Chest Physiotherapy

Clinical History and Lung Function

Fifty four patients were included in the study, and 43 completed the study. The reasons for exclusion were malignant lung tumor in three patients (all in the PEP group), long-term use of acetylcysteine in one patient (in the PEP group), discontinued treatment in seven patients (three in the PEP group and four patients in the control group). There was no significant difference between the control group and the PEP group with respect to age, smoking habits, duration of disease, number of acute exacerbations during the previous year, number of treatments with antibiotics during the previous year, and medication (corticoste­roid, be tag-agonist, parasympathicolytica and theo­phyllines) (Table 1). About one-third of the patients used theophylline or betas-agonist, only one patient in each group used oral corticosteroid, two patients in the РЁР group used low-dose inhaled corticosteroid.

The majority of the patients had retired from work because of age. One patient in the PEP group and three patients in the control group had stopped working because of lung disease.

The lung function was normal or moderately re­duced (Table 1), and there was no difference between the groups concerning the initial values of FEV1, FVC, and VC. The FEV1 in relation to predicted normal was significantly lower in the PEP group compared to control group (p<0.025, Students f-test).

The 11 patients not completing the study did not differ concerning baseline data. They were mean age 61.4 years, ten patients were smokers, one patient was an exsmoker. The mean duration of chronic bronchitis was 16.2 years and they had, as a mean, one acute exacerbation during the previous 12 months. Mean FEV1 and FVC was 1.95 and 2.99 L.
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Table 1—Morphometric Details, History, and hung Function at Start of Study (Mean ± SD)

PEP

Control

Patients, number

20

23

Still working,
number

9

5

Age, yr

61.7(4.6)

62.7 (5.2)

FEV1, L*

1.72 (0.73)

2.07 (0.57)

FEV1, in percent
of predicted FEV1*

62.5 (23.9)

77.4 (20.7)

FVC, L*

2.60 (0.82)

2.91 (0.54)

FEV1/FVC*

0.65 (0.14)

0.71(0.11)

Smokers, number

16

17

Nonsmokers or
exsmokers, number

4

6

Duration of
disease, yr

18.4 (15.7)

12.6 (10.7)

Number of acute
exacerbations

2.3 (2.3)

1.4 (1.4)

during the
previous
12
months

Number of acute
exacerbations

1.5(1.5)

0.8(1.3)

Cooperation of the Patients

A part of the information collected in this study was based on the diary cards, which makes it important to evaluate the patients cooperation. The patients receiv­ing treatment for 12 months had a maximum of 96 diary days, and the patients treated only during the winter had a maximum of 40 diary days. The actual number of days with completed diary (the observation time), divided by the maximum possible number of diary days are shown in Table 2. There was no difference between the groups in this respect.

Discontinued treatment was defined as less than eight completed diary days (treatment for less than one month) and/or missing more than one of the control visits. Four patients did not show up after the first visit, one patient had less than eight diary days and stayed away from more than one control visit, two patients stayed away from more than one visit, giving a total of seven patients who discontinued the treat­ment. The data from these patients were not included in the data analysis. One patient was not able to perform the lung function tests correctly (because of cough) but otherwise cooperated very well, so the data from this patient, except lung function values, were included in analysis.

Table 2—Diary Days Fitted In and Total Number of Diary Days (Mean±SD)

PEP

Control

Patients treated
one year

n=
17

n=
17

Maximum diary
days

96

96

Actual
observation time

81.5(20.7)

79.4(11.6)

Percentage
observation time

84.9

82.7

Patients treated
for five months

n = 3

n = 6

Maximum diary
days

40

40

Actual
observation time

33.7 (5.5)

28.2 (4.3)

Percentage
observation time

84.4

70.4

From the diary cards, the actual daily use of treatments was calculated. The PEP group had a mean daily use of the mask of 2.5 times (range 1.8 to 4.6), and the control group had a mean daily use of physiotherapy of 2.5 times (range 0.7 to 6.1). Fourteen patients in the PEP group and 13 in the control group used the treatments more than twice daily; the mean values were 2.8 and 3.4 times daily, respectively.

Symptoms

According to the diary answers, the PEP group reported significantly less cough (p = 0.025, Mann- Whitney test) and less mucus production (p = 0.013) than the control group. There was a tendency of less dyspnea in the PEP group, but this was not statistically significant (p = 0.33).

The overall assessment of the treatment after one month of treatment and at the end of the study was significantly more positive in the PEP group (p<0.05 and p = 0.0001, chi-square test) where a majority of the patients called it definitely useful. But the control group also found the treatment useful. Only a few patients found the treatments useless, and none found them harmful. The patients who found the treatment useful were asked to describe the effect. A majority in the PEP group (13 patients) found the main effect to be a facilitation of expectoration compared to the control group where most patients (16) could not describe the effect and five found it to facilitate expectoration. levitra professional

Finally, the patients were asked both in the diary and at the clinic visits about any side effects of the treatment. A few patients complained of dizziness, especially in the PEP group. This was caused by hyperventilation, and the complaints ceased after repeated instruction.

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

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