Original ArticlesLong-term comparative trial of positive expiratory pressure versus oscillating positive expiratory pressure (flutter) physiotherapy in the treatment of cystic fibrosis☆,☆☆
Section snippets
Patients
Patients with CF attending BC’s Children’s Hospital CF Clinic (n = 40, 24 boys), aged 7 to 17 years, with Shwachman scores 54 to 98 and forced expiratory volume in 1 second 47% to 107% predicted for age, sex, and height were enrolled. Informed consent was obtained as approved by the University of British Columbia Ethical Review committee. The diagnosis of CF was confirmed by the Gibson-Cooke sweat test.18 At entry to the study all patients were performing the PEP technique as their daily home
Results
A broad range of pulmonary function was represented (FEV1 47% to 107% predicted). Both groups appeared to be evenly matched with regard to FEV1, age, colonization with Pseudomonas aeruginosa, Shwachman score, and sex (Table).Empty Cell Group A Group B PEP Flutter Mean FVC (%) 92.40 ± 12.93 90.81 ± 15.35 Mean FEV1 (%) 84.45 ± 16.32 81.25 ± 16.32 Mean FEF25-75 (%) 59.45 ± 22.96 54.85 ± 17.48 Mean Shwachman 86.45 ± 9.77 84.90 ± 8.52 Pseudomonas aeruginosa colonization 8/20 10/20
Discussion
This study compared the efficacy of physiotherapy with the flutter device versus the PEP technique. Although we could not mask (“blind”) the patient or physiotherapist as to which technique the patient with CF was performing, the clinic physicians assessing the patients and the respiratory therapist performing pulmonary function testing were blinded as to which physiotherapy technique the patients were using. Compliance (or adherence) also was an important issue in this study, because it is one
Acknowledgements
The authors thank Anna Gravelle and Sharon Gyorgy from the Division of Biochemical Diseases and Cystic Fibrosis Clinic, the physiotherapy staff at B.C.’s Children’s Hospital, and the safety monitoring committee for this study.
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Supported by Telethon Funds, B.C.’s Children’s Hospital, Vancouver, British Columbia, Canada.
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Reprint requests: A. G. F. Davidson, MD, B.C.’s Children’s Hospital - Room 2C66, 4480 Oak St, Vancouver, British Columbia V6H 3V4, Canada.