Don't shake it all about

Airway clearance techniques in cystic fibrosis are probably regarded by patients with as much enthusiasm as children contemplate a plate of brussels sprouts. High frequency, external chest wall oscillation looked like the perfect answer—wrap yourself up in a vest or jacket, plug in and switch on, it vibrates away while you watch TV or whatever, and then some minutes later, all done! However, no gain without pain, and this pain-free (but very expensive) physiotherapy technique in fact turns out to be inferior to the bump and grind positive pressure device mask. McIlwaine et al (see page 746, Editors’ choice) recruited over 100 CF patients to a year-long randomised controlled trial of oscillation versus positive pressure mask (the latter >200-fold cheaper), and showed that there were fewer CF lung attacks and a longer time to first attack in those using the positive pressure mask. Congratulations to the investigators on improving the evidence free land of chest physiotherapy, and for showing clear benefit of one technique …