Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 23:10:858410.
doi: 10.3389/fped.2022.858410. eCollection 2022.

The Short Term Influence of Chest Physiotherapy on Lung Function Parameters in Children With Cystic Fibrosis and Primary Ciliary Dyskinesia

Bjarne Vandervoort  1 , Django De Beuckeleer  1 , Elke Huenaerts  2 , Marianne Schulte  2 , François Vermeulen  2   3 , Marijke Proesmans  2   3 , Thierry Troosters  1 , Myriam Vreys  1   2 , Mieke Boon  2   3
Affiliations

The Short Term Influence of Chest Physiotherapy on Lung Function Parameters in Children With Cystic Fibrosis and Primary Ciliary Dyskinesia

Bjarne Vandervoort et al. Front Pediatr. .

Abstract

Airway clearance therapy (ACT) is one of the cornerstone treatment modalities to improve mucociliary clearance for patients with bronchiectasis. The progression of lung disease in patients with bronchiectasis can be evaluated by spirometry and multiple breath washout (MBW) and it is advised to monitor these on a regular basis. However, the short term effect of ACT on spirometry and MBW parameters is insufficiently clear and this variability may impact standardization. For cystic fibrosis (CF), available literature refutes a short time effect on spirometry and MBW parameters in children, however, for primary ciliary dyskinesia (PCD) no data are available. We performed a single-center, prospective cross-over study to evaluate the short term effect of a single ACT session using positive expiratory pressure mask on forced expiratory volume in 1 s (FEV1) and lung clearance index (LCI), derived from MBW, compared to no ACT (control) in pediatric patients with CF and PCD. A total of 31 children were included: 14 with PCD and 17 with CF. For the whole group, there was no difference in median change of FEV1 pp between the treatment and the control group (p 0.969), nor in median change of LCI (p 0.294). For the CF subgroup, the mean change in FEV1 pp with ACT was -1.4% (range -9 to + 5) versus -0.2% (range -6 to + 5) for no ACT (p 0.271), the mean change in LCI with ACT was + 0.10 (range -0.7 to + 1.2) versus + 0.17 (range -0.5 to + 2.8) for no ACT (p 0.814). In the PCD subgroup, the mean change in FEV1 pp with ACT was + 1.0 (range -7 to + 8) versus -0.3 (range -6 to + 5) for no ACT (p 0.293) and the mean change in LCI with ACT was -0.46 (range -3.7 to + 0.9) versus -0.11 (range -1.4 to + 1.3) for no ACT (p 0.178). There was no difference between PCD and CF for change in FEV1 pp after ACT (p = 0.208), nor for LCI (p = 0.095). In this small group of pediatric patients, no significant short-term effect of chest physiotherapy on FEV1 pp nor LCI in PCD and CF values nor variability was documented.

Keywords: airway clearance; bronchiectasis; cystic fibrosis; physiotherapy; primary ciliary dyskinesia.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Study overview. A total of 33 patients were recruited to participate in the study: 19 with CF, 14 with PCD. Two patients with CF were excluded. Patients were randomly selected before visit 1 for ACT or the control visit. After the first visit, cross-over to the other study intervention was done. In total, data from 17 patients with CF and 14 with PCD were available for spirometry, 15 with CF and 14 with PCD for MBW.
FIGURE 2
FIGURE 2
Change in FEV1 pp after ACT in patients with CF and PCD, compared to the control condition. No significant changes were observed, nor were significant differences observed between CF and PCD. The dashed line indicates the lower limit of normal for FEV1 pp.
FIGURE 3
FIGURE 3
Change in LCI after ACT in patients with CF and PCD, compared to the control condition. No significant changes were observed, nor were significant differences observed between CF and PCD. The dashed line indicates the upper limit of normal for LCI.
FIGURE 4
FIGURE 4
Bland and Altman plot for FEV1 pp in the ACT condition (A) compared to the control condition (B), in patients with CF (black) and patients with PCD (gray). The difference of FEV1 pp is plotted against the mean of FEV1 pp to illustrate the change of the measurement after the intervention. There is no significant difference in change with ACT compared to the control condition.
FIGURE 5
FIGURE 5
Bland and Altman plot for LCI in the ACT condition (A) compared to the control condition (B), in patients with CF (black) and patients with PCD (gray). The difference of LCI is plotted against the mean of LCI to illustrate the change of the measurement after the intervention. There is no significant difference in change with ACT compared to the control condition.
See this image and copyright information in PMC

References

    1. Fahy JV, Dickey BF. Airway mucus function and dysfunction. N Engl J Med. (2010) 363:2233–47. 10.1056/nejmra0910061 - DOI - PMC - PubMed
    1. Chang AB, Fortescue R, Grimwood K, Alexopoulou E, Bell L, Boyd J, et al. European respiratory society guidelines for the management of children and adolescents with bronchiectasis. Eur Respir J. (2021) 58:2002990. 10.1183/13993003.02990-2020 - DOI - PubMed
    1. Elborn JS. Cystic fibrosis. Lancet. (2016) 388:2519–31. - PubMed
    1. Boon M, Jorissen M, Proesmans M, De Boeck K. Primary ciliary dyskinesia, an orphan disease. Eur J Pediatr. (2013) 172:151–62. 10.1007/s00431-012-1785-6 - DOI - PubMed
    1. McIlwaine MP, Son NML, Richmond ML. Physiotherapy and cystic fibrosis: what is the evidence base? Curr Opin Pulm Med. (2014) 20:613–7. 10.1097/MCP.0000000000000110 - DOI - PubMed