ABSTRACT
OBJECTIVE: To compare the short-term efficacy of two respiratory physiotherapy protocols on sputum clearance, lung function and symptoms in patients with cystic fibrosis. Treatment A consisted of diaphragm breathing with incentive spirometry and postural drainage. Treatment B consisted of diaphragm breathing with positive expiratory pressure (PEP-mask) and postural drainage. METHODS: Twenty-seven cystic fibrosis patients in stable condition followed both protocols (A and B) in random order on different days separated by at least 48 hours. After each treatment session the amount of sputum removed was weighed. Lung function variables (FVC, FEV1, FEV1%, MMEFwt-75, MVV and PEF) were measured pre- and posttreatment. PEF was measured with a peak flow meter. The patients later recorded PEF every hour at home and filled in a questionnaire on frequency and intensity of coughing, sputum characteristics, chest discomfort and dyspnea. RESULTS: During treatment A with incentive spirometry, 14.6 +/- 13.7 g of sputum was removed, whereas 9.8 +/- 10.2 g was eliminated during treatment B (p < 0.05). The differences in PEF after treatments A and B in comparison with baseline values were +19.3 l/min and -0.2 l/min, respectively (p < 0.01). PEF stayed high during the afternoon, in comparison with baseline, with treatment A (p < 0.02). After treatment B, no changes in PEF in comparison with baseline were observed (p = 0.49). Neither treatment led to significant differences in symptoms reported on the clinical questionnaire. CONCLUSIONS: Respiratory physiotherapy with incentive spirometry significantly increases sputum clearance in cystic fibrosis patients, with no immediate repercussions on lung function or symptoms.
