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A short-term comparison of two methods of sputum expectoration in cystic fibrosis

Dept of Physiotherapy and Section of Respiratory and Communicable Diseases, University of Wales College of Medicine, Academic Centre, Llandough Hospital, Cardiff and Vale NHS Hospital Trust, Penarth, UK

CORRESPONDENCE: D.J. Shale, Section of Respiratory and Communicable Diseases, University of Wales College of Medicine, Academic Centre, Cardiff and Vale NHS Trust, Llandough Hospital, Penarth, Vale of Glamorgan, CF64 2XX, UK. Fax: 44 2920716416. E-mail: shaledj@cardiff.ac.uk

Keywords: cystic fibrosis, physiotherapy, resistive inspiratory manoeuvres

Received: July 22, 2003
Accepted November 26, 2003

A.A. Ionescu and L.S. Nixon were supported by CF Trust UK project grants. Other support was from the Astra Foundation UK and GlaxoSmithKline UK.

The aim of this study was to determine whether repeated maximum inspiratory vital capacity manoeuvres against a fixed resistance increased effective short-term sputum clearance in adults with cystic fibrosis (CF).

Twenty adults with CF were randomised to receive, on alternate days, either standardised physiotherapy (SP) for 30 min, comprising postural drainage and the active cycle of breathing technique, or a series of resistive inspiratory manoeuvres (RIM) at 80% of their maximum sustained inspiratory pressure developed between residual volume and total lung capacity during the first 4 days of the treatment of an exacerbation of respiratory symptoms. Expectorated sputum was collected during and for 30 min after each treatment and weighed. Total protein, immunoreactive interleukin (IL)-8 and human neutrophil elastase (HNE) concentrations, and the amount of each component expectorated, were determined.

Compared with SP, RIM increased sputum weight two-fold, independent of treatment order or day. The concentrations of protein, IL-8 and HNE in sputum were similar for both treatments, while the quantity expectorated was greater with RIM treatment.

In conclusion, short-term resistive inspiratory manoeuvres treatment was more effective at clearing sputum and inflammatory mediators than standardised physiotherapy.

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