Vandervoort Bjarne, De Beuckeleer Django, Huenaerts Elke, Schulte Marianne, Vermeulen François, Proesmans Marijke, Troosters Thierry, Vreys Myriam, Boon Mieke
Department of Rehabilitation Sciences, Catholic University of Leuven, Leuven, Belgium.
Department of Pediatrics, University Hospital Leuven, Leuven, Belgium.
Front Pediatr. 2022 May 23;10:858410. doi: 10.3389/fped.2022.858410. eCollection 2022.
Airway clearance therapy (ACT) is one of the cornerstone treatment modalities to improve mucociliary clearance for patients with bronchiectasis. The progression of lung disease in patients with bronchiectasis can be evaluated by spirometry and multiple breath washout (MBW) and it is advised to monitor these on a regular basis. However, the short term effect of ACT on spirometry and MBW parameters is insufficiently clear and this variability may impact standardization. For cystic fibrosis (CF), available literature refutes a short time effect on spirometry and MBW parameters in children, however, for primary ciliary dyskinesia (PCD) no data are available. We performed a single-center, prospective cross-over study to evaluate the short term effect of a single ACT session using positive expiratory pressure mask on forced expiratory volume in 1 s (FEV) and lung clearance index (LCI), derived from MBW, compared to no ACT (control) in pediatric patients with CF and PCD. A total of 31 children were included: 14 with PCD and 17 with CF. For the whole group, there was no difference in median change of FEV pp between the treatment and the control group ( 0.969), nor in median change of LCI ( 0.294). For the CF subgroup, the mean change in FEV pp with ACT was -1.4% (range -9 to + 5) versus -0.2% (range -6 to + 5) for no ACT ( 0.271), the mean change in LCI with ACT was + 0.10 (range -0.7 to + 1.2) versus + 0.17 (range -0.5 to + 2.8) for no ACT (p 0.814). In the PCD subgroup, the mean change in FEV pp with ACT was + 1.0 (range -7 to + 8) versus -0.3 (range -6 to + 5) for no ACT ( 0.293) and the mean change in LCI with ACT was -0.46 (range -3.7 to + 0.9) versus -0.11 (range -1.4 to + 1.3) for no ACT ( 0.178). There was no difference between PCD and CF for change in FEV pp after ACT ( = 0.208), nor for LCI ( = 0.095). In this small group of pediatric patients, no significant short-term effect of chest physiotherapy on FEV pp nor LCI in PCD and CF values nor variability was documented.
气道清除疗法（ACT）是改善支气管扩张症患者黏液纤毛清除功能的基石性治疗方法之一。支气管扩张症患者的肺部疾病进展可通过肺量计和多次呼气冲洗法（MBW）进行评估，建议定期监测这些指标。然而，ACT对肺量计和MBW参数的短期影响尚不清楚，这种变异性可能会影响标准化。对于囊性纤维化（CF），现有文献驳斥了ACT对儿童肺量计和MBW参数的短期影响，然而，对于原发性纤毛运动障碍（PCD），尚无相关数据。我们进行了一项单中心、前瞻性交叉研究，以评估在患有CF和PCD的儿科患者中，使用呼气正压面罩进行单次ACT治疗对1秒用力呼气量（FEV）和源自MBW的肺清除指数（LCI）的短期影响，并与不进行ACT（对照组）进行比较。总共纳入了31名儿童：14名患有PCD，17名患有CF。对于整个组，治疗组和对照组之间FEV pp的中位数变化（0.969）以及LCI的中位数变化（0.294）均无差异。对于CF亚组，进行ACT时FEV pp的平均变化为-1.4%（范围为-9至+5），而不进行ACT时为-0.2%（范围为-6至+5）（p = 0.271）；进行ACT时LCI的平均变化为+0.10（范围为-0.7至+1.2），而不进行ACT时为+0.17（范围为-0.5至+2.8）（p = 0.814）。在PCD亚组中，进行ACT时FEV pp的平均变化为+1.0（范围为-7至+8），而不进行ACT时为-0.3（范围为-6至+5）（p = 0.293）；进行ACT时LCI的平均变化为-0.46（范围为-3.7至+0.9），而不进行ACT时为-0.11（范围为-1.4至+1.3）（p = 0.178）。ACT后PCD和CF在FEV pp变化方面（p = 0.208）以及LCI变化方面（p = 0.095）均无差异。在这一小群儿科患者中，未记录到胸部物理治疗对PCD和CF患者的FEV pp、LCI值及变异性有显著短期影响。
