Physiotherapy in cystic fibrosis: optimising techniques to improve outcomes

Rand, S.; Hill, L.; Prasad, S. Ammani

doi:10.1016/j.prrv.2012.08.006

Cited by 30 publications

(44 citation statements)

References 54 publications

(73 reference statements)

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“…A c c e p t e d M a n u s c r i p t 4 would move the focus towards techniques that are chosen as much for the needs of parents and families, who are more involved at that stage, as the needs of the person with CF.…”

Section: Page 4 Of 24mentioning

confidence: 99%

“…Many different airway clearance techniques have been developed and modified to optimise outcomes in CF [4]. Despite various studies and meta-analyses (including five Cochrane systematic reviews), the best airway clearance technique for people with CF has yet to be identified [5].…”

Section: Introductionmentioning

confidence: 99%

“…Adherence is crucial for an airway clearance technique to work optimally [4], and self-reported adherence correlates best with self-reported satisfaction with a particular airway clearance technique [10]. There is emerging evidence that giving people with CF a choice of airway clearance techniques may improve outcome [34].…”

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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: Page 4 Of 24mentioning

confidence: 99%

Section: Introductionmentioning

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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“…Here the neutrophils eventually degenerate and disgorge their cellular contents, [38] including large quantities of nuclear DNA and cytoskeletal actin, both of which are known to markedly increase the viscosity of sputum when released into the airway [1]. Hence, inhalation of mucolytics and clearance of viscous airway secretions with physiotherapy are a cornerstone in the management of established CF pulmonary disease [39][40][41]. The most common mucoactive agents used in CF care are rhDNase and HS [41].…”

Section: Bhr and Mucolyticsmentioning

confidence: 99%

“…Hence, inhalation of mucolytics and clearance of viscous airway secretions with physiotherapy are a cornerstone in the management of established CF pulmonary disease [39][40][41]. The most common mucoactive agents used in CF care are rhDNase and HS [41]. …”

Section: Bhr and Mucolyticsmentioning

confidence: 99%

Bronchial Hyperreactivity Related to Inhalation Therapy in Cystic Fibrosis Patients

Eyns¹

2014

J Pulm Respir Med

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It is presumed that bronchial hyperreactivity (BHR) can occur with any inhaled agent and may be a reason for discontinuation of inhalation therapy in cystic fibrosis (CF) patients. On the other hand, inhalation of antibiotics is being increasingly used to eradicate or treat infections.This review focuses on identifying the mechanisms of BHR for a better understanding of its impact on inhalation treatment. BHR in CF is suggested to be secondary to underlying airway disease (associated to poor pulmonary function, chronic inflammation and aerosol distribution) or to be a separate condition occurring more in CF. Furthermore, certain characteristics of the aerosol solution itself, such as the active molecule, chemical additives and particle size, can cause BHR.Recombinant human DNase (rhDNase), hypertonic saline (HS) and the antibiotics tobramycin, colistin and aztreonam lysine for inhalation (AZLI) are frequently used inhalation drugs in the treatment of CF. Prevalence of BHR related to both short and long-term inhalation of these drugs as reported in the literature was investigated. Acute BHR is documented in up to two thirds of CF patients. Despite the widespread use of rhDNase, HS, tobramycin, colistin and AZLI, only one long-term trial looked for, but did not demonstrate, BHR at the end of the trial period.

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Autogenic drainage for airway clearance in cystic fibrosis

McCormack

Burnham

Southern

2017

Cochrane Database of Systematic Reviews

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BackgroundAutogenic drainage is an airway clearance technique that was developed by Jean Chevaillier in 1967. The technique is characterised by breathing control using expiratory airflow to mobilise secretions from smaller to larger airways. Secretions are cleared independently by adjusting the depth and speed of respiration in a sequence of controlled breathing techniques during exhalation. The technique requires training, concentration and effort from the individual. It is important to systematically review the evidence demonstrating that autogenic drainage is an effective intervention for people with cystic fibrosis. ObjectivesTo compare the clinical effectiveness of autogenic drainage in people with cystic fibrosis with other physiotherapy airway clearance techniques. Search methodsWe searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews, as well as two trials registers (31 August 2017).

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Physiotherapy in cystic fibrosis: optimising techniques to improve outcomes

Cited by 30 publications

References 54 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

Bronchial Hyperreactivity Related to Inhalation Therapy in Cystic Fibrosis Patients

Autogenic drainage for airway clearance in cystic fibrosis

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