Chest physiotherapy compared to no chest physiotherapy for cystic fibrosis

van der Schans CP, Prasad A, Main E

Published Online:

April 15, 2009

The lungs of people with cystic fibrosis produce excess mucus. This leads to repeated infection and tissue damage in the lungs. It is important to clear the mucus using drugs and chest physiotherapy (CPT). Physiotherapy clears mucus by various techniques or by using mechanical devices or both. Daily physiotherapy takes a lot of time and trouble. We found that techniques for clearing the airways have short-term benefits for mucus transport. Four studies measured radioactive tracer clearance and found increased clearance with CPT; three studies measured sputum which had been coughed up, found a higher amount with CPT. At present there is no clear evidence of long-term effects in chest clearance, quality of life or survival with CPT.

Abstract (click to read)

Background:

Chest physiotherapy is widely used in people with cystic fibrosis in order to clear mucus from the airways.

Objectives:

To determine the effectiveness and acceptability of chest physiotherapy compared to no treatment or spontaneous cough alone to improve mucus clearance in cystic fibrosis.

Search strategy:

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.

Date of the most recent search of the Group's Cystic Fibrosis Trials Register: 09 February 2009.

Selection criteria:

Randomised or quasi-randomised clinical trials in which a form of chest physiotherapy (airway clearance technique) were taken for consideration in people with cystic fibrosis compared with either no physiotherapy treatment or spontaneous cough alone.

Data collection and analysis:

Both authors independently assessed trial eligibility, extracted data and assessed trial quality.

Main results:

One hundred and twenty-six trials were identified by the search, of which six cross-over trials with 66 participants were found eligible for inclusion in the review. Five studies were single treatment studies; in one study each treatment regimen was used twice daily for two consecutive days. Three studies, involving 36 participants, found a higher amount of expectorated secretions during chest physiotherapy as compared to a control period. Two studies, involving 24 participants found no significant effect on pulmonary function variables following intervention. In four studies radioactive tracer clearance was used as an outcome variable. In three of these, involving 28 participants, it was found that chest physiotherapy, including coughing, increased radioactive tracer clearance as compared to the control period. One study of eight participants, reported no significant difference between chest physiotherapy, without coughing, compared to the control period.

Authors' conclusions:

The results of this review show that airway clearance techniques have short-term effects in the terms of increasing mucus transport. No evidence was found on which to draw conclusions concerning the long-term effects.

This record should be cited as:

van der Schans CP, Prasad A, Main E. Chest physiotherapy compared to no chest physiotherapy for cystic fibrosis. Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.: CD001401. DOI: 10.1002/14651858.CD001401

Assessed as up to date:

February 18, 2009

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Primary Review Group:

Cystic Fibrosis and Genetic Disorders Group

Health topics:

Genetic disorders > Cystic fibrosis > Physiotherapy & exercise

Lungs & airways > Cystic fibrosis > Physiotherapy & exercise

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Chest physiotherapy compared to no chest physiotherapy for cystic fibrosis

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