The immediate effects of a single autogenic drainage session on ventilatory mechanics in adult subjects with cystic fibrosis

Elliot Wallaert, Thierry Perez, Anne Prevotat, Gregory Reychler, Benoit Wallaert, Olivier Le Rouzic, Elliot Wallaert, Thierry Perez, Anne Prevotat, Gregory Reychler, Benoit Wallaert, Olivier Le Rouzic

Abstract

Introduction: The aim of this study was to gain insight into the physiological changes occurring in subjects with cystic fibrosis (CF) after autogenic drainage (AD). Changes in respiratory system resistance (Rrs), reactance (Xrs), and spirometry were analyzed in adult CF subjects after a single AD physiotherapy session.

Methods: This prospective observational study was conducted during the annual check-up of adult CF subjects in stable condition. Spirometry and Rrs and Xrs measurements using the forced oscillations technique at 5, 11, and 19 hertz (Hz) were performed before and 30 min after a 20-min AD session. Control CF subjects were tested at baseline and 50 min without AD. Results are expressed as mean ± standard deviation or median [interquartile range].

Results: Thirty subjects were included in the physiotherapy group (age 29 [25-34] years, forced expiratory volume in 1 s (FEV1) 40.3 [30.1-57.9]% predicted) and 11 in the control group (age 31 [28.5-36.5] years, FEV1 43.6 [31.1-51.9] % predicted). No significant changes in any parameter were observed in the control group. AD modestly but significantly increased the forced vital capacity (FVC) and FEV1 (p<0.001). Inspiratory resistance was also significantly improved by AD: Rrs5 from 5.74±2.39 to 5.24±2.17 cmH2O/L/s, p<0.05; Rrs11 from 4.83±1.98 to 4.32±1.7 cmH2O/L/s, p = 0.003; and Rrs19 from 4.18 [3.46-5.07] to 3.86 [2.76-4.98] cmH2O/L/s, p<0.001. In contrast, AD had no significant effects on frequency dependence of resistance (Rrs5-Rrs19) or expiratory resistance. Inspiratory Xrs5, but not ΔXrs5 (expiratory-inspiratory Xrs), was improved by AD (p<0.05). Moderate correlations were detected between the improvement in FEV1 and FVC and inspiratory resistance (r = 0.53, p = 0.005 and r = 0.44, p = 0.02, respectively).

Conclusion: A single session of AD improved inspiratory airway resistance, except in the distal airways. The forced oscillations technique provides a new tool for understanding the pathophysiological effects of airway clearance physiotherapy in CF.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Individual values of inspiratory resistances…
Fig 1. Individual values of inspiratory resistances before and after autogenic drainage in 30 CF patients.
A, Rrs5; B, Rrs11; C, Rrs19; D, Rrs5–Rrs19.

References

    1. Goss CH, Burns JL. Exacerbations in cystic fibrosis. 1: Epidemiology and pathogenesis. Thorax. 2007;62: 360–367. doi:
    1. McIlwaine MP, Lee Son NM, Richmond ML. Physiotherapy and cystic fibrosis: what is the evidence base? Curr Opin Pulm Med. 2014;20: 613–617. doi:
    1. Bradley JM, Moran FM, Stuart Elborn J. Evidence for physical therapies (airway clearance and physical training) in cystic fibrosis: An overview of five Cochrane systematic reviews. Respir Med. 2006;100: 191–201. doi:
    1. Main E, Prasad A, Schans C. Conventional chest physiotherapy compared to other airway clearance techniques for cystic fibrosis. Cochrane Database Syst Rev. 2005; CD002011 doi:
    1. Cabillic M, Gouilly P, Reychler G. Techniques manuelles de drainage bronchique des adultes et adolescents: quel niveau de preuve? Kinésithérapie Rev. 2014;14: 43–64. doi:
    1. McIlwaine M, Wong LT, Chilvers M, Davidson GF. Long-term comparative trial of two different physiotherapy techniques; postural drainage with percussion and autogenic drainage, in the treatment of cystic fibrosis. Pediatr Pulmonol. 2010;45: 1064–1069. doi:
    1. McCormack P, Burnham P, Southern KW. Autogenic drainage for airway clearance in cystic fibrosis. Cochrane Database Syst Rev. 2017;10: CD009595 doi:
    1. Reychler G. Quelle kinésithérapie de désencombrement pour demain? Rev Mal Respir. 2014;31: 691–692. doi:
    1. Dubois AB, Brody AW, Lewis DH, Burgess BF. Oscillation mechanics of lungs and chest in man. J Appl Physiol. 1956;8: 587–594. doi:
    1. Kaczka DW, Dellacá RL. Oscillation mechanics of the respiratory system: applications to lung disease. Crit Rev Biomed Eng. 2011;39: 337–359.
    1. Lima AN, Faria ACD, Lopes AJ, Jansen JM, Melo PL. Forced oscillations and respiratory system modeling in adults with cystic fibrosis. Biomed Eng Online. 2015;14: 11 doi:
    1. Guimarães FS, Lopes AJ, Moço VJR, Cavalcanti de Souza F, Silveira de Menezes SL. Eltgol acutelly improves airway clearance and reduces static pulmonary volumes in adult cystic fibrosis patients. J Phys Ther Sci. 2014;26: 813–816. doi:
    1. Smyth AR, Bell SC, Bojcin S, Bryon M, Duff A, Flume P, et al. European Cystic Fibrosis Society Standards of Care: Best Practice guidelines. J Cyst Fibros Off J Eur Cyst Fibros Soc. 2014;13 Suppl 1: S23–42. doi:
    1. Dab I, Alexander F. The mechanism of autogenic drainage studied with flow volume curves. Monogr Paediatr. 1979;10: 50–53.
    1. Chevallier J. Autogenic drainage. Cystic fibrosis: horizons. John Wiley & sons. New York: Lawson D; 1984. p. 235.
    1. Pryor JA. Physiotherapy for airway clearance in adults. Eur Respir J. 1999;14: 1418–1424.
    1. Oostveen E, MacLeod D, Lorino H, Farré R, Hantos Z, Desager K, et al. The forced oscillation technique in clinical practice: methodology, recommendations and future developments. Eur Respir J. 2003;22: 1026–1041. doi:
    1. Aarli BB, Calverley PMA, Jensen RL, Eagan TML, Bakke PS, Hardie JA. Variability of within-breath reactance in COPD patients and its association with dyspnoea. Eur Respir J. 2015;45: 625–634. doi:
    1. Oostveen E, Boda K, van der Grinten CPM, James AL, Young S, Nieland H, et al. Respiratory impedance in healthy subjects: baseline values and bronchodilator response. Eur Respir J. 2013;42: 1513–1523. doi:
    1. Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012;40: 1324–1343. doi:
    1. Jones PW, Beeh KM, Chapman KR, Decramer M, Mahler DA, Wedzicha JA. Minimal clinically important differences in pharmacological trials. Am J Respir Crit Care Med. 2014;189: 250–255. doi:
    1. Brashier B, Salvi S. Measuring lung function using sound waves: role of the forced oscillation technique and impulse oscillometry system. Breathe. 2015;11: 57–65. doi:
    1. Baier H, Wanner A, Zarzecki S, Sackner MA. Relationships among glottis opening, respiratory flow, and upper airway resistance in humans. J Appl Physiol. 1977;43: 603–611. doi:
    1. Higenbottam T, Payne J. Glottis narrowing in lung disease. Am Rev Respir Dis. 1982;125: 746–750
    1. Timmins SC, Coatsworth N, Palnitkar G, Thamrin C, Farrow CE, Schoeffel RE, et al. Day-to-day variability of oscillatory impedance and spirometry in asthma and COPD. Respir Physiol Neurobiol. 2013;185: 416–424. doi:
    1. Komarow HD, Myles IA, Uzzaman A, Metcalfe DD. Impulse oscillometry in the evaluation of diseases of the airways in children. Ann Allergy Asthma Immunol Off Publ Am Coll Allergy Asthma Immunol. 2011;106: 191–199. doi:
    1. Downie SR, Salome CM, Verbanck S, Thompson BR, Berend N, King GG. Effect of methacholine on peripheral lung mechanics and ventilation heterogeneity in asthma. J Appl Physiol Bethesda Md 1985. 2013;114: 770–777. doi:
    1. Dellacà RL, Santus P, Aliverti A, Stevenson N, Centanni S, Macklem PT, et al. Detection of expiratory flow limitation in COPD using the forced oscillation technique. Eur Respir J. 2004;23: 232–240.
    1. Guimarães FS, Moço VJR, Menezes SLS, Dias CM, Salles REB, Lopes AJ. Effects of ELTGOL and Flutter VRP1® on the dynamic and static pulmonary volumes and on the secretion clearance of patients with bronchiectasis. Rev Bras Fisioter São Carlos São Paulo Braz. 2012;16: 108–113.
    1. Figueiredo PHS, Zin WA, Guimarães FS. Flutter valve improves respiratory mechanics and sputum production in patients with bronchiectasis. Physiother Res Int. 2012;17: 12–20. doi:
    1. Saadeh C, Cross B, Saadeh C, Gaylor M. Retrospective observations on the ability to diagnose and manage patients with asthma through the use of impulse oscillometry: comparison with spirometry and overview of the literature. Pulm Med. 2014;2014: 376890 doi:
    1. Pfleger A, Steinbacher M, Schwantzer G, Weinhandl E, Wagner M, Eber E. Short-term effects of physiotherapy on ventilation inhomogeneity in cystic fibrosis patients with a wide range of lung disease severity. J Cyst Fibros. 2015;14: 627–631. doi:
    1. Sokol G, Vilozni D, Hakimi R, Lavie M, Sarouk I, Bat-El Bar, et al. The Short-Term Effect of Breathing Tasks Via an Incentive Spirometer on Lung Function Compared With Autogenic Drainage in Subjects With Cystic Fibrosis. Respir Care. 2015;60: 1819–1825. doi:
    1. Mortensen J, Hansen A, Falk M, Nielsen IK, Groth S. Reduced effect of inhaled beta 2-adrenergic agonists on lung mucociliary clearance in patients with cystic fibrosis. Chest. 1993;103: 805–811.
    1. Rodriguez Hortal MC, Hjelte L. Time point to perform lung function tests evaluating the effects of an airway clearance therapy session in cystic fibrosis. Respir Care. 2014;59: 1537–1541. doi:

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever