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Mucus clearance with three chest physiotherapy regimes in cystic fibrosis: a comparison between postural drainage, PEP and physical exercise
Lannefors L, Wollmer P
The European Respiratory Journal 1992 Jun;5(6):748-753
clinical trial
4/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

The effects of three different regimes of chest physiotherapy were compared in this cross-over study. Mucus clearance was monitored in nine clinically stable cystic fibrosis (CF) patients. The patients performed: (1) postural drainage with thoracic expansion exercises plus forced expiration technique (FET) in the left decubitus position; (2) positive expiratory pressure (PEP)-mask breathing plus FET; and (3) physical exercise on a bicycle ergometer plus FET. All treatments had the same duration and FET was standardized. Mucus clearance was assessed using a technique based on measurement of the elimination of inhaled radiolabelled particles. Mean clearance of tracer from the right lung by postural drainage, PEP and physical exercise was 18% (range 10 to 29%), 20% (12 to 43%), 16% (8 to 25%), respectively, and from the left lung 20% (8 to 42%), 15% (5 to 23%) and 13% (5 to 17%), respectively. The differences were not statistically significant. Surprisingly, postural drainage (PD) was the most effective technique in the left, dependent lung in 7 of the 9 patients.
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