Intervention Review

Positive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis

  1. Mark Elkins1,*,
  2. Alice Jones2,
  3. Cees P van der Schans3

Editorial Group: Cochrane Cystic Fibrosis and Genetic Disorders Group

Published Online: 19 APR 2006

Assessed as up-to-date: 21 FEB 2006

DOI: 10.1002/14651858.CD003147.pub3


How to Cite

Elkins M, Jones A, van der Schans CP. Positive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD003147. DOI: 10.1002/14651858.CD003147.pub3.

Author Information

  1. 1

    Royal Prince Alfred Hospital, Department of Respiratory Medicine, Camperdown, Australia

  2. 2

    The Hong Kong Polytechnic University, Department of Rehabilitation Sciences, Kowloon, Hong Kong, China

  3. 3

    Hanze University Groningen, GRONINGEN, Netherlands

*Mark Elkins, Department of Respiratory Medicine, Royal Prince Alfred Hospital, Level 11 South, Edinburgh Building, Missenden Road, Camperdown, NSW 2050, Australia. elkinsm@med.usyd.edu.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 APR 2006

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Chest physiotherapy is widely prescribed to assist the clearance of airway secretions in people with cystic fibrosis (CF). Positive expiratory pressure (PEP) devices provide constant back pressure to the airways during expiration. This may improve clearance by building up gas behind mucus via collateral ventilation. Given the widespread use of PEP devices, there is a need to determine the evidence for their effect.

Objectives

To determine the effectiveness and acceptability of PEP devices compared to other forms of physiotherapy as a means of improving mucus clearance and other outcomes in people with CF.

Search methods

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. The electronic database CINAHL was also searched from 1982 to 2001.

Most recent search of the Group's register: February 2006.

Selection criteria

Randomised controlled studies in which PEP was compared with any other form of physiotherapy in people with CF.

Data collection and analysis

Two authors independently applied the inclusion and exclusion criteria to publications and assessed the quality of the included studies.

Main results

Forty studies were identified and twenty-five studies involving 507 participants met the review inclusion criteria. Most included studies had low scores on a scale of study quality. Twenty of these studies involving 300 participants 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. Single interventions or series of treatments continued for up to three months demonstrated no significant difference in effect between PEP and other methods of airway clearance on FEV1. Long-term studies had equivocal or conflicting results regarding the effect on FEV1. Participant preference was reported in nine studies. In all studies with an intervention period of at least one month, measures of participant preference were in favour of PEP. The results for the remaining outcome measures were not examined or reported in sufficient detail to provide any high level evidence.

Authors' conclusions

There was no clear evidence that PEP was a more or less effective intervention overall than other forms of physiotherapy. There was limited evidence that PEP was preferred by participants compared to other techniques, but this finding is from studies of low quality.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Not enough strong evidence about the effects of positive expiratory pressure (PEP) devices for chest physiotherapy for people with cystic fibrosis

Cystic fibrosis (CF) causes frequent respiratory infection and blocks the airways with mucus secretions. Chest physiotherapy is frequently used to try to clear these secretions out of the lungs. Positive expiratory pressure (PEP) devices provide pressure behind the mucus to try to push it out of the lungs. The review of studies found only weak evidence about the effects of PEP. The evidence does not show that PEP is more effective than other methods of chest physiotherapy. There was some evidence that people with CF may prefer PEP to other chest physiotherapy methods, but more research is needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

囊狀纖維化患者呼吸道廓清的吐氣正壓物理治療

胸部物理治療被廣泛的用於輔助囊狀纖維化(CF)患者清除呼吸道分泌物。吐氣正壓(PEP)設備可以提供呼吸道在吐氣時固定的背景壓力,它能經由側肢循環在黏液後累積空氣,以改善呼吸道廓清情形。有鑑於PEP設備的廣泛使用,我們必須確定它的效果。

目標

為了確定PEP設備相較於其他形式的物理治療用於改善CF患者在廓清黏液以及其他結果的效力及可接受性。

搜尋策略

我們搜尋了Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register,其中包含綜合性電子資料庫、相關期刊以及學術會議摘要等的參考資料。同時,我們也搜尋了CINAHL電子資料庫從1982年到2001年的資料。最新的搜尋資料是2006年2月。

選擇標準

比較PEP與其他形式的物理治療用於CF患者身上之隨機對照試驗。

資料收集與分析

2位作者分別的採用納入與排除條件來挑選並評估這些研究的品質。

主要結論

總共有40篇研究被挑選出,其中共有25個研究、507位受試者符合回顧的納入條件。大部分被採用的研究之研究品質分數都不高。其中20份研究、包含300位受試者被交叉比對。大多數的研究並沒有提出充分仔細的數據以進行統合設分析。第1秒用力吐氣容積(FEV1)是最常被用來計量的結果。PEP或是其他呼吸道廓清法在單一療法或是持續3個月以內的系列治療上,結果都並未顯示它們的FEV1有明顯差異。而長期研究的FEV1影響方面,則出現模稜兩可或是互相違背的結果。有9項研究有提出受試者的偏好。在所有至少治療1個月的研究中,受試者比較偏好PEP療法。其他預後的結果並未被充分仔細的檢視及報告,因此無法提供任何高階證據。

作者結論

並沒有明顯的證據證明PEP相較於其他物理治療來說,其療效是更好或更差。只有有限的證據提出受試者比較偏好PEP療法,但這是從低品質研究中所得出的結論。

翻譯人

本摘要由臺灣大學附設醫院林珮璇翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有足夠的證據證明吐氣正壓(PEP)設備對於囊狀纖維化患者肺部物理治療的效果如何。 囊狀纖維化患者(CF)容易造成呼吸道感染,並且分泌的黏液容易阻塞呼吸道。肺部物理治療常常用於企圖清除這些肺部的分泌物。吐氣正壓(PEP)設備可以提供壓力協助將黏液推出肺部。這篇研究回顧只發現了有關PEP效能的微弱證據。證據並未指出PEP比其他肺部物理治療方法更有效。有部份的證據顯示相較於其他肺部物理治療方法,CF患者可能比較喜歡PEP,但我們仍需要更多的研究來證實。