Chest
Volume 106, Issue 6, December 1994, Pages 1872-1882
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Chest Physiotherapy and Cystic Fibrosis: Why Is the Most Effective Form of Treatment Still Unclear?

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CONVENTIONAL CHEST PHYSICAL THERAPY

Chest physiotherapy has been incorporated in the management of suppurative lung conditions since the early 1900s.9,10 Chest physiotherapy included postural drainage, breathing exercises for relaxation and improving ventilation to atelectatic areas, percussion and vibration for increasing mucociliary clearance, and coughing. This combination of techniques was accepted as the standard daily physiotherapy management for CF patients regardless of the severity of pulmonary disease. Now, it is known

Cough

A session of directed coughing can be as effective as conventional CPT in improving the pulmonary function of CF patients.12, 13, 14 Rossman et al (1982)14 showed that vigorous directed coughing was as effective as therapist-administered CPT in the removal of isotope-labelled respiratory secretions in a group of six clinically stable CF subjects. CPT has been found to result in an increased volume of sputum expectorated and an increased peripheral isotope clearance.14, 15, 16, 17, 18 Lorin and

Definition of Techniques

In general, individual CPT techniques are poorly defined within studies, and this is perhaps the most confounding factor when reviewing the literature. While the later studies (1988 onward) make a concerted effort to describe techniques in detail or reference a source for clarification, most studies are unclear regarding which components are specifically included. This is particularly evident in studies comparing treatment regimens, for example, PEP vs FET, multimodality CPT vs cough, and

CONCLUSION

Chest physiotherapy is generally accepted as a routine part of the medical management of CF patients. Despite the extensive array of literature concerning the effects of various physiotherapy regimens, the most effective form of CPT treatment has yet to be conclusively proven. Interpretation and analysis of the results of these studies is difficult due to technical, methodologic, and statistical factors. There is a great need for improvements in experimental research design if future studies of

ACKNOWLEDGMENTS

I wish to thank Dr. D. W. Parsons and Dr. A. J. Martin, Department of Pulmonary Medicine, Women's and Children's Hospital, Adelaide, South Australia, and Dr. Elizabeth Ellis, School of Physiotherapy, University of Sydney, for reviewing the manuscript.

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    This study was supported in part by grants from the Women's and Children's Hospital and the University of South Australia, Adelaide.

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