Long-term multicentre randomised controlled study of high frequency chest wall oscillation versus positive expiratory pressure mask in cystic fibrosis

McIlwaine, Maggie; Alarie, Nancy; Davidson, George; Lands, Larry C.; Ratjen, Félix; Milner, Ruth; Owen, Blythe; Agnew, Jennifer L.

doi:10.1136/thoraxjnl-2012-202915

Cited by 87 publications

(77 citation statements)

References 24 publications

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“…The results of this survey influenced the choice of airway clearance techniques used for the comparator and intervention arms in a recent multicentre randomised control trial [13]. The proportions of the different airway clearance techniques recorded for people with CF in the UK are broadly comparable with Canada, except for a bias towards PEP over oscillating PEP in Canada.…”

Section: Variation By Countrymentioning

confidence: 96%

“…high-frequency chest wall oscillation, non-invasive ventilation) being reserved for sicker patients. However, recent trials comparing high-frequency chest wall oscillation with PEP have raised uncertainty regarding the effectiveness of high-frequency chest wall oscillation for airway clearance [13,32]. It will be interesting to repeat a similar analysis in several years' time to determine if the pattern of airway clearance techniques changes with emerging evidence.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

“…Three of the four recent randomised controlled trials on airway clearance techniques used PEP or oscillating PEP in one of the comparator arms [13][14][15]. Given their level of use across different countries and the relative evidence of benefit, all future randomised control trials on airway clearance techniques should consider using PEP or oscillating PEP as a comparator.…”

Section: Levels Of Airway Clearance Technique Use In the Ukmentioning

confidence: 99%

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Airway clearance techniques used by people with cystic fibrosis in the UK

et al. 2015

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Please cite this article as: Hoo ZH, Daniels T, Wildman MJ, Teare MD, Bradley JM, Airway clearance techniques used by people with cystic fibrosis in the UK, Physiotherapy (2015), http://dx.doi.org/10.1016/j.physio. 2015.01.008 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Setting and participants All people with CF in the UK aged ≥11 years (n=6372). ResultsOf the 6372 people on the UK CF registry in 2011, 89% used airway clearance techniques.The most commonly used primary techniques were forced expiratory techniques (28%) and oscillating positive expiratory pressure (PEP) (23%). Postural drainage and high-frequency chest wall oscillation were used by 4% and 1% of people with CF, respectively. The male:female ratio of individuals who used exercise as their primary airway clearance technique was 2:1, compared with 1:1 for other techniques. Individuals with more severe lung disease tended to use devices such as non-invasive ventilation or high-frequency chest wall oscillation.Conclusions Forced expiratory techniques and oscillating PEP are the most common airway clearance techniques used by people with CF in the UK, and postural drainage and high-frequency chest wall oscillation are the least common techniques. This is significant in terms of planning airway clearance technique trials, where postural drainage has been used traditionally as the comparator. The use of airway clearance techniques varies between countries, but the reasons for these differences are unknown.

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Section: Variation By Countrymentioning

confidence: 96%

Section: Baseline Characteristicsmentioning

confidence: 99%

Section: Levels Of Airway Clearance Technique Use In the Ukmentioning

confidence: 99%

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Airway clearance techniques used by people with cystic fibrosis in the UK

et al. 2015

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“…However, multiple different techniques are used, and the optimal approach is not clear. A recent multicentre randomized controlled study found no evidence in support of high-frequency chest wall oscillating devices (vests) when compared to positive expiratory pressure (the most commonly used method of airway clearance) and actually found a higher level of pulmonary exacerbations (PEs) requiring antibiotics associated with their use [McIlwaine et al 2013]. Multiple interventions to promote health and exercise have been trialled although there is no unanimous verdict over which technique has been the most successful [Cox et al 2013].…”

Section: Physiotherapy and Exercisementioning

confidence: 99%

Current and future treatment options for cystic fibrosis lung disease: latest evidence and clinical implications

Edmondson

Davies

2016

Therapeutic Advances in Chronic Disease

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Treatment for cystic fibrosis (CF) has conventionally targeted downstream consequences of the defect such as mucus plugging and infection. More recently, significant advances have been made in treating the root cause of the disease, namely a defective CF transmembrane conductance regulator (CFTR) gene. This review summarizes current pulmonary treatment options and highlights advances in research and development of new therapies

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“…Failure of response is also described in primary ciliary dyskinesia [6]. Lung attacks, as we shall continue to describe them, have been used as clinical trial end-points in CF [7] and bronchiectasis [8], and may be a more sensitive marker of response than spirometry [9]. They are very far from being a minor and reversible inconvenience to the patient with airways disease.…”

mentioning

confidence: 99%

Asthma attacks: should we nail our colours to the mast (cell)?

2016

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@ERSpublications Why do only some asthmatic children exacerbate, what is the underlying pathology, and how should we treat them? http://ow.ly/Mrik304eIVUMany common airway diseases are characterised by chronic symptoms with interspersed acute and unpredictable deteriorations, conventionally called "pulmonary exacerbations". Until relatively recently, these so-called exacerbations were a rather Cinderella subject, relatively neglected in favour of treating day-to-day problems. This may in part be because in asthma, for example, we have treatments such as inhaled corticosteroids (ICS) which are enormously effective in treating chronic symptoms, but prevention of exacerbations is much less successful. However, it is becoming increasingly clear that pulmonary exacerbations carry much more sinister overtones than once we thought, to the extent that the term "lung attacks" has been proposed to describe them [1,2]. In cystic fibrosis (CF), treatment of lung attacks even with intravenous antibiotics may fail to restore spirometry to baseline [3], and are associated with an accelerated decline in lung function [4] and a worse prognosis [5]. Failure of response is also described in primary ciliary dyskinesia [6]. Lung attacks, as we shall continue to describe them, have been used as clinical trial end-points in CF [7] and bronchiectasis [8], and may be a more sensitive marker of response than spirometry [9]. They are very far from being a minor and reversible inconvenience to the patient with airways disease.Exacerbations of asthma cause considerable morbidity and mortality; and, as recently confirmed yet again by the UK National Review of Asthma Deaths (NRAD) [10], a previous acute attack is a very strong predictor of asthma death. It has long been known that, physiologically, loss of asthma control and asthma attacks are different phenomena [11]. Furthermore, asthma attacks are predictive both of failure of normal airway growth [12], and an accelerated rate of decline of spirometry [13]. It is thus very clear that understanding why patients have asthma attacks, and preventing them, is a high priority. It is also abundantly clear that our definitions of "severe" asthma are woefully inadequate, a point to which we return; nearly 70% of asthma deaths were in people who did not have "severe" asthma [10], despite most people believing that asthma death is a pretty bad outcome! However, seemingly paradoxically, only a subset of asthmatics appear to exacerbate [14], and this is certainly an area in which risk stratification is needed. Reasons for asthma attacks may be considered as behavioural and biological, and so prevention needs a multifaceted approach. On the behavioural side, failure to attend follow-up appointments, overuse of short-acting β2-agonists and underuse of ICS are among the most important factors [10]. Biologically, the combination of viral infection, allergen sensitisation and high environmental allergen exposure are strongly predictive of attacks needing hospitalisation [15]. Adult data, in particular, have...

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Long-term multicentre randomised controlled study of high frequency chest wall oscillation versus positive expiratory pressure mask in cystic fibrosis

Cited by 87 publications

References 24 publications

Airway clearance techniques used by people with cystic fibrosis in the UK

Airway clearance techniques used by people with cystic fibrosis in the UK

Current and future treatment options for cystic fibrosis lung disease: latest evidence and clinical implications

Asthma attacks: should we nail our colours to the mast (cell)?

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