Regular Chest Physiotherapy Research Articles

Efficacy of pulmonary rehabilitation plus chest physiotherapy versus chest physiotherapy alone in patients with bronchiectasis

Abstract Context Bronchiectasis is a chronic airway disease characterized by cough, dyspnoea, expectoration, and poor quality of life. Besides medical treatment, regular chest physiotherapy and Pulmonary rehabilitation (PR) may be an effective approach for bronchiectasis. Aims To compare the effects of PR and chest physiotherapy with chest physiotherapy alone in bronchiectasis. Settings and design This randomized controlled trial observational research enrolled 40 cases with bronchiectasis who were categorized into two groups: (group I); 20 cases received PR and chest physiotherapy in addition to medical treatment, (group II): 20 cases received chest physiotherapy in addition to medical treatment. Methods and material Cases were assessed with modified borg scale, 6-minute walk test (6-MWT), arterial blood gases, Spirometry and underwent PR program. Statistical analysis used The same group’s quantitative data were compared using the paired Student’s t-test. The frequency and percentage (%) of qualitative characteristics were displayed. Results In (group I), there was a statistically notable improvement in modified Borg Scale, 6-MWT, arterial oxygen pressure (PaO2), partial pressure of carbon dioxide (PaCO2), arterial oxygen saturation, FEV1 (actual and predicted %values), FVC (actual and predicted %values), FEV1/FVC actual value, sputum volume and training intensity. In (group II) there was a statistically notable improvement in 6-MWT, PaO2, PaCO2, FEV1 (actual and predicted %values), FVC (actual and predicted %values), FEV1/FVC actual value, and sputum volume. The percentage of improvement in all parameters was significantly higher among group (I). Conclusions PR in addition to chest physiotherapy is superior to chest physiotherapy alone in the improvement of symptoms and exercise tolerance in bronchiectasis.

YOUNG MAN WITH PRODUCTIVE COUGH AND RIGHT SIDED HEART

Case of a young man who presented with repeated episodes of productive cough and shortness of breath. Clinical and non-invasive evaluation revealed situs inversus, dextrocardia, features of brochiectasis and lung cysts along with immotile sperms on semen analysis. A diagnosis of Kartagener’s syndrome was established. Genetic study could not be done due to financial restrains. Regular chest physiotherapy, antibiotics and bronchodilators were advised with close follow-up.

Short term Effectiveness of Structured Exercise Protocol on Respiratory Parameters in subjects with COVID

Few studies have demonstrated that subjects with Covid have breathless at rest, fever, sore throat and other pneumonia like symptoms and are known to respond effectively towards Drug therapy which boosts their immunity. Physiotherapy is very well studied to improve immunity by imposing various exercises on the affected part, thus strengthening that part. Deep breathing and chest expansion exercises are known to be effective in treating subjects with such symptoms. Various exercises have been demonstrated for subjects with Covid. According to authors’ knowledge there is very less number of studies demonstrating the effectiveness of the exercise protocol formed for Covid subjects. The objective of the study is to investigate the short term effectiveness of Structured Exercise Protocol on respiratory parameters in subjects with Covid. It is an experimental study conducted on 50 Covid positive subjects who were given regular chest physiotherapy including deep breathing exercises, segmental breathing exercises, chest expansion exercises and dedicated prone lying. The results demonstrated that: modified Borg’s scale of dyspnoea, SPO2, Respiratory rate, Xray changes, Heart rate and number of active cough extraction showed significant changes. Dedicated prone lying along with regular chest physiotherapy showed great improvement in respiratory parameters.

WS14.2 Potential factors influencing reduced requirements for intravenous antibiotics during the COVID-19 pandemic

Objective: The use of intravenous antibiotics (IVAB) is a central part of the management of pulmonary infections in cystic fibrosis (CF). Adult patients with CF in England were advised to “shield” by the government (23.03.2020–01.08.2020) during the COVID-19 pandemic. Shielding was described as the requirement to not leave home and minimise all face-to-face contact. At our adult CF centre in London, there was a 50% reduction in requirement for IVAB, compared to the same period in 2019. We aimed to identify potential factors contributing to the reduced requirement of IVAB during shielding. Method: An 8-point patient questionnaire was given to 27 patients who had required ≥3 courses of IVAB in the year 2019. These were designed to identify: percentage of patients shielding, percentage of patients starting a modulator, variation in adherence to regular medications, chest physiotherapy, and requirement to IVAB. Results: 70% response rate (n = 19). [Table Presented] Despite a 50% reduction in IVAB compared to the previous year, the majority of patients reported their requirement for IVAB remained the same (68%). There was no self-reported increase in adherence to regular medications or chest physiotherapy. The majority of patients felt their overall health status remained stable or improved (78%). During this period the majority of patients fully shielded (84%) and started Symkevi®/Kalydeco or Kaftrio®/Kalydeco (as part of a trial or compassionate use program) (84%). Conclusion: Increased adherence to regular medication and physiotherapy did not appear to be a factor in reducing the requirement for IVAB observed during the UK COVID-19 pandemic lockdown. Adherence to government shielding may have reduced exposure to community acquired infections and associated requirement for IVAB. Commencement of a modulator therapy was likely to have a positive impact on overall health and associated of reduction in requirement of IVAB.

Comparison between active cycles of breathing with postural drainage versus conventional chest physiotherapy in subjects with bronchiectasis

IntroductionBronchiectasis is a chronic debilitating condition with abnormal permanent dilatation of the airways causing impaired mucus clearance, despite regular chest physiotherapy being mainstay of management for bronchiectasis, there is little evidence supporting regular chest physiotherapy in bronchiectasis which aims to mobilize secretions and facilitate effective expectoration, providing control of cough and improving airway clearance. The objective of this study was to compare between the efficacy of 2 techniques of chest physiotherapy ACBT with postural drainage and conventional chest physical therapy as a method of airway clearance in adults with productive bronchiectasis. MethodsThe study included 30 subjects, 20 males and 10 females; all having bronchiectasis, the study was carried out on October 6 at the University Hospital. The participating subjects underwent conventional chest physical therapy or ACBT following postural drainage as the airway clearance technique in random order on 14 successive days with twice daily frequency. ResultsThere was a significant difference regarding mMRC before and after both ACBT and conventional physiotherapy, there was a significant improvement regarding FVC and MMEF after ACBT while there was a significant improvement of FEV1 and MMEF after conventional physiotherapy. As regards arterial blood gas data comparison, there were significant improvements regarding PaCO2, PaO2 and PAO2 while there was no significant difference as regards P (A-a) O2 after both types of physiotherapy techniques. Comparison between the 2 groups regarding mMRC dyspnea score, spirometry, arterial blood gas data, Leicester cough questionnaire (LCQ) and sputum wet volume before starting physiotherapy shows no significant difference while there were significant differences in advance to post ACBT physiotherapy sessions as regards PaO2, P (A-a) O2 gradient, LCQ (physical domain score and total score) and sputum wet volume. ConclusionACBT with postural drainage is found to be more effective than conventional chest physical therapy management of bronchiectasis during infective exacerbation.

Justification for Chest Physiotherapy during Ultra‐Protective Lung Ventilation and Extra‐Corporeal Membrane Oxygenation: A Case Study

This case report describes the chest physiotherapy (CPT) intervention provided to a 32-year old man with severe respiratory failure undergoing extra-corporeal membrane oxygenation (ECMO) support and ultra-protective ventilatory strategy. Low tidal volume ventilation when used in patients with extremely low dynamic respiratory compliance may predispose the patient to secretion retention, and the role of CPT in this setting is unclear. The method used is a single subject case report. Written consent obtained from patient's representative. Secretion clearance in this patient was initially limited to suctioning; however, after developing major airway occlusion secondary to impacted secretions, he received intensive CPT consisting of positioning, ventilator hyperinflation, expiratory chest wall shaking and suctioning. After 13 days of two to three times daily CPT, the patient weaned from ECMO support. Regular CPT may have facilitated secretion clearance and lung recovery in this patient. Future research should investigate the optimal CPT techniques for patients with sub-dead space tidal ventilation and extremely low dynamic respiratory compliance during ECMO with ultra-protective ventilatory strategy (UPVS).

A pilot study of pulmonary rehabilitation and chest physiotherapy versus chest physiotherapy alone in bronchiectasis

The aim of our study was to assess the efficacy of pulmonary rehabilitation in addition to regular chest physiotherapy in non cystic fibrosis bronchiectasis. Thirty patients with clinically significant bronchiectasis and limited exercise tolerance were randomized into either the control group receiving chest physiotherapy (8 weeks) or into the intervention group, receiving pulmonary rehabilitation in addition to chest physiotherapy (8 weeks). Both groups were encouraged to maintain their exercise program and or chest physiotherapy, following completion of the study. End of training (8 weeks) No improvement in control group. In the intervention group, incremental shuttle walk test (ISWT) improved by 56.7 m (p = 0.03), endurance walk test (EWT) by 193.3 m (p = 0.01), Leicester Cough Questionnaire (LCQ) improved by 2.6 units (p < 0.001) and St. George's Respiratory Questionnaire (SGRQ) by 8 units (p < 0.001). At 20 weeks (12 weeks post end of training) No improvement in control group. In the intervention group, ISWT improved by 80 m (p = 0.04) and EWT by 247.5 m (p = 0.003). LCQ improved by 4.4 units (p < 0.001) and SGRQ by 4 units (p < 0.001). Pulmonary rehabilitation in addition to regular chest physiotherapy, improves exercise tolerance and health related quality of life in non cystic fibrosis bronchiectasis and the benefit was sustained at 12 weeks post end of pulmonary rehabilitation. Clinical trials regn no. NCT00868075.

A randomised crossover trial of chest physiotherapy in non-cystic fibrosis bronchiectasis

Regular chest physiotherapy is advocated in non-cystic fibrosis bronchiectasis despite little evidence supporting its routine use. This study aimed to establish the efficacy of regular chest physiotherapy in non-cystic fibrosis bronchiectasis compared with no regular chest physiotherapy. 20 patients not practising regular chest physiotherapy were enrolled in a randomised crossover trial of 3 months of twice daily chest physiotherapy using an oscillatory positive expiratory pressure device compared with 3 months of no chest physiotherapy. The primary end-point was the Leicester Cough Questionnaire (LCQ). Additional outcomes included 24-h sputum volume, forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC), forced expiratory flow at 25-75% of FVC (FEF(25-75%)), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), exercise capacity, sputum microbiology and St George's Respiratory Questionnaire (SGRQ). The treatment effect was estimated using the differences of the pairs of observations from each patient. There was a significant improvement in all domains and total LCQ score with regular chest physiotherapy (median (interquartile range) total score improvement 1.3 (-0.17-3.25) units; p = 0.002). 24-h sputum volume increased significantly with regular chest physiotherapy (2 (0-6) mL; p = 0.02), as did exercise capacity (40 (15-80) m; p = 0.001) and SGRQ total score (7.77 (-0.99-14.5) unit improvement; p = 0.004). No significant differences were seen in sputum bacteriology, FEV(1), FVC, FEF(25-75%), MIP or MEP. Regular chest physiotherapy in non-cystic fibrosis bronchiectasis has small, but significant benefits.

Chest physiotherapy for the surgical patient.

This article reviews the evidence that chest physiotherapy is effective in the prevention and treatment of pulmonary complications after major abdominal and thoracic surgery. There is some evidence that regular chest physiotherapy significantly decreases the incidence of pulmonary complications, although the mechanism of this effect is uncertain. It is not known whether chest physiotherapy is effective in the treatment of postoperative pulmonary complications after they have developed.

Bronchoscopic insufflation of room air for the treatment of lobar atelectasis in mechanically ventilated patients.

Segmental and lobar pulmonary atelectasis is a common occurrence in mechanically ventilated patients. Standard therapy for atelectasis relies on positive pressure ventilation, positive and expiratory pressure (PEEP), tracheobronchial toilet and regular chest physiotherapy. Various adjuncts to physiotherapy such as bronchoscopic clearance of secretions have not proved to be of additional benefit. Bronchoscopic clearance of secretions followed by insufflation of room air at 30 cm H2O into the atelectatic segment was employed on ten occasions in mechanically ventilated patients. Rapid re-expansion of the collapsed segment or lobe occurred in seven out of the ten treatments.

Croup : A primer

Croup is the single most common cause of death from airway obstruction, taking all ages into account. The patient’s general appearance is an extremely unreliable guide to the severity of the obstruction in croup and specific signs must be used in the assessment. Management is discussed. It is emphasized that chest physiotherapy is specifically contra-indicated in conservatively managed children with croup. But in children who have had artificial airways inserted for life-threatening airway obstruction regular intensive chest physiotherapy is essential.