Long-term comparative trial of positive expiratory pressure versus oscillating positive expiratory pressure (flutter) physiotherapy in the treatment of cystic fibrosis☆☆☆

Abstract 

Objective: The objective was to evaluate the long-term effects of physiotherapy with an oscillating positive pressure device (“flutter”) compared with physiotherapy with the use of a positive expiratory pressure (PEP) mask in patients with cystic fibrosis (CF). Study design: Forty children with CF were randomly assigned to performing physiotherapy with the PEP mask or the flutter device for 1 year. Clinical status, pulmonary function, and compliance were measured at regular intervals throughout the study. Results: The flutter group demonstrated a greater mean annual rate of decline in forced vital capacity compared with the PEP group (–8.62 ± 15.5 vs 0.06 ± 7.9; P = .05) with a similar trend in forced expiratory volume in 1 second (–10.95 ± 19.96 vs –1.24 ± 9.9; P = .08). There was a significant decline in Huang scores (P = .05), increased hospitalizations (18 vs 5; P = .03), and antibiotic use in the flutter group. Conclusion: Flutter was not as effective in maintaining pulmonary function in this group of patients with CF compared with PEP and was more costly because of the increased number of hospitalizations and antibiotic use.(J Pediatr 2001;138:845-50)

Abbreviations:  CF , Cystic fibrosis, FEF_25-75, Forced expiratory flow between 25% and 75% of vital capacity, FEV₁, Forced expiratory volume in 1 second, FVC , Forced vital capacity, PD&P , Postural drainage and percussion, PEP , Positive expiratory pressure