There are now more than 80 Cochrane Reviews of a wide variety of interventions for people with cystic fibrosis. In May 2017, one of these was updated by Lisa Morrison and Stephanie Milroy from the Queen Elizabeth Hospital in Glasgow in Scotland to bring together the latest evidence on the effects of oscillating devices. Lisa tells us what they found in this podcast.
John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. There are now more than 80 full Cochrane Reviews of a wide variety of interventions for people with cystic fibrosis. In May 2017, one of these was updated by Lisa Morrison and Stephanie Milroy from the Queen Elizabeth Hospital in Glasgow in Scotland to bring together the latest evidence on the effects of oscillating devices. Lisa tells us what they found in this podcast.
Lisa: Cystic fibrosis is a genetic disorder which affects the lungs, producing a thick, sticky mucus. This can lead to constant infections and inflammations, damage to the airways and to the function of the lungs over time.
People with cystic fibrosis are helped to clear the mucus using methods such as chest physiotherapy, breathing techniques and mechanical devices, including vibrating devices. These are also sometimes known as oscillators or oscillating devices, and they use pressure which is generated either inside or outside of the person’s body to clear the mucus.
We were most interested in the effects of these devices on lung function, but also explored secondary outcomes related to sputum volume, frequency of exacerbations and hospitalisations, quality of life and participant satisfaction with the device compared to other methods of airway clearance.
We found 35 studies for this updated review, which now includes data from more than 1100 people with cystic fibrosis aged between 4 and 63 years of age. The studies were mostly quite short, ranging from two days to 13 months in duration, and tested devices that included Flutter, cornet, intrapulmonary percussive ventilation, high frequency chest wall oscillators (such as the Vest®) that were compared to each other or to other airway clearance techniques such as physiotherapy or breathing techniques.
Many of the studies found that lung function improved after people had used a vibrating device, compared to what it was before the study. However, when devices were compared to each other or to other airway clearance techniques, there were few differences in lung function between the interventions.
We found some small but significant changes in sputum volume for oscillating devices compared to other interventions, but one study identified an increase in the frequency of exacerbations requiring antibiotics among patients using an oscillating device compared to an alternative physiotherapy technique.
Participant satisfaction was mixed across the studies. Some preferred the oscillating devices, while others preferred the airway clearance techniques they had been using before they joined the study.
In conclusion, physiotherapists should consider the evidence we have accumulated but also the specific needs of the people they are treating when recommending the most suitable method of airway clearance. For the future, trials need to be larger and longer and to measure outcomes that are of particular importance to patients, including the frequency of lung infections, preference, adherence to and general satisfaction with treatment, and financial constraints faced by those with cystic fibrosis.
John: If you would like to find out more about the trials and the interventions in Lisa’s review, it’s available online at Cochrane Library dot com. Just visit the website and do a search for ‘oscillating devices and cystic fibrosis’ to see it at the top of the list.