Efficacy of the Flutter device for airway mucus clearance in patients with cystic fibrosis
1996; Elsevier BV; Volume: 128; Issue: 1 Linguagem: Inglês
10.1016/s0022-3476(96)70460-2
ISSN1097-6833
AutoresVinit K. Mahesh, Julie McDougal, Lisa Haluszka,
Tópico(s)Cystic Fibrosis Research Advances
ResumoTo the Editor:We read the article, “Efficacy of the Flutter Device for Airway Mucus Clearance in Patients with Cystic Fibrosis,” and wish to share a concern regarding an implication by the authors.1Konstan MW Stern RC Doershuk CF Efficacy of the Flutter device for airway mucus clearance in patients with cystic fibrosis.J PEDIATR. 1994; 124: 689-693Abstract Full Text Full Text PDF PubMed Scopus (154) Google Scholar The authors concluded that “the use of the Flutter device is more effective than conventional techniques in clearing mucus from the airways of patients with CF [cystic fibrosis].” The authors further stated that, “For hospitalized patients, elimination of the need for a therapist could reduce health care costs,” suggesting that the Flutter device could be used as “stand-alone” therapy.In the year since this article was published, we have surveyed all CF Centers in the United States concerning their use of the Flutter device. Numerous respondents are using the Flutter device in place of percussion and postural drainage (P/PD), on the basis of the above-mentioned article. In this study, however, the patients continued to receive their chest physiotherapy—“Throughout the study period, subjects continued to receive their usual therapeutic regimen for CF, including ... postural drainage.” Thus the study was limited to measuring the mucus expectorated from an additional therapy session consisting of cough alone, P/PD and cough, or the Flutter device. In contrast, previous studies have suggested that the use of the Flutter device as a stand-alone chest therapy is disadvantageous.2Lyons E Chatham K Campbell IA Prescott RJ Evaluation of the Flutter VRP1 device in young adults with cystic fibrosis.Med Sci Res. 1993; 21: 101-102Google Scholar, 3Chatham K Marshall C Campbell IA Prescott RJ The use of the Flutter VRP1 device in post thoracotomy patients.Physiotherapy. 1993; 79: 95-98Abstract Full Text PDF Scopus (17) Google ScholarAlthough controversy remains about its benefits, P/PD has been shown to improve clearance of mucus.4Thomas J Cook DJ Brooks D Chest physical therapy management of patients with cystic fibrosis.Am J Respir Crit Care Med. 1995; 151: 846-850Crossref PubMed Google Scholar There has been a suggestion that P/PD is superior in clearing mucus from more peripheral airways than coughing.5Bateman JRM Newman SP Daunt KM Sheahan NF Pavia D Clarke SW Is cough as effective as chest physiotherapy in the removal of excessive tracheobronchial secretions?.Thorax. 1981; 36: 683-687Crossref PubMed Scopus (64) Google Scholar Conversely, there is no presented evidence that the Flutter-generated oscillations are transmitted to peripheral airways.In light of the hope of aerosolized gene therapy for CF, the task of keeping the airways as patent as possible becomes critical. Because study patients continued to receive chest physiotherapy, we believe that an interpretation that stand-alone therapy with the Flutter device is superior to other forms of chest therapy is premature and potentially devastating for patients with CF.9/35/69593 To the Editor:We read the article, “Efficacy of the Flutter Device for Airway Mucus Clearance in Patients with Cystic Fibrosis,” and wish to share a concern regarding an implication by the authors.1Konstan MW Stern RC Doershuk CF Efficacy of the Flutter device for airway mucus clearance in patients with cystic fibrosis.J PEDIATR. 1994; 124: 689-693Abstract Full Text Full Text PDF PubMed Scopus (154) Google Scholar The authors concluded that “the use of the Flutter device is more effective than conventional techniques in clearing mucus from the airways of patients with CF [cystic fibrosis].” The authors further stated that, “For hospitalized patients, elimination of the need for a therapist could reduce health care costs,” suggesting that the Flutter device could be used as “stand-alone” therapy.In the year since this article was published, we have surveyed all CF Centers in the United States concerning their use of the Flutter device. Numerous respondents are using the Flutter device in place of percussion and postural drainage (P/PD), on the basis of the above-mentioned article. In this study, however, the patients continued to receive their chest physiotherapy—“Throughout the study period, subjects continued to receive their usual therapeutic regimen for CF, including ... postural drainage.” Thus the study was limited to measuring the mucus expectorated from an additional therapy session consisting of cough alone, P/PD and cough, or the Flutter device. In contrast, previous studies have suggested that the use of the Flutter device as a stand-alone chest therapy is disadvantageous.2Lyons E Chatham K Campbell IA Prescott RJ Evaluation of the Flutter VRP1 device in young adults with cystic fibrosis.Med Sci Res. 1993; 21: 101-102Google Scholar, 3Chatham K Marshall C Campbell IA Prescott RJ The use of the Flutter VRP1 device in post thoracotomy patients.Physiotherapy. 1993; 79: 95-98Abstract Full Text PDF Scopus (17) Google ScholarAlthough controversy remains about its benefits, P/PD has been shown to improve clearance of mucus.4Thomas J Cook DJ Brooks D Chest physical therapy management of patients with cystic fibrosis.Am J Respir Crit Care Med. 1995; 151: 846-850Crossref PubMed Google Scholar There has been a suggestion that P/PD is superior in clearing mucus from more peripheral airways than coughing.5Bateman JRM Newman SP Daunt KM Sheahan NF Pavia D Clarke SW Is cough as effective as chest physiotherapy in the removal of excessive tracheobronchial secretions?.Thorax. 1981; 36: 683-687Crossref PubMed Scopus (64) Google Scholar Conversely, there is no presented evidence that the Flutter-generated oscillations are transmitted to peripheral airways.In light of the hope of aerosolized gene therapy for CF, the task of keeping the airways as patent as possible becomes critical. Because study patients continued to receive chest physiotherapy, we believe that an interpretation that stand-alone therapy with the Flutter device is superior to other forms of chest therapy is premature and potentially devastating for patients with CF. We read the article, “Efficacy of the Flutter Device for Airway Mucus Clearance in Patients with Cystic Fibrosis,” and wish to share a concern regarding an implication by the authors.1Konstan MW Stern RC Doershuk CF Efficacy of the Flutter device for airway mucus clearance in patients with cystic fibrosis.J PEDIATR. 1994; 124: 689-693Abstract Full Text Full Text PDF PubMed Scopus (154) Google Scholar The authors concluded that “the use of the Flutter device is more effective than conventional techniques in clearing mucus from the airways of patients with CF [cystic fibrosis].” The authors further stated that, “For hospitalized patients, elimination of the need for a therapist could reduce health care costs,” suggesting that the Flutter device could be used as “stand-alone” therapy. In the year since this article was published, we have surveyed all CF Centers in the United States concerning their use of the Flutter device. Numerous respondents are using the Flutter device in place of percussion and postural drainage (P/PD), on the basis of the above-mentioned article. In this study, however, the patients continued to receive their chest physiotherapy—“Throughout the study period, subjects continued to receive their usual therapeutic regimen for CF, including ... postural drainage.” Thus the study was limited to measuring the mucus expectorated from an additional therapy session consisting of cough alone, P/PD and cough, or the Flutter device. In contrast, previous studies have suggested that the use of the Flutter device as a stand-alone chest therapy is disadvantageous.2Lyons E Chatham K Campbell IA Prescott RJ Evaluation of the Flutter VRP1 device in young adults with cystic fibrosis.Med Sci Res. 1993; 21: 101-102Google Scholar, 3Chatham K Marshall C Campbell IA Prescott RJ The use of the Flutter VRP1 device in post thoracotomy patients.Physiotherapy. 1993; 79: 95-98Abstract Full Text PDF Scopus (17) Google Scholar Although controversy remains about its benefits, P/PD has been shown to improve clearance of mucus.4Thomas J Cook DJ Brooks D Chest physical therapy management of patients with cystic fibrosis.Am J Respir Crit Care Med. 1995; 151: 846-850Crossref PubMed Google Scholar There has been a suggestion that P/PD is superior in clearing mucus from more peripheral airways than coughing.5Bateman JRM Newman SP Daunt KM Sheahan NF Pavia D Clarke SW Is cough as effective as chest physiotherapy in the removal of excessive tracheobronchial secretions?.Thorax. 1981; 36: 683-687Crossref PubMed Scopus (64) Google Scholar Conversely, there is no presented evidence that the Flutter-generated oscillations are transmitted to peripheral airways. In light of the hope of aerosolized gene therapy for CF, the task of keeping the airways as patent as possible becomes critical. Because study patients continued to receive chest physiotherapy, we believe that an interpretation that stand-alone therapy with the Flutter device is superior to other forms of chest therapy is premature and potentially devastating for patients with CF. 9/35/69593
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