Review question

Is conventional chest physiotherapy (CCPT) better than other methods of airway clearance for people with cystic fibrosis (CF)?

Key messages

Airway clearance techniques (ACTs) are a very important part of therapy in people with CF.

There are now lots of different types of ACTs, but there is still very little known about how good each one is and how they compare to each other.

The focus of this review was to compare CCPT (also known as traditional chest physiotherapy) with alternative ACTs.

What is cystic fibrosis?

CF is a life-limiting inherited disease affecting between 70,000 and 100,000 people worldwide. People with CF produce mucus in their lungs that can be thick, sticky and difficult to clear. This leads to repeated infections and lung damage. It is important to clear this mucus using medicines and various chest physiotherapy ACTs. CCPTs such as postural drainage, percussion and vibration, huffing and coughing have generally required assistance from someone else during treatments. Alternative ACTs such as active cycle of breathing techniques, forced expiration technique, autogenic drainage, positive expiratory pressure devices, oscillating positive expiratory pressure devices (e.g. Acapella, Aerobika, Flutter, RC-Cornet) or high-frequency chest compression and exercise are self-administered, which increases independence and flexibility.

What did we want to find out?

We wanted to compare how different ACTs affect lung function (how well the lungs work), respiratory exacerbations (flare-ups of lung disease), a person's preference, adherence (how well the person follows their doctor's advice), quality of life and impact on fitness levels.

What did we do?

We searched medical databases for well-designed studies comparing CCPT with other ACTs in people with CF. Studies selected people for one treatment or the other in a random or partly random way. We chose studies lasting longer than one week to allow enough time for treatments to have an impact on the outcomes we were interested in.

What did we find?

We found 21 studies with 778 people with CF aged from newborn to 45 years and with all levels of disease severity. The number of people included in each study ranged from 13 to 166. There were more females than males included in all but two studies.

Main results

The studies did not show that any alternative ACTs were better than CCPT in terms of lung function, respiratory exacerbations, a person's preference, adherence, quality of life and impact on fitness level. Studies in which participants had flare-ups of chest infections showed that lung function improved considerably after treatment, irrespective of the type of ACT. Longer-term studies showed smaller improvements or a decline in lung function. In 10 studies, participants preferred the chest physiotherapy techniques they could administer themselves, but, since the studies measured preference in different ways, we could not combine the individual study results in an analysis. Side effects from different ACTs tended to be rare, mild and resolved quickly. We cannot recommend any single treatment over another at this time.

What are the limitations of the evidence?

The quality of evidence varied greatly between the studies. We are not sure that the present evidence is able to answer the questions we were asking. We did not find enough evidence to confirm or exclude any differences between CCPT and alternative ACTs in terms of our outcome measures. Furthermore, data from our included studies did not show that any of the alternative ACTs were better than CCPT in people with CF. This may be because the studies did not report enough data for us to analyse, rather than confirming that the ACTs all worked equally well. There were differences in how the studies were run and how the researchers collected data, so this also makes it difficult to compare results. These differences included the number of people in the studies, length of time the studies lasted, location of the studies (e.g. in hospital or at home), types of ACTs used and outcomes measured by the researchers to assess the impact of the different techniques. In future studies it would be better if these factors were more similar to make it easier to compare results.

How up to date is this evidence?

We last searched the databases in June 2022.

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