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Postural drainage in cystic fibrosis: is there a link with gastro-oesophageal reflux?
B M Button1, R G Heine, A G Catto-Smith
1Department of Physiotherapy, Royal Children's Hospital, Melbourne, Australia.
Insights
Positive expiratory pressure (PEP) chest physiotherapy improved reflux symptoms and lung function in children with cystic fibrosis (CF). Postural drainage (PD) worsened gastro-oesophageal reflux (GOR) in CF patients.
Area of Science:
- Pediatric Pulmonology
- Gastroenterology
- Respiratory Therapy
Background:
- Cystic Fibrosis (CF) is a genetic disorder affecting multiple organs, including the lungs and digestive system.
- Gastro-oesophageal reflux (GOR) is common in children with CF and can exacerbate pulmonary symptoms.
- Current chest physiotherapy techniques, such as postural drainage (PD), may influence GOR.
Purpose of the Study:
- To evaluate the clinical effects of switching from PD to positive expiratory pressure (PEP) chest physiotherapy in CF patients with symptomatic GOR.
- To assess the impact of PD on GOR in children with CF.
Main Methods:
- Study 1: Six adolescents with CF and GOR symptoms switched from PD to upright PEP physiotherapy, with measurements of lung function, reflux symptoms, and hospitalizations.
- Study 2: Twenty-four children with CF and suspected GOR underwent 24-hour pH monitoring during chest physiotherapy sessions.
Main Results:
- In Study 1, all patients reported reduced reflux symptoms with PEP (P < 0.001), improved lung function (P < 0.001), and decreased hospital days (P < 0.0005).
- In Study 2, 37.5% of patients had pathological GOR, with significantly increased reflux episodes and fractional reflux time during PD (P < 0.0001 and P < 0.01, respectively).
Conclusions:
- Upright PEP physiotherapy may be a more suitable option than PD for select CF patients experiencing symptomatic GOR.
- Further research is needed to clarify the role of GOR as a contributing factor in the progression of pulmonary disease in CF.
Objectives:
To determine the clinical effects of a change from postural drainage (PD) to positive expiratory pressure chest physiotherapy (PEP) in children with cystic fibrosis (CF) and symptoms of gastro-oesophageal reflux (GOR). To measure the effects of PD on GOR in children with CF.
Methods:
Study 1: Six adolescents with CF and symptoms of GOR during PD were changed to upright PEP physiotherapy. The effects on lung function, reflux symptom scores and annual hospital days were measured. Study 2: Twenty-four children with CF (mean age 11 years) and symptoms suggestive of GOR underwent 24-h pH monitoring, including periods of chest physiotherapy.
Results:
Study 1: All six patients reported a reduction in reflux symptoms during PEP therapy (P < 0.001). Lung function parameters improved during the first 6 months of PEP (P < 0.001). This improvement was sustained for a further 18 months. Annual hospital days decreased significantly (P < 0.0005). Study 2: Nine of 24 patients (37.5%) had pathological GOR. Reflux episodes were significantly increased during PD (P < 0.0001), as was fractional reflux time (P < 0.01).
Conclusions:
Upright PEP physiotherapy may be more appropriate than PD in selected patients with CF and symptomatic GOR. The role of GOR as a cofactor in the progression of pulmonary disease in CF needs further evaluation.