Related Experiment Videos
Chest physiotherapy in infants with cystic fibrosis: to tip or not? A five-year study
Brenda M Button1, Ralf G Heine, Anthony G Catto-Smith
1Department of Physiotherapy, Royal Children's Hospital, Melbourne, Australia. b.button@alfred.org.au
Insights
Modified physiotherapy without head-down tilt (MPT) reduced respiratory symptoms and antibiotic use in infants with cystic fibrosis (CF). This approach also improved long-term lung function compared to standard postural drainage physiotherapy (SPT).
Area of Science:
- Pediatric Pulmonology
- Respiratory Physiotherapy
- Cystic Fibrosis Research
Background:
- The necessity of standard postural drainage physiotherapy (SPT) for asymptomatic infants with cystic fibrosis (CF) remains debated.
- Current practices often involve head-down tilt, which may pose risks or be unnecessary in certain patient populations.
Purpose of the Study:
- To compare the efficacy of standard postural drainage chest physiotherapy (SPT) against a modified regimen excluding head-down tilt (MPT) in infants diagnosed with CF.
- To evaluate the impact of these physiotherapy techniques on respiratory symptoms, infection rates, and long-term pulmonary function.
Main Methods:
- A randomized controlled trial involving 20 newly diagnosed infants with CF (mean age 2.1 months).
- Infants were assigned to either SPT or MPT for 12 months, with parents maintaining symptom and treatment diaries.
- Serial chest radiographs (Brasfield score) and pulmonary function tests (PFTs) were conducted at multiple time points up to 5-6 years of age.
Main Results:
- Infants receiving SPT experienced significantly more days with upper respiratory tract symptoms (70 vs. 37 days) and required longer antibiotic courses (P=0.04 and P=0.05, respectively).
- Chest X-ray scores at 2.5 years were worse in the SPT group (P=0.03).
- Long-term pulmonary function, including forced vital capacity and FEV(1) at 5-6 years, was lower in the SPT group compared to the MPT group (P < 0.05).
Conclusions:
- Modified physiotherapy without head-down tilt (MPT) demonstrated superior outcomes compared to SPT in infants with CF.
- MPT was associated with fewer respiratory complications, reduced antibiotic requirements, and better long-term lung function.
- These findings suggest that MPT may be a more effective and potentially safer physiotherapy approach for infants with CF.
Abstract:
There is controversy about the need for postural drainage physiotherapy in asymptomatic infants with cystic fibrosis (CF). We aimed to compare the effectiveness of standard postural drainage chest physiotherapy (SPT) with a modified physiotherapy regimen without head-down tilt (MPT) in young infants with CF. Twenty newly diagnosed infants with CF (mean age, 2.1 months; range, 1-4) were randomized to SPT or MPT. Parents kept a detailed symptom and treatment diary for the following 12 months. Serial chest radiographs, taken at diagnosis, 12 months, 2(1/2) years, and 5 years after diagnosis, were assessed using the Brasfield score. Pulmonary function tests were compared between groups after 5 years. Of the 20 infants, 16 (80%) completed the review at 12 months, and 14 (70%) at 2(1/2) and 5 years. Patients receiving SPT had more days with upper respiratory tract symptoms than those on MPT (70 +/- 32.8 vs. 37 +/- 24.9 days; P = 0.04) and required longer courses of antibiotics (23 +/- 28.5 vs. 14 +/- 11.2 days; P = 0.05). Chest x-ray scores were similar at diagnosis but were worse at 2(1/2) years for those receiving SPT (P = 0.03). Forced vital capacity and forced expired volume in 1 sec (FEV(1)) at 5-6 years was lower for SPT than for MPT (P < 0.05). In conclusion, MPT was associated with fewer respiratory complications than SPT in infants with CF.