we screened all dyspneic SSc consecutive patients attending the Rheumatological day hospital in the University hospital of Parma from January 2019 and June 2019. The aim of our study was to understand if a PR unsupervised home-based program could improve respiratory disability in this specific population. Dyspnea was evaluated with the self-administered questionnaires modified Medical Research Council (mMRC) and  Saint George's Respiratory Questionnaire (SGRQ).Patients also filled in Short Form 36 (SF36) and the Modified-Health Assessment Questionnaire for SSc (HAQ-MOD). Health Professionals assessed and trained the patients and collected data before PR and at the end of the program. PR consisted in 5 weekly unsupervised sessions for 8 weeks. Wilcoxon test for paired data evaluated the changes after PR. p<0.05 was considered statistically significant. 46 SSc patients were included (43 female). Only 31 (29 female) performed PR as planned (Adherent Group-AG) while the others gave up within the first week (Non-Adherent Group-NAG). All SGRQ domains (Symptoms: from 30 to 18; p=0.0055; Activity: from 47 to 35, p=0.23; Impact from 29 to 25, p=0.044) and SGRQ total score (from 35 to 29; p=0.022) improved in AG. SGRQ scores did not change in NAG as well as SF36 and HAQ-MOD in both groups. The home-based PR program dramatically decreased the effect, frequency and severity of respiratory symptoms. Conversely, it slightly changed the activities causing breathlessness and dyspnea-related social functioning disturbances. PR appears to be a useful tool in treatment strategies aiming to achieve a QoL improvement in SSc patients.

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Background: Mucus hypersecretion has a negative impact in chronic obstructive pulmonary disease (COPD). Expiratory Flow Accelerator (EFA) technique removes secretions noninvasively by accelerating expiratory flow. The aim of our study was to compare EFA efficacy with the non-oscillatory positive expiratory pressure (PEP) bottle in airways clearing in COPD with hypersecretion and reduced cough efficiency after severe exacerbation. Methods:In an exploratory prospective, randomized, open-label study, we analyzed COPD patients with severe airflow obstruction (forced expiratory volume at 1 st second-FEV 1 <50%), mucus hypersecretion (sputum volume >30 ml/die) and reduced cough efficiency (peak cough expiratory flow-PCEF <300 l/min) referred to pulmonary rehabilitation after severe exacerbation. Comparison was made between group using EFA and group using PEP. Primary outcome was change in perceived bronchial encumbrance (visual analogue scale-VAS). Secondary outcomes were changes in peak expiratory flow (PEF), PCEF, lung volumes, arterial blood gases exchanges, maximum inspiratory and expiratory pressure (MIP and MEP), health status (COPD questionnaire score-CCQ) and impact of disease (COPD Assessment Test-CAT).Results: Twenty seven patients completed the study (14 EFA, 13 PEP). VAS, CAT, and CCQ improved in both groups (p<0.05). A greater improvement in VAS was recorded in the EFA group. Static and dynamic volumes (residual volume-RV and forced vital capacity-FVC) improve in both groups while total lung capacity (TLC) and MIP improved in the EFA group. No significant changes were recorded for arterial blood gases, PEF and PCEF. Conclusions:EFA technique can enhance airways clearing in these patients, improving lung volumes and inspiratory muscle strength.