Background: Chest physiotherapy has been used for many years to assist in the removal of abnormal viscid bronchial secretions in cystic fibrosis (CF) patients. Objectives:This study compared the short-term effects of two physiotherapy regimens in patients with CF: autogenic drainage (AD) preceded by either saline inhalation (‘salineNEB + AD’) or by intrapulmonary percussive ventilation (IPV) with saline (‘salineIPV + AD’). Methods: In a randomized crossover design, 20 clinically stable CF patients with similar pulmonary function at baseline received either ‘salineNEB + AD’ or ‘salineIPV + AD’ on 2 consecutive days. Transcutaneous oxygen saturation, heart rate, Borg dyspnea score and mucus wet weight were evaluated after 15 min of either salineNEB or salineIPV, and after a subsequent 30 min of AD. Results: There were no significant changes in oxygen saturation, heart rate or Borg score at any point of either physiotherapy intervention. There was no significant difference in sputum wet weight recovered with either salineNEB (2.2 ± 1.8 g, mean ± SD) or salineIPV (1.7 ± 1.9 g) alone. Subsequent AD did produce significantly greater amounts of sputum wet weight (p < 0.0001 for both) than in the initial saline delivery period, yet the amount of wet weight was similar irrespective of whether AD was preceded by salineNEB (9.7 ± 6.5 g) or salineIPV (11.6 ± 7.3 g). Conclusions: Recovered sputum weight is similar whether AD is preceded by salineNEB or salineIPV. The much greater amount of mucus obtained during the AD period than during the saline delivery period warrants further investigation.
The evidence is not conclusive on whether respiratory physiotherapy induces or aggravates GOR in infants and small children. Age, disease, and treatment options play an important role. More specific research, also focussing on the influence of respiratory physiotherapy on non-acid reflux and the impact of recently developed airway clearance techniques (ACT's) on GOR is necessary.
The Belgian CF Association sent this questionnaire to all Belgian CF patients. Of the 903 questionnaires distributed, 379 (42%) were returned. Fifty-two, 40 and 8% of patients used a vibrating-mesh nebulizer, jet nebulizer, or ultrasonic device, respectively. Ninety-eight percent of patients cleaned their material and soap was used by 35% of patients. Disinfection was performed by 91% of the patients and was daily performed by 57% of patients. Thermal disinfection (boiling water or sterilizer), a hypochlorite-based solution, or acetic acid solution was used by 44, 29, and 25% of patients, respectively, to disinfect their nebulizers. Thermal disinfection was used by 37 and 53% of patients using a classical or vibrating-mesh nebulizer, respectively. After cleaning or disinfection, 91% of the material was dried. The high percentage of Belgian CF patients disinfecting their nebulizer proves that they seem aware of the hygiene problem. The lack of unanimous guidelines in Belgium at the time of the study perhaps explains the variety of methods used. The arrival of vibrating-mesh nebulizers has led to a change in disinfection methods.
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