Resistive inspiratory manoeuvre as airway clearance technique in stable patients with cystic fibrosis: A randomised crossover trial

Abstract

Sputum clearance seems to be greater using resistive inspiratory manoeuvres (RIM) than standardized physiotherapy in exacerbated patients with cystic fibrosis (CF),(Chatham et al. Eur Respir J 2004). This randomised crossover trial investigates whether RIM, set at 60% of maximal inspiratory pressure, in stable patients with CF are equally efficacious than autogenic drainage (AD) in enhancing sputum clearance Methods: 26 patients with CF (mean age 26.8 yrs. (8.8), FEV 1 64.1%(17.4)pred.) performed 3 sessions for 30 minutes in a random order, 7-days apart: RIM, AD and RIM+AD. The primary outcome was the wet sputum clearance in the 24h after each intervention. Secondary outcomes included sputum collected during and 2h after the sessions. Perceived efficacy was rated by a visual analogue scale. Data were reported as mean difference, 95% confidence interval(CI) Results: Sputum clearance 24h after session was similar for all interventions, [AD vs RIM] 1.0g, CI95%=-2.3–4.3; [RIM+AD vs RIM] 2.3g, CI95%=-1.1–5.6; [RIM+AD vs AD] 1.3g, CI95%=-2.1–4.7. During sessions, AD and RIM+AD enhanced similar expectoration rates [AD vs RIM+AD] 1.7g CI95%= -1.2-4.7; being greater than RIM [AD vs RIM] 7.0g, CI95%=4.1–10.0; [RIM+AD vs RIM] 5.3g, CI95%=2.3–8.2. The RIM+AD intervention induced higher expectoration during the 2h after the session compared to RIM [RIM+AD vs RIM] 2.6g, CI95%=0.8-4.5 and similar to AD (p=0.2). Perceived efficacy was rated worse for RIM [AD vs RIM] 2.7cm, CI95%=1.2–2.9; [RIM+AD vs RIM] 2.3cm, CI95%=1.2–2.9 Conclusion: In our study,RIM resulted in lower expectoration rates compared to AD during session but was similar during the 24h after the sessions in CF.