We report a study comparing the effects of postural drainage and the administration of positive expiratory pressure as techniques of physiotherapy in the domiciliarymanagement of patients with chronic bronchial sepsis. The comparison is in the form of an open study on 12 patients over a period of six weeks. After two weeks run-in, analysis was performed on the subsequent four weeks, with conventional techniques of postural drainage being administered on one day alternating with the use of positive expiratory pressure on the next. Measurements have been made of sputum production during physiotherapy, total daily sputum production, total time spent on physiotherapy, mean daily peak expiratory flow rates derived from morning and evening measurements, and an assessment of overall well-being derived from a visual analogue scale. At the end of the study the subjects were also asked to score the two techniques with regard to ease of use, convenience of use, effect on clearing secretions and overall performance. Contrary to some earlier studies we find that positive expiratory pressure does not produce an overall improvement in the management of patients with chronic bronchial sepsis. A minority of patients benefit from the technique, but for those who can demonstrate a good independent treatment with postural drainage and the use of the forced expiration technique (FET). The positive expiratory pressure (PEP) mask does not provide added advantages. The technique may serve as a useful adjunct to treatment in some cases, but is not regarded as a method of priority in chest clearance.

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