Comparison of the Flutter Device to Standard Chest Physiotherapy in Hospitalized Patients With Cystic Fibrosis

A Pilot Study

¹ From the Michigan State University, Kalamazoo Center for Medical Studies, Kalamazoo, MI.
² From the Western Michigan University, Kalamazoo, MI.

Douglas N. Homnick, MD, MPH, FCCP, Professor of Pediatrics, Director, Division of Pediatric Pulmonology, MSU, Kalamazoo Center for Medical Studies, 1000 Oakland Dr, Kalamazoo, MI 49008, email: homnnick{at}kcms.msu.edu

Study objective: A preliminary study comparing the efficacy and safety of the flutter device (Flutter) to standard, manual chest physiotherapy (CPT) in hospitalized cystic fibrosis (CF) patients undergoing an acute pulmonary exacerbation.

Design: Open label, comparative trial with alternate assignment.

Setting: Community and childrens' hospital acute-care wards.

Participants: Twenty-two CF patients (ages 8 to 44 years) undergoing a total of 33 hospitalizations for acute pulmonary exacerbation.

Interventions: Complete pulmonary function tests (PFTs) were done at baseline (admission), weekly, and upon discharge from the hospital. Clinical score (CS) was determined at the time of hospital admission and at discharge. Participants were assigned to receive supervised Flutter therapy or standard, manual CPT four times per day during the hospitalization. Patients were monitored for complications, including hemoptysis, hypoxemia, and pneumothorax.

Results: The groups (CPT and Flutter) did not differ at baseline in demographics or Shwachman score, nor was length of hospitalization different. Significant improvements were noted from admission to discharge in CS and PFT results within each group. Mean percent change in CS and PFT results between CPT and Flutter groups showed no significant difference from hospital admission to discharge. Subsequent power analysis using the observed difference in percent change from admission to discharge for FEV₁ indicated that to attain 80% power at = 0.05, a sample of 219 subjects in each group would be necessary.

Summary: Comparative trials of airway clearance techniques with sufficient sample size are lacking. Although the Flutter appears to be a useful device for independent, cost-effective, and safe administration of CPT in this pilot study, a much larger clinical trial would be necessary to make definitive conclusions.

Key Words: chest physiotherapy • cystic fibrosis • flutter • inpatient • pulmonary function

Submitted on October 16, 1997
Accepted on April 3, 1998

This article has been cited by other articles:

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