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Oscillating devices for airway clearance in people with cystic fibrosisMorrison L, Agnew J
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SummaryThe use of vibrating devices to help people with cystic fibrosis clear their airways of mucusExcess mucus in the lungs of people with cystic fibrosis can lead to constant infection and inflammation. This damages the airways and results in a progressive loss in lung function. Chest physiotherapy attempts to clear excess mucus from the lungs of people with cystic fibrosis. There are a number of different methods used on their own or in combination with each other - manual techniques, breathing techniques and mechanical devices. Oscillating devices generate pressure within or outside of the body to move the mucus. We included thirty trials (708 people) of different devices in the review. We did not find any evidence that oscillating devices were better than any other form of physiotherapy considered in the included trials. There was little evidence that any one device was better than the others. Physiotherapists should consider the needs of their patients and recommend the most suitable method of airway clearance for the individual. It is therefore advisable to consider in more depth the therapy techniques used (a full description of these can be found under the heading 'Types of Interventions' in the review).
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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January 21. 2009 AbstractBackgroundChest physiotherapy is widely prescribed to assist the clearance of airway secretions in people with cystic fibrosis (CF). Oscillating devices generate intra- or extra-thoracic oscillations orally or external to the chest wall. Internally they create variable resistances within the airways, generating controlled oscillating positive pressure which mobilises mucus. Extra-thoracic oscillations are generated by forces outside the respiratory system, e.g. high frequency chest wall oscillation. ObjectivesTo determine the effectiveness and acceptability of oscillating devices compared to other forms of physiotherapy to improve respiratory function, mucus clearance and other outcomes in people with CF. Search strategyWe searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and hand searches of relevant journals and abstract books of conference proceedings. Selection criteriaRandomised controlled studies and controlled clinical studies of oscillating devices compared with any other form of physiotherapy in people with CF. Data collection and analysisTwo authors independently applied the inclusion criteria to publications and assessed the quality of the included studies. Main resultsTwo hundred and sixty-five studies were identified; thirty studies (total of 708 participants) met the inclusion criteria. Single treatment interventions (therapy technique used only once in the comparison) were excluded. Studies varied in duration from up to one week to one year in duration. Nineteen of the studies were cross-over in design. Data were not published in sufficient detail in most of these studies to perform meta-analysis. Forced expiratory volume in one second (FEV1) was the most frequently measured outcome. Results did not show significant difference in effect between oscillating devices and other methods of airway clearance on FEV1 or other lung function parameters. Where there has been a small but significant change in secondary outcome variables such as sputum volume or weight this has not been wholly in favour of oscillating devices. Participant satisfaction was reported in eleven studies, but this was not specifically in favour of an oscillating device as some participants preferred breathing techniques or techniques used prior to the study interventions. The results for the remaining outcome measures were not examined or reported in sufficient detail to provide any high level evidence. Authors' conclusionsThere was no clear evidence that oscillation was a more or less effective intervention overall than other forms of physiotherapy. More adequately-powered long-term randomised controlled trials are needed. |