A comparison of usual chest physiotherapy to other methods of airway clearance in people with cystic fibrosis

Excess mucus is produced in the lungs of people with cystic fibrosis. This leads to recurrent infection and tissue damage. It is important to clear this mucus using drugs and various chest physiotherapy techniques. We aimed to compare the effects of different methods on lung function and patient preference. We looked for studies lasting over one week. We included fifteen studies in the review. These studies did not show any difference between chest physiotherapy and other therapies in terms of lung function. Studies of acute infections showed improved lung function irrespective of type of treatment. Longer-term studies showed smaller improvements or decline. In ten studies participants preferred techniques they administered on themselves. The review was limited by the lack of well-designed long-term trials. We did not find evidence that conventional chest physiotherapy techniques were any better than other treatments for lung function. We can not recommend any single treatment over another at this time.

Authors' conclusions: 

This review was unable to demonstrate any advantage of CCPT over other airway clearance techniques in terms of respiratory function, but this may have reflected insufficient evidence rather than real equivalence between methods. 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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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.


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 conference proceedings. We also searched CINAHL from 1982 to 2002 and AMED from 1985 to 2002.

Date of most recent search: 01 September 2008.

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 authors 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: 

We identified 83 publications and 29 were included, representing 15 data sets (475 participants). There was insufficient evidence to confirm or exclude any differences, 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.