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Meta-Analysis
. 2005 Jan 25;2005(1):CD002011.
doi: 10.1002/14651858.CD002011.pub2.

Conventional chest physiotherapy compared to other airway clearance techniques for cystic fibrosis

E Main  1 , A Prasad, C Schans
Affiliations
Meta-Analysis

Conventional chest physiotherapy compared to other airway clearance techniques for cystic fibrosis

E Main et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Cystic fibrosis is an inherited life-limiting disorder, characterised by pulmonary infections and thick airway secretions. Chest physiotherapy has been integral to clinical management in facilitating removal of airway secretions. Conventional chest physiotherapy techniques (CCPT) have depended upon assistance during treatments, while more contemporary airway clearance techniques are self-administered, facilitating independence and flexibility.

Objectives: To compare CCPT with other airway clearance techniques in terms of their effects on respiratory function, individual preference, adherence, quality of life and other outcomes.

Search strategy: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group trials register which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched CINAHL from 1982 to 2002 and AMED from 1985 to 2002. Date of most recent search: January 2004.

Selection criteria: Randomised or quasi-randomised clinical trials including those with a cross-over design where CCPT was compared with other airway clearance techniques. Studies of less than seven days duration were excluded.

Data collection and analysis: Two reviewers allocated quality scores to relevant studies and independently extracted data. If we were unable to extract data, we invited authors to submit their data. We excluded studies from meta-analysis when data were lost or study design precluded comparison. For some continuous outcomes, we used the generic inverse variance method for meta-analysis of data from cross-over trials and data from parallel-designed trials were incorporated for comparison. We also examined efficacy of specific techniques and effects of treatment duration.

Main results: Seventy-eight publications were identified by the searches. Twenty-nine of these were included, representing 15 data sets with 475 participants. There was no difference between CCPT and other airway clearance techniques in terms of respiratory function measured by standard lung function tests. Studies undertaken during acute exacerbations demonstrated relatively large gains in respiratory function irrespective of airway clearance technique. Longer-term studies demonstrated smaller improvements or deterioration over time. Ten studies reported individual preferences for technique, with participants tending to favour self-administered techniques. Heterogeneity in the measurement of preference precluded these data from meta-analysis.

Authors' conclusions: This review demonstrated no advantage of CCPT over other airway clearance techniques in terms of respiratory function. There was a trend for participants to prefer self-administered airway clearance techniques. Limitations of this review included a paucity of well-designed, adequately-powered, long-term trials.

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Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 CCPT versus specific other treatments, Outcome 1 FEV1 (% predicted).
1.2
1.2. Analysis
Comparison 1 CCPT versus specific other treatments, Outcome 2 FVC (% predicted).
1.3
1.3. Analysis
Comparison 1 CCPT versus specific other treatments, Outcome 3 FEF25‐75 (% predicted).
1.4
1.4. Analysis
Comparison 1 CCPT versus specific other treatments, Outcome 4 Number of hospital admissions.
1.5
1.5. Analysis
Comparison 1 CCPT versus specific other treatments, Outcome 5 Number of days in hospital.
1.6
1.6. Analysis
Comparison 1 CCPT versus specific other treatments, Outcome 6 Schwachman score.
See this image and copyright information in PMC

References

References to studies included in this review

Arens 1994 {published data only}
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McIlwaine 1997 {published data only}
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Reisman 1988 {published data only}
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Tyrrell 1986 {published data only}
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Van Asperen 1987 {published data only}
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References to studies excluded from this review

Baldwin 1994 {published data only}
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Braggion 1995 {published data only}
    1. Braggion C, Cappelletti LM, Cornacchia M, Zanolla L, Mastella G. Short‐term effects of three chest physiotherapy regimens in patients hospitalized for pulmonary exacerbations of cystic fibrosis: a cross‐ over randomized study. Pediatric Pulmonology 1995;19(1):16‐22. - PubMed
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Button 2003 {published data only}
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de Boeck 1984 {published data only}
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Desmond 1983 {published data only}
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Falk 1984 {published data only}
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Giles 1995 {published data only}
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Grasso 2000 {published data only}
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Hartsell 1978 {published data only}
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Kerrebijn 1982 {published data only}
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Kluft 1996 {published data only}
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Lannefors 1992 {published data only}
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Majaesic 1996 {published data only}
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Marks 2000 {unpublished data only}
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Maxwell 1979 {published data only}
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Morris 1982 {published data only}
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Natale 1994 {published data only}
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Newhouse 1998 {published data only}
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Oberwaldner 1986 {published data only}
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Orlik 2001 {published data only}
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Pryor 1979 {published data only}
    1. Hodson ME, Batten JC, Pryor JA, Webber BA. Evaluation of the forced expiration technique as an adjunct to postural drainage in the treatment of cystic fibrosis [abstract]. Proceedings of the 9th Meeting European Working Group for Cystic Fibrosis; 1979 June 12‐13; Noordwijkerhout, The Netherlands. 1979:57.
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Rossman 1982 {published data only}
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Samuelson 1994 {published data only}
    1. Samuelson W, Woodward V, Lowe V. Utility of a Dynamic air therapy bed vs. conventional chest physiotherapy in adult CF patients [abstract]. Pediatric Pulmonology 1994;Suppl 10:313.
Scherer 1998 {published data only}
    1. Scherer TA, Barandun J, Martinez E, Wanner A, Rubin EM. Effect of high‐frequency oral airway and chest wall oscillation and conventional chest physical therapy on expectoration in patients with stable cystic fibrosis. Chest 1998;113(4):1019‐27. - PubMed
Stites 2006 {published data only}
    1. Stites SW, Perry GV, Peddicord T, Cox G, McMillan C, Becker B. Effect of high‐frequency chest wall oscillation on the central and peripheral distribution of aerosolized diethylene triamine penta‐acetic acid as compared to standard chest physiotherapy in cystic fibrosis. Chest 2006;129(3):712‐7. - PubMed
Tonnesen 1984 {published data only}
    1. Tonnesen P, Stovring S. Positive expiratory pressure (PEP) as lung physiotherapy in cystic fibrosis: a pilot study. European Journal of Respiratory Diseases 1984;65(6):419‐22. - PubMed
Warwick 1990 {published data only}
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Warwick 2004 {published data only}
    1. Warwick WJ, Wielinski CL, Hansen LG. Comparison of expectorated sputum after manual chest physical therapy and high‐frequency chest compression. Biomedical Instrumentation Technology 2004;38(6):470‐5. - PubMed

References to studies awaiting assessment

Bain 1988 {published data only}
    1. Bain J, Bishop J, Olinsky A. Evaluation of directed coughing in cystic fibrosis. British Journal of Diseases of the Chest 1988;82(2):138‐48. - PubMed
Giles 1996 {published data only}
    1. Giles D, Sontag M, Wagener J, Accurso F. Effect of one month of treatment with flutter valve or postural drainage and clapping on pulmonary function and sputum recovery in cystic fibrosis [abstract]. Pediatric Pulmonology 1996;Suppl 13:307.
Gondor 1999 {published data only}
    1. Gondor M, Nixon PA, Mutich R, Rebovich PJ, Orenstein DM. Comparison of flutter device and chest physical therapy in the treatment of cystic fibrosis pulmonary exacerbation. Pediatric Pulmonology. 1999; Vol. 28, issue 4:255‐60. - PubMed
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Hare 2002 {published data only}
    1. Hare KL, Homnick DN, Cucos D, Marks JH. The PercussiveTech HF device compared to standard chest physiotherapy in hospitalized patients with cystic fibrosis [abstract]. Pediatric Pulmonology 2002;Suppl 24:316.
Keller 2001 {published data only}
    1. Keller H, Liniger W, Fopp A, Hoch M, Knopfli B. Effects of daily harmonica play during in‐hospital care of patients with cystic fibrosis [abstract]. Proceedings of the 24th European Cystic Fibrosis Conference; 2001 June 6‐9; Vienna, Austria. 2001:P339.
Klig 1989 {published data only}
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Orlik 2000 {published data only}
    1. Orlik T. Evaluation of the efficiency of selected thoracic physiotherapy methods used in the treatment of patients with cystic fibrosis [Ocena efektywnosci wybranych metod fizjoterapii klatki piersiowej stosowanej w leczeniu chorych na mukowiscydoze.]. Medycyna Wieku Rozwojowego 2000, (3):233‐46. - PubMed
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van Hengstum 1988 {published data only}
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Warwick 1991 {published data only}
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