Sputum Rheology Changes in Cystic Fibrosis Lung Disease Following Two Different Types of Physiotherapy

Flutter vs Autogenic Drainage

¹ From the Division of Pneumonology, Department of Internal Medicine, Cystic Fibrosis Outpatient Clinic, Albert-Ludwigs-University Freiburg, Freiburg im Breisgau, Germany
² From the Cystic Fibrosis Physiotherapy Center, Institute of Inhalational Biology, Munich, Germany
³ From the Division of Pediatric Pneumology, Institute of Inhalational Biology, Munich, Germany
⁴ From the Division of Pediatric Pneumology, University of Giessen, Giessen, Germany
⁵ From the Pulmonary Research Group, University of Alberta, Edmonton, Alberta, Canada
⁶ From the University of Munich, and the GSF-Research Center for Environment and Health, Institute of Inhalational Biology, Munich, Germany

Objective: The aim of the present study was to investigate the efficacy of two frequently used physiotherapies (PTs) for the removal of bronchial secretions in cystic fibrosis (CF) lung disease: autogenic drainage (AD) and the Flutter (Desitin in Germany). AD is believed to improve mucus clearance from peripheral to central airways due to airway caliber changes in combination with a special breathing technique. The Flutter is an easy-to-use physiotherapy device based on oscillations of a steel ball during expiration through a pipe-type device.

Materials and methods: To evaluate the acute and chronic physiotherapy effects of these two techniques, 14 CF patients underwent either twice daily AD or Flutter treatment for 4 consecutive weeks in a randomized crossover design. Prior to each therapy interval, for a 1-week wash-out period, no PT was administered, but patients continued regular medication. At the beginning and end of each 4-week interval, pulmonary function was measured before and after an acute 30-min therapy. At the end of the PT session, sputum was collected, weighed, and deep frozen until analyzed. The viscoelasticity of the sputum was evaluated using a magnetic microrheometer.

Results: No significant changes were noted for FVC, FEV₁, or sputum volume throughout the study. Sputum viscoelasticity (rigidity index), however, was significantly lower (p<0.01) after therapy with the Flutter in comparison with AD, predicting improvements in mucociliary and cough clearability of the secretions. In a companion in vitro experiment, oscillations generated by passing humidified air over CF sputum lining an acrylic tube connected to a Flutter device were found to decrease sputum elasticity, as measured by a filancemeter. These findings suggest that applied oscillations are capable of decreasing mucus viscoelasticity within the airways at frequencies and amplitudes achievable with the Flutter device, and provide direct evidence that PT can reduce the viscoelasticity of sputum.

Key Words: autogenic drainage • cystic fibrosis • Flutter • mucus clearance • mucus viscoelasticity • physiotherapy • pulmonary function

Submitted on February 24, 1997
Accepted on December 15, 1997

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