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Physiotherapy and airway clearance
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Miguel R. Gonçalves, Amanda J. Piper
While these devices are widely used for patients with obstructive lung disease and secretion encumbrance (28,29), there is little evidence that PEP with or without oscillation is any more or less effective than other techniques aimed at peripheral airway clearance (30–32). Likewise, there is no clear evidence PEP improves short- or long-term outcomes when used during an exacerbation of COPD (33). A number of factors will influence clinician prescription and patient use of an airway clearance technique including cost, convenience, comfort and perceived effectiveness of therapy. Patient preference is important, as this will likely impact acceptance and adherence to routine airway clearance therapy. Patients with NMD and respiratory muscle weakness are unlikely to generate sufficient expiratory flow for PEP devices to be effective and a recent state-of-the-art review recommended against using PEP in this population (34).
Cystic fibrosis infection and biofilm busters
Published in Anthony J. Hickey, Heidi M. Mansour, Inhalation Aerosols, 2019
Jennifer Fiegel, Sachin Gharse
Up to 95% of people with CF die due to respiratory failure caused by chronic bacterial infections, airway inflammation, and the resulting severe lung damage (4,5). Current clinical therapy is primarily focused on managing the disease through a regular treatment routine to ease symptoms and reduce complications. The treatment regimen includes airway clearance therapy, inhaled mucoactive agents, antibiotic therapy, and nutrient therapy. These strategies have significantly improved the quality of life for CF patients and increased their median age from less than 5 years in the early 1950s, before the introduction of airway clearance and antibiotic treatments, to almost 40 years today (3).
The physiotherapy consultation: A qualitative study of the experience of parents of infants with cystic fibrosis in Australia
Published in Physiotherapy Theory and Practice, 2023
Kristen Andrews, Megan Smith, Narelle S Cox
Cystic fibrosis (CF) is a chronic inherited condition typified by a progressive decline in respiratory health. Physiotherapy is an integral component of the CF care regimen and aims to slow the decline of lung function through the use of techniques such as inhalation therapy, airway clearance therapy, musculoskeletal management and exercise (Button et al., 2016). In the Australian context, an average of 87 new diagnosis were made each year between 2014–16, with up to 70% of these diagnoses being made in the first year of life (Ruseckaite et al., 2018). Physiotherapy education is delivered to parents shortly after diagnosis and through subsequent regular clinic appointments (Button et al., 2016; Jessup et al., 2016). Parents of infants with CF are frequently responsible for conducting physiotherapy for their child, in the form of airway clearance techniques, outside of the hospital or clinic environment. This is commonly on a daily basis as guided by their physiotherapist’s recommendations (Ziaian et al., 2006). Early provision of education is required to enable parents to perform physiotherapy independently from the time of their child’s diagnosis (Sawyer and Glazner, 2004). However, parents’ educational needs may vary between individuals and across the dynamic period of growth and behavior change displayed by their child during infancy (Hummelinck and Pollock, 2006).
A retrospective evaluation of vitamin K for hemoptysis in adult cystic fibrosis patients
Published in Hospital Practice, 2021
Elizabeth Marie Gavioli, Kevin Pao, Matthew Harrington
This was an observational single-center study conducted in New York City from 1 January 2016 to 1 January 2018. CF patients were included if they were greater than 18 years of age at time of admission, admitted with an acute pulmonary exacerbation, hospitalized for greater than 48 hours, and hemodynamically stable. There is currently no consensus or formally validated definition of a pulmonary exacerbation of CF. Our institution defines an acute pulmonary exacerbation of CF according to the Fuchs criteria [7]. Patients were excluded if they were admitted to the intensive care unit (ICU), transferred to or from another facility during an exacerbation or had a history of organ transplant or malignancy. Patients were also excluded if they had cirrhosis or liver dysfunction, any bleeding disorders, or on current anticoagulant or antiplatelet therapy. CF patients admitted to our hospital with hemoptysis receive vitamin K supplementation in addition to the standard of care treatments including intravenous (IV) antibiotics. Chest physiotherapy and other airway clearance therapy including mucolytics are typically held in patients with hemoptysis. The aim of this study was to describe a cohort of adult CF patients who utilized vitamin K therapy for hemoptysis during an acute pulmonary exacerbation.
Pharmacotherapeutic strategies for treating bronchiectasis in pediatric patients
Published in Expert Opinion on Pharmacotherapy, 2019
Symptoms of bronchiectasis including chronic productive cough, purulent mucus secretion, impaired mucociliary clearance, and atelectasis can be improved by airway clearance therapy [51]. The diverse methods that can be used for this type of treatment, active cycle of breathing, oscillatory positive expiratory pressure devices, and high frequency assisted airway clearance, can be applied in accordance with the age of the patient and stage of the disease. A supervised program of chest physical therapy for one month has proven to be beneficial for lung function, including forced expiratory volume in 1 s (FEV1) % predicted (mean ± standard deviation, from 74.6 ± 18.8 to 86.3 ± 23.3 in the chest physical therapy group vs from 68.0 ± 11.7 to 68.8 ± 19.7 in the control group), in children with chronic pulmonary diseases compared to unsupervised chest physical therapy at home [52]. The most recent Cochrane review (six studies in adults and one study in children with stable bronchiectasis, low quality evidence) on the effectiveness of airway clearance techniques has identified that they are safe for both children and adults with stable bronchiectasis with respect to improvements in sputum expectoration, lung function, symptoms, and health-related quality of life [53]. However, studies on these areas have been relatively limited due to inadequate study design, especially in children. Nonetheless, airway clearance techniques are recommended on a daily basis and specific choices should be individualized. Future studies on the long-term and short-term effects of airway clearance therapy are needed to improve the prognosis of bronchiectasis in children.