Short‐term effects of positive expiratory pressure mask on ventilation inhomogeneity in children with cystic fibrosis: A randomized, sham‐controlled crossover study

Abstract

AbstractBackgroundCan physiotherapy with a positive expiratory pressure (PEP) mask improve peripheral ventilation inhomogeneity, a typical feature of children with cystic fibrosis (cwCF)? To answer this question, we used the nitrogen multiple‐breath washout (N2MBW) test to measure diffusion‐convection‐dependent inhomogeneity arising within the intracinar compartment (Sacin*VT).MethodsFor this randomized, sham‐controlled crossover trial, two N2MBW tests were performed near the hospital discharge date: one before and the other after PEP mask therapy (1 min of breathing through a flow‐dependent PEP device attached to a face mask, followed by three huffs and one cough repeated 10 times) by either a standard (10–15 cmH20) or a sham (<5 cmH20) procedure on two consecutive mornings. Deception entailed misinforming the subjects about the nature of the study; also the N2MBW operators were blinded to treatment allocation. Study outcomes were assessed with mixed‐effect models.ResultsThe study sample was 19 cwCF (ten girls), aged 11.4 (2.7) years. The adjusted Sacin*VT mean difference between the standard and the sham procedure was −0.015 (90% confidence interval [CI]: −∞ to 0.025) L−1. There was no statistically significant difference in Scond*VT and lung clearance index between the two procedures: −0.005 (95% CI: −0.019 to 0.01) L−1 and 0.49 (95% CI: −0.05 to 1.03) turnovers, respectively.ConclusionOur findings do not support evidence for an immediate effect of PEP mask physiotherapy on Sacin*VT with pressure range 10–15 cmH20. Measurement with the N2MBW and the crossover design were found to be time‐consuming and unsuitable for a short‐term study of airway clearance techniques.