To the Editors:
A physiological rationale has been demonstrated for the use of noninvasive ventilation (NIV) in patients with cystic fibrosis (CF) [1]; however, there is little evidence [2] to support NIV as a routine clinical treatment in people with CF, especially for those with advanced lung disease. Possible explanations include the lack of clearly validated criteria to propose NIV, controversies with regard to the optimal ventilatory modes and settings, scepticism with regard to long-term efficacy [3], poor acceptance by some patients and, above all, lack of familiarity with this technique among health workers. Instead, respiratory physiotherapists are often involved in the NIV management with different skills and tasks [4]. The aim of this study was to survey and evaluate the role and competencies of Italian physiotherapists involved in NIV management in CF centres and to understand the rationale of NIV as perceived by them. A semi-structured online questionnaire consisting of 31 closed and nine open-ended questions was sent to the Italian Group of Physiotherapists (n=63) belonging to the Italian Society for the Study of Cystic Fibrosis, between March and April 2010. Respondents (n=42, 67%) worked in 24 CF centres (18 centres and six clinics), which had a total of 4,064 CF patients at the time of the study, 96 (2.4%) of those were using NIV. NIV was the therapeutic choice used in 63% of those centres and 28 (93%) out of 30 physiotherapists were involved in its management. According to respondents, NIV was the first-line treatment to improve gas exchange (89%) and was a valid tool as support to clearance techniques (68%) and to exercise training (43%). The main criteria to propose NIV, according to physiotherapists who use NIV (n=28), were hypercapnic pulmonary exacerbation, awaiting lung transplantation, severe impairment of pulmonary function and difficulties experienced with clearing secretions (fig. 1). Almost all interviewees agreed that NIV was part of the “core competence” for physiotherapists who work in CF centres (95%) and clinics (85%). A detailed picture revealed that 71% (n=20) of them chose ventilators, 96% were involved in the crucial choice of interfaces and 75% were in charge of ventilator settings. The majority (93%) took care of patients' comfort and compliance enhancement and set frequent follow-ups to periodically review patients and, thus, improve their adherence. Although there are some limitations, this is the first Italian study that explores how physiotherapists are involved in the NIV management in CF centres and their expectations and beliefs about the benefits of NIV. Despite the absence of standard protocols and guidelines, Italian CF centres and clinics take into consideration the therapeutic use of NIV and physiotherapists are involved in its use. According to our results, the rationale of adopting NIV as a therapeutic choice in CF as perceived by physiotherapists is in line with what the literature has recently suggested [5]. Harmonising the core competencies of physiotherapists all over Italy and the NIV management of CF patients is, however, still urgently needed.
The main criteria for noninvasive ventilation initiation according to physiotherapists.
Footnotes
Statement of Interest
None declared.
- ©ERS 2012
