Evaluation of the forced expiration technique as an adjunct to postural drainage in treatment of cystic fibrosis.

Pryor, Jennifer; Webber, B A; Hodson, M E; Batten, John

doi:10.1136/bmj.2.6187.417

Cited by 176 publications

(79 citation statements)

References 3 publications

(1 reference statement)

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“…CAMPBELL et al [25] and WOLLMER et al [26] demonstrated an increase in airflow obstruction when chest clapping was included in an airway clearance regimen, but other studies have not shown any increase [27,28]. Chest clapping has also been shown to cause an increase in hypoxaemia [29,30], but, when short periods of chest clapping (<30 s) have been combined with three or four thoracic expansion exercises, no fall in oxygen saturation has been seen [31].…”

Section: Percussion and Vibrationmentioning

confidence: 99%

Physiotherapy for airway clearance in adults

1999

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Techniques for augmenting, when necessary, the normal mucociliary and cough clearance mechanisms of the lungs are not new, but, in more recent years, techniques have been developed which are effective, comfortable and can be used independent of an assistant in the majority of adolescents and adults.Postural drainage with chest clapping and chest shaking has, in most parts of the world, been replaced by the more effective techniques of the active cycle of breathing, autogenic drainage, R-C Cornet1, Flutter1, positive expiratory pressure mask, highfrequency chest wall oscillation and intrapulmonary percussive ventilation. Glossopharyngeal breathing is being considered again and is often a useful technique for increasing the effectiveness of cough in patients with tetraplegia or neuromuscular disorders.The evidence in support of these techniques is variable, and the literature is confusing and conflicting. There may or may not be significant differences among the techniques in the short or long term. Many of the regimens now include the forced expiratory manoeuvre of a "huff" and this has probably increased the effectiveness of airway clearance. If objective differences are small, individual preferences and cultural influences may be significant in increasing adherence to treatment and in the selection of an appropriate regimen or regimens for an individual patient.

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Section: Percussion and Vibrationmentioning

confidence: 99%

Physiotherapy for airway clearance in adults

1999

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“…[8][9][10][11][12][13][14][15][16][17][18][19][20] However, most studies evaluated efficacy based on spirometry, 8,28,29 the inhalation of a radioaerosol 30 or the volume of expectorated secretion. 10,12,15,18,19,31,32 Thus, the aim of the present study was to examine the viscoelasticity of mucus removed following PD, percussion, and huffing in subjects with cylindrical and/or varicose bronchiectasis.…”

Section: Discussionmentioning

confidence: 99%

“…A number of respiratory physiotherapeutic techniques have been used for this purpose, 7 such as postural drainage (PD), percussion (PERC), the coughing technique (CT), and other types of cough therapy, such as huffing, employed either alone or in combination. [8][9][10][11][12][13][14][15][16][17][18][19][20] However, the studies cited only report the expectorated volume and did not assess the rheological properties of the mucus. Changes in the rheological properties of mucus may interfere with ciliary clearance and clearance by coughing.…”

Section: Introductionmentioning

confidence: 99%

Viscoelastic Properties of Bronchial Mucus After Respiratory Physiotherapy in Subjects With Bronchiectasis

Ramos¹,

Ramos²,

Moreira³

et al. 2015

Respir Care

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BACKGROUND: Previous studies have evaluated the effectiveness of postural drainage (PD), percussion (PERC), the coughing technique (CT), and other types of coughing in subjects with bronchiectasis. However, the application times of these techniques and the quality of the expectorated mucus require further study. The aim of our study was to evaluate the effectiveness of PD, percussion, CT, and huffing in subjects with bronchiectasis and assess the quantity and quality of bronchial mucus produced (measurement of wet and dry weight and determination of viscoelastic properties). METHODS: Twenty-two subjects with stable bronchiectasis (6 men; mean age: 51.5 y) underwent 4 d of experimental study (CT, PD؉CT, PD؉PERC؉CT, and PD؉huffing). The techniques were performed in 3 20-min periods separated by 10 min of rest. Before performing any technique (baseline) and after each period (30, 60, and 90 min), expectorated mucus was collected for analysis of viscoelasticity. RESULTS: A significant increase in the dry weight/wet weight ratio was found after 60 min of PD؉PERC؉CT (P ‫؍‬ .01) and 90 min of PD؉huffing (P ‫؍‬ .03) and PD؉PERC؉CT (P ‫؍‬ .007) in comparison with CT. PD؉PERC؉CT and PD؉huffing led to the greatest removal of viscoelastic mucus at 60 min (P ‫؍‬ .02 and P ‫؍‬ .002, respectively) and continued to do so at 90 min (P ‫؍‬ .02 and P ‫؍‬ .01, respectively) in comparison with CT. An interaction effect was found, as all techniques led to a greater removal of elastic mucus in comparison with CT at 60 min (PD؉CT, P ‫؍‬ .001; PD؉PERC؉CT, P < .001; PD؉huffing, P < .001), but only PD؉PERC؉CT and PD؉huffing led to a greater removal of elastic mucus than CT at 90 min (P < .001 and P ‫؍‬ .005, respectively). CONCLUSIONS: PD؉PERC؉CT and PD؉huffing performed similarly regarding the removal of viscoelastic mucus in 2 and 3 20-min periods separated by 10 min of rest. PD؉PERC؉CT led to the greatest removal of mucus in the shortest period (2 20-min periods separated by 10 min of rest).

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“…Return to breathing control till the patient is ready to begin another cycle. The patient is advised to start coughing out any sputum if necessary [7,8]. Each standardized ACBT cycle lasted approximately for 2 min and was repeated for 15-20 min with postural drainage/gravity assisted drainage i.e., the use of specific positioning in which gravity enhances mucus transport from distal bronchi.…”

Section: Methodsmentioning

confidence: 99%

The Efficacy of Flutter® and Active Cycle of Breathing Techniques in Patients with Bronchiectasis: A Prospective, Randomized, Comparative Study

Üzmezoğlu¹,

Altıay

Özdemır³

et al. 2018

Turk Thorac J

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OBJECTIVES:The objective of the study was to compare the efficacy of an oscillating positive expiratory device and the active cycle of breathing techniques (ACBT) in patients with bronchiectasis. MATERIALS AND METHODS:A home-based study that lasted for 4 weeks was designed to compare the oscillating physiotherapy device Flutter ® and the ACBT in 40 patients, who were randomly assigned into two groups containing 20 patients each. The effect of the two methods of physiotherapy on sputum production, pulmonary functions, and the quality of life was compared. RESULTS:The results of the present study indicate that both the methods were associated with a reduced number of patients complaining of cough and fatigue and increased sputum production (p=0.000, p=0.004, and p=0.002, respectively). In addition, statistically significant reductions were determined by the Medical Research Council and Borg Dyspnea scores (p=0.001 and 0.002, respectively). The Flutter® device caused a more significant effect on the perception of dyspnea. Overall, there was an improvement in the physical sub-scale of the Short Form (SF)-36 Quality of Life Questionnaire scores of 36 patients who completed the study (p=0.001). During the physiotherapy period, no changes in pulmonary functions were observed. Exacerbations were recorded in 3 patients in the ACBT group and in 1 patient in the Flutter® group. CONCLUSION:The Flutter® device and ACBT represent effective home-based physiotherapeutic methods. The Flutter® device appears to be more effective with regard to sputum production.

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Evaluation of the forced expiration technique as an adjunct to postural drainage in treatment of cystic fibrosis.

Cited by 176 publications

References 3 publications

Physiotherapy for airway clearance in adults

Physiotherapy for airway clearance in adults

Viscoelastic Properties of Bronchial Mucus After Respiratory Physiotherapy in Subjects With Bronchiectasis

The Efficacy of Flutter® and Active Cycle of Breathing Techniques in Patients with Bronchiectasis: A Prospective, Randomized, Comparative Study

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