Acute Exacerbations

The PEP group had fewer acute exacerbations compared to the control group (six vs 28). Also, the number of patients who experienced acute exacerba­tions were smaller in the PEP group compared to the control group (three vs 12). In the PEP group, 85 percent of the patients remained free from acute exacerbations, compared to 48 percent in the control group (p = 0.011, chi-square). No patient in the PEP group and three patients in the control group had more than three acute exacerbations (Fig 2).

The exacerbation rate defined as the number of acute exacerbations divided by the observation time was calculated for each patient, and this value was significantly lower in the PEP group compared to the control group (p<0.0005, chi-square test).

Sick Leaves

Only a few of the patients actually were still working. Five patients in the control group and four patients in the PEP group stayed home from work because of acute exacerbations. There was a large difference between the number of days on the sick list: 17 in the PEP group and 64 in the control group, but 36 of the sick list days were accorded to one patient, who left work during the study period.

Antibiotics

The number of diary days with use of antibiotic was less in the PEP group compared to the control group (21 vs 74 days). The antibiotic rate, defined as the number of days when the patients used antibiotics divided by the observation time, was significantly lower in the PEP group compared to the control group (p<0.005, chi-square test). The patient with 36 days of sick leaves had antibiotics for 19 days, and when the data from this patient were excluded from the analysis, the PEP group still had significantly less use of antibiotics (p<0.05). cialis super active

Mucolytics

At the control visits, the patients were questioned about use of mucolytic medication (acetylcysteine or other). Only a few positive answers were given. In the PEP group, there was one occasion when acetylcys­teine was used and two occasions for other mucolytics. In the control group, the corresponding figures were eight and nine. An incidence rate for use of mucolytics was defined as the number of occasions when muco­lytics were used divided by the total number of occasions and the rates were then compared between the groups. The use of acetylcysteine and other mucolytic drugs was, in this manner, significantly lower in the PEP group compared to the control group (p<0.025 and p<0.05, chi-square test).

Table 3—Lung Function Values at Start and End of Study for Fatiente Completing the Study

PEPt

Control

Patients completing

n = 20

n = 22

^ FEV1, ml

+ 62(175)

-43 (181) (p = 0.062)

^ FVC,
ml

+ 55(241)

-36 (234) (p = 0.220)

^ VC, ml

+ 133(366)

-41 (366) (p = 0.115)

12 Months treated

n= 17

n —16

^ FEV1, ml

+ 50(166)

— 72 (159) (p = 0.039)

^ FVC, ml

+62(229)

-84 (213) (p = 0.067)

^ VC, ml

+ 121(335)

-91 (361) (p = 0.091)

Other Medical Treatment During the Study

Treatment with corticosteroids, beta2-agonists, para- sympathicolytica, and theophyllines did not change significantly during the study and was similar in the PEP group and the control group.

FIGURE 2. The number of acute exacerbations

FIGURE 2. The number of acute exacerbations in the PEP-treated group (20 patients) and in the control group (23 patients).

Lung Function

At the start of the study, FEVb FVC, and VC for the PEP group was lower than in the control group but without significant difference between the groups.

At the end of the study, a similar pattern was seen, and again, without significant difference between the groups.
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However, the PEP group had a small, insignificant increase in FEVb FVC, and VC during the study, whereas the control group had a small, insignificant decline in these parameters (Table 3). This difference between the groups was more pronounced when the analysis was done with only the patients treated for 12 months included. Then the increase in FEV1 for the PEP group during the study was found significantly different from the decrease in FEV1 found in the control group (p = 0.039, analysis of variance) (Table 3). In the PEP group, a majority of the patients (13) had an increase in FEV1 from the start to the end of the study, compared to six in the control group. Seven patients in the PEP group had unchanged or decreased FEV1 compared to 16 patients in the control group, (p<0.025, chi-square test).

Category: asthma / Tags: Chest Physiotherapy, Chronic Bronchitis, Expiratory Pressure

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