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.…”

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.…”

Non-Pharmaceutical Techniques for Obstructive Airway Clearance Focusing on the Role of Oscillating Positive Expiratory Pressure (OPEP): A Narrative Review

“…] feedback via St George's Respiratory Questionnaire (SGRQ) total-scores (Table 4). The lung performance measures were largely insensitive to OPEP therapy, confirming previous observations [66]. However, with their sputum-producer cohort, they obtained a small, but significant (paired t test; p = 0.01) improvement in FVC (mean ± SD) from 81 ± 23% to 87 ± 21% predicted.…”

“…Poncin et al [54], based on analyses of studies such as those previously mentioned, observed that, in general, mechanical effects with OPEP devices such as PEP, oscillation frequency, and oscillation amplitude vary widely from one device type to another. These authors also affirmed the observation of Morrison and Innes [59] that clinical studies comparing the efficacy of various OPEP devices with CF patients have thus far failed to report the superiority of any one technique over another. The study by Poncin et al [54] represents a further advance from previous OPEP device comparison attempts, in that they included expiratory profiles from three patients with COPD and CF as well as reference profiles acquired from a healthy adult.…”

Treatment of Pulmonary Disease of Cystic Fibrosis: A Comprehensive Review

“…Morrison et al [ 16 ] did not find any clear evidence that vibrating devices were better than any other form of physiotherapy, which they were compared to in these studies, or that one device was better than another.…”

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.…”

Non-Pharmaceutical Techniques for Obstructive Airway Clearance Focusing on the Role of Oscillating Positive Expiratory Pressure (OPEP): A Narrative Review

“…] feedback via St George's Respiratory Questionnaire (SGRQ) total-scores (Table 4). The lung performance measures were largely insensitive to OPEP therapy, confirming previous observations [66]. However, with their sputum-producer cohort, they obtained a small, but significant (paired t test; p = 0.01) improvement in FVC (mean ± SD) from 81 ± 23% to 87 ± 21% predicted.…”

“…Poncin et al [54], based on analyses of studies such as those previously mentioned, observed that, in general, mechanical effects with OPEP devices such as PEP, oscillation frequency, and oscillation amplitude vary widely from one device type to another. These authors also affirmed the observation of Morrison and Innes [59] that clinical studies comparing the efficacy of various OPEP devices with CF patients have thus far failed to report the superiority of any one technique over another. The study by Poncin et al [54] represents a further advance from previous OPEP device comparison attempts, in that they included expiratory profiles from three patients with COPD and CF as well as reference profiles acquired from a healthy adult.…”

Treatment of Pulmonary Disease of Cystic Fibrosis: A Comprehensive Review

“…Morrison et al [ 16 ] did not find any clear evidence that vibrating devices were better than any other form of physiotherapy, which they were compared to in these studies, or that one device was better than another.…”

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.…”

Non-Pharmaceutical Techniques for Obstructive Airway Clearance Focusing on the Role of Oscillating Positive Expiratory Pressure (OPEP): A Narrative Review

“…] feedback via St George's Respiratory Questionnaire (SGRQ) total-scores (Table 4). The lung performance measures were largely insensitive to OPEP therapy, confirming previous observations [66]. However, with their sputum-producer cohort, they obtained a small, but significant (paired t test; p = 0.01) improvement in FVC (mean ± SD) from 81 ± 23% to 87 ± 21% predicted.…”

“…Poncin et al [54], based on analyses of studies such as those previously mentioned, observed that, in general, mechanical effects with OPEP devices such as PEP, oscillation frequency, and oscillation amplitude vary widely from one device type to another. These authors also affirmed the observation of Morrison and Innes [59] that clinical studies comparing the efficacy of various OPEP devices with CF patients have thus far failed to report the superiority of any one technique over another. The study by Poncin et al [54] represents a further advance from previous OPEP device comparison attempts, in that they included expiratory profiles from three patients with COPD and CF as well as reference profiles acquired from a healthy adult.…”

Treatment of Pulmonary Disease of Cystic Fibrosis: A Comprehensive Review

“…Morrison et al [ 16 ] did not find any clear evidence that vibrating devices were better than any other form of physiotherapy, which they were compared to in these studies, or that one device was better than another.…”