Oermann C M, Sockrider M M, Giles D, Sontag M K, Accurso F J, Castile R G
Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA.
Pediatr Pulmonol. 2001 Nov;32(5):372-7. doi: 10.1002/ppul.1146.
Enhanced airway clearance is thought to result in better-maintained pulmonary function in cystic fibrosis (CF). Postural drainage, percussion, and vibration (PDPV) have been the primary airway clearance technique (ACT) employed in CF for over 40 years. Two new airway clearance modalities are high-frequency chest wall oscillation (HFCWO) and oscillating positive expiratory pressure (OPEP). This pilot study was undertaken to evaluate the efficacy of these techniques during home use, assess patient satisfaction with them as compared to PDPV, and assess the feasibility of performing a definitive comparative trial. The prospective, randomized, multicenter crossover trial was conducted at three urban academic CF Care Centers. Twenty-nine CF patients, 9-39 years of age, participated. Subjects performed 4 weeks each of HFCWO and OPEP following 2-week lead-in/washout periods. Spirometry, lung volumes, National Institutes of Health and Petty Scores, and a satisfaction survey were performed at baseline and after each treatment period. An ACT preference survey was completed at the conclusion of the study. Twenty-four subjects completed both therapies. There were no statistically significant differences between therapies for spirometry, lung volumes, or clinical scores. No significant safety issues arose during the study period. Compliance between therapies was similar. Significant differences among therapies existed in patient satisfaction. Given a choice of therapy, 50% of subjects chose HFCWO, 37% OPEP, and 13% PDPV. This study suggests that HFCWO and OPEP are safe and as effective as patients' routine therapies when used for airway clearance in a home setting. Patient satisfaction and preference differ among ACTs and should be considered when prescribing home therapy. A definitive, multi-center, comparative study evaluating long-term efficacy of these techniques is feasible.
增强气道清除功能被认为可使囊性纤维化（CF）患者的肺功能得到更好的维持。体位引流、叩击和振动（PDPV）在40多年来一直是CF患者主要采用的气道清除技术（ACT）。两种新的气道清除方式是高频胸壁振荡（HFCWO）和振荡呼气末正压（OPEP）。本前瞻性、随机、多中心交叉试验在三个城市学术性CF护理中心开展，旨在评估这些技术在家用期间的疗效，与PDPV相比评估患者对它们的满意度，并评估进行确定性对照试验的可行性。29名9至39岁的CF患者参与了研究。在为期2周的导入/洗脱期后，受试者分别进行了4周的HFCWO和OPEP治疗。在基线期和每个治疗期结束后进行了肺活量测定、肺容积测定、美国国立卫生研究院和佩蒂评分以及满意度调查。在研究结束时完成了ACT偏好调查。24名受试者完成了两种治疗。在肺活量测定、肺容积或临床评分方面，各治疗组之间无统计学显著差异。研究期间未出现重大安全问题。各治疗组的依从性相似。各治疗组在患者满意度方面存在显著差异。在可供选择的治疗方法中，50%的受试者选择HFCWO，37%选择OPEP，13%选择PDPV。本研究表明，HFCWO和OPEP在家用气道清除时是安全的，且与患者的常规治疗同样有效。不同ACT的患者满意度和偏好存在差异，在开具家庭治疗处方时应予以考虑。开展一项评估这些技术长期疗效的确定性多中心对照研究是可行的。
