Oscillating devices for airway clearance in people with cystic fibrosis

Abstract

There was no clear evidence that oscillation was a more or less effective intervention overall than other forms of physiotherapy; furthermore there was no evidence that one device is superior to another. The findings from one study showing an increase in frequency of exacerbations requiring antibiotics whilst using an oscillating device compared to positive expiratory pressure may have significant resource implications. More adequately-powered long-term randomised controlled trials are necessary and outcomes measured should include frequency of exacerbations, individual preference, adherence to therapy and general satisfaction with treatment. Increased adherence to therapy may then lead to improvements in other parameters, such as exercise tolerance and respiratory function. Additional evidence is needed to evaluate whether oscillating devices combined with other forms of airway clearance is efficacious in people with cystic fibrosis.There may also be a requirement to consider the cost implication of devices over other forms of equally advantageous airway clearance techniques. Using the GRADE method to assess the quality of the evidence, we judged this to be low or very low quality, which suggests that further research is very likely to have an impact on confidence in any estimate of effect generated by future interventions.

Intrapulmonary Percussive Ventilation as an Airway Clearance Technique in Subjects With Chronic Obstructive Airway Diseases

“…However, even though a recent study in bronchiectasis observed such an effect, 40 it was rarely found with other airway clearance techniques in subjects with CF. [41][42][43] In this systematic review, we did not find any benefit of IPV on airway clearance, contrary to what was demonstrated in subjects with Duchenne muscular dystrophy. 19 The wet weight of sputum increased with IPV compared to other airway clearance techniques in 1 study including 3 daily sessions, 30 but the combination of IPV and autogenic drainage was as efficient on sputum as autogenic drainage used alone.…”

“…These new techniques, however, are not always supported by well-designed, randomized studies. [5][6][7] Intrapulmonary percussive ventilation (IPV) derives from high-frequency percussive ventilation, which was initially applied to treat respiratory failure after smoke inhalation or burns. [8][9][10][11] It is a pressure-limited, time-cycled, high-frequency mode of ventilation that delivers sub-physiologic tidal volumes.…”

Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial

“…Physiotherapy with a device creating oscillating positive expiratory pressure, the Flutter®, is an established form of airway clearance in CF and is equally effective to other airway clearance techniques [16]. The Flutter® improves mucus clearance mechanisms in CF by increasing PEF and creating an expiratory airflow bias, [17] as well as reducing sputum mechanical impedance [18].…”

Airway Clearance Strategies in Cystic Fibrosis and Non-Cystic Fibrosis Bronchiectasis

“…PEP devices that contain an expiratory oscillatory component such as the Acapella, RC Cornet, Flutter, Aerobika (Trudell Medical International, Ontario, Canada), Lung Flute (Medical Acoustics, Buffalo, NY), and Quake (Thayer Medical Corporation, Tucson, AZ) are all theoretically useful for patients with tenacious secretions, as the frequency of oscillations are hypothesized to loosen secretions and reduce mucus viscoelasticity. 9,66 They are similar to the PEP device, in that they involve breathing against an expiratory resistance, but the resistance is intermittent or interrupted by a ball valve, lever, or collapsible tubing, such that oscillations of variable frequency (depending on device or use) are transmitted to the airways during the expiratory cycle. An airflow bias is created as the oscillations increase the expiratory airflow.…”

“…6 The best evidence from a plethora of early, underpowered, short-term studies, typically crossover design and 1 to 14 days in length, has been synthesized in five Cochrane reviews related to ACTs for CF, published between 2000 and 2011. [7][8][9][10][11] All conclude that there is currently insufficient evidence to suggest superiority of any one technique over another. The earliest of these reviews, recently updated, compared airway clearance to no treatment in people with CF.…”