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Positive expiratory pressure physiotherapy for airway clearance in people

with cystic fibrosis (Cochrane Review)

A substantive amendment to this systematic review was last made on 22

November 2003. Cochrane reviews are regularly checked and updated if

necessary.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

strategy: We searched the Cochrane Cystic Fibrosis and Genetic Disorders

Group trials register comprising of references identified from

comprehensive electronic database searches and handsearching 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: November 2003.Selection criteria: Randomised

controlled trials in which PEP was compared with any other form of

physiotherapy in people with CF. Data collection and analysis: Two

reviewers independently applied the inclusion and exclusion criteria to

publications and assessed the quality of the included studies. Main

results: Thirty-three studies were identified and twenty studies

involving 429 participants met review inclusion criteria. Most included

studies had low scores on a scale of study quality. Sixteen of these

studies involving 257 participants were cross-over in design. Data were

not published in sufficient detail in 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 one month 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. Patient preference was reported in nine studies. In all

studies with an intervention period of at least one month, measures of

patient 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. Reviewers' conclusions: There was no

clear evidence that PEP was a more or less effective intervention

overallthan 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. Citation: Elkins MR, A, van

der Schans C. Positive expiratory pressure physiotherapy for airway

clearance in people with cystic fibrosis (Cochrane Review). In: The

Cochrane Library, Issue 1, 2004. Chichester, UK: Wiley & Sons, Ltd.

This is an abstract of a regularly updated, systematic review prepared

and maintained by the Cochrane Collaboration. The full text of the review

is available in The Cochrane Library (ISSN 1464-780X).

The Cochrane Library is designed and produced by Update Software Ltd, and

published by Wiley & Sons Ltd.

Becki

Life is not measured by the number of breaths we take, but by the moments

that take our breath away.

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