Postural drainage techniques and gastro-oesophageal reflux in infants with cystic fibrosis

Standard (head-down tilt) versus modified (without head-down tilt) postural drainage in infants and young children with cystic fibrosis

“…The angle of the head-down was 20° in the Doumit study and 30° in the Button study (Button 2003;Doumit 2012). According to Button, by reducing the angle of head-down tilt, the likelihood of increasing episodes of reflux is reduced (Button 1999). This may explain the lack of di erence found between the two postural drainage regimens regarding the occurrence of gastroesophageal reflux and the number of proximal episodes in the Doumit study (Doumit 2012) and the higher occurrence of respiratory complications associated with the standard postural drainage in the Button study (Button 2003) and also the di erences between the two postural drainage regimens regarding the occurrence of gastroesophageal reflux (Button 2003).…”

“…Thus, postural drainage is primarily used in infants from diagnosis up to the moment when they are mature enough to actively participate in selfadministered treatments (Lannefors 2004;RBHT 2017). Modified postural drainage is recommended for airway clearance in children with CF under two years of age (Button 2016;RBHT 2017).…”

Focus on gastroesophageal reflux disease in patients with cystic fibrosis

“…Although alternative drugs such as antioxidant agents[ 74 - 78 ], postural drainage[ 79 ], respiratory physiotherapy[ 80 ], and inhaled beta(2)-adrenergic agonists[ 81 ] have been proposed in treating GERD in CF, only a new group of drugs called CF transmembrane conductance regulator (CFTR) modulators seem able to correct the basic effect of CFTR and, consequently, also GERD in this population. Ivacaftor (Kalydeco) and the combination of Ivacaftor and Lumacaftor (Orkambi) are two new molecules that improve chloride transport through CFTR channels respectively in patients with gating mutations and for patients homozygous for the F508del mutation[ 82 ].…”

Routine airway clearance in asymptomatic infants and babies with cystic fibrosis in the UK: obligatory or obsolete?

“…43 An expanding list of publications suggests that postural drainage positions used during standard physiotherapy treatments exacerbate GOR in babies with cystic fibrosis, and create significant risk of lung and oesophageal damage from tracheal aspiration and micro-aspiration. 39,[43][44][45][46][47] More episodes of GOR are measurable recorded during head-down postural drainage treatments than during treatments which avoid such positions, and more severe long-term deterioration in lung function appears to be associated with physiotherapy regimens which include acute head-down positions. 10,18 Furthermore, aspiration of gastric contents has the potential to worsen lung inflammatory processes already evident in infants with cystic fibrosis.…”