Chest Physical Therapy in Patients With Acute Exacerbation of Chronic Bronchitis: Effectiveness of Three Methods.

Chest Physical Therapy in Patients With Acute Exacerbation of Chronic Bronchitis: Effectiveness of Three Methods Ballone A, Lascioli R, Raschi S, et al. (Department of Respiratory Medicine, Passirana Hospital, Rho-Milano, Italy), Arch Phys Med Rehabil. 2000;81: 558-560.

Chronic bronchitis is a disease that involves a chronic cough and sputum production and often requires airway clearance assistance. The purpose of this study was to compare the effectiveness of 3 airway clearance techniques in improving oxygen saturation, improving pulmonary function, and increasing sputum production. The methods were a positive pressure oscillating device (the FLUTTER device), postural drainage (PD) with percussion and vibration, and expiration with the glottis open in the lateral posture (ELTGOL).

Ten male patients (mean age = 57.5 [+ or -] 6.0 years, range = 47-64) who met the criteria for chronic bronchitis and who were having an acute exacerbation of their symptoms were studied. During the first 3 or 4 days of their treatment, subjects were instructed on all techniques. Following this familiarization period, the subjects were randomly assigned to a technique for the first treatment; the other techniques were randomly given during the second and third treatments. Oxygen saturation (Sa[O.sub.2]) and forced expiratory volume in one second ([FEV.sub.1]) were measured before, immediately after, 15 minutes after, and 1 hour after each treatment. Sputum was collected 15 minutes after each treatment, immediately following the 30-minute treatment session, and at 1 hour after the treatments.

No significant differences in Sa[O.sub.2] or [FEV.sub.1] were found among any of the treatments. For all methods, sputum production increased significantly 30 minutes after treatment began. Moreover, no differences were found among treatments on sputum production immediately after the end of treatment. For treatments with the FLUTTER device and ELTGOL, sputum production 1 hour after the end of treatment was significantly greater than the amount produced immediately following each respective treatment. Sputum production 1 hour after the end of PD, however, was not significantly greater than the amount produced immediately after PD.

According to the researchers, all methods of airway clearance were found to significantly increase sputum clearance in patients with exacerbation of chronic bronchitis. Treatment with the FLUTTER device and ELTGOL, however, may be more effective than PD in prolonging the ability to raise secretions. The authors pointed out that both the FLUTTER device and ELTGOL also offer patients the advantage of self-treatment, which is not possible with postural drainage and percussion.

Anne K Swisher, PT West Virginia University Morgantown, WVa