Chest Physiotherapy and Cystic Fibrosis: Treatment
The appropriateness of CPT treatment and the selection of specific techniques provide yet another confounding variable. Studies resulting in poor performance for CPT often include conditions which would not clinically be treated. For example, the association between CPT and decreases in oxygenation has been noted by several authors. Connors et al (1980) studied the effects of percussion and PD on a group of acutely ill adults with conditions such as acute pneumonia and pulmonary edema. It was found that CPT treatment resulted in significant decreases in oxygen levels, which were particularly evident in patients with little or no sputum retention. Since that study, CPT has been shown to have no advantageous effect on the recovery from acute pneumonia or pulmonary edema. The techniques of percussion and PD are indicated for use in patients with conditions in which secretion retention is evident; therefore, it is not surprising that falls in oxygen occur in patients who do not have secretions. further
Additionally, interactions between chemical and physical regimens for the removal of secretions require consideration. Bronchodilators are commonly used before physiotherapy in CF subjects with reactive airways. Eber et al (1988) found that while /^-sympathomimetics relieved bronchospasm in many patients with CF, in some this medication enhanced airway compressibility and reduced expiratory airflow. Kohler et al (1986) showed that inhaled amiloride enhanced mucociliary clearance in CF subjects while App et al (1990) found that mucociliary clearance and cough clearance significantly increased using the FET augmented by pretreatment with amiloride. Given that physiotherapy treatments are commonly conducted in conjunction with medication, the specific contributions of chemical and physical intervention require further investigation.