Comparison of different levels of positive expiratory pressure on chest wall volumes in healthy children and patients with fibrosis
DOI:
https://doi.org/10.1590/1809-2950/17015824032017Keywords:
Cystic Fibrosis, Respiratory Therapy, Respiratory System, Thoracic WallAbstract
Positive Expiratory Pressure (PEP) improves lung function, however, PEP-induced changes are not fully established. The aim of this study was to assess the acute effects of different PEP levels on chest wall volumes and the breathing pattern in children with Cystic Fibrosis (CF). Anthropometric data, lung function values, and respiratory muscle strength were collected. Chest wall volumes were assessed by Optoelectronic plethysmography at rest and during the use of different PEP levels (10 and 20 cm H2O), randomly chosen. Eight subjects with CF (5M, 11.5±3.2 years, 32±9.5 kilograms) and seven control subjects (4M, 10.7±1.5 years, 38.2±7.8 kilograms) were recruited. The CF group showed significantly lower FEF values 25-75% (CF: 1.8±0.8 vs. CG: 2.3±0.6) and FEV1/FVC ratio (CF: 0.8±0.1 vs. CG: 1±0.1) compared with the control group (p<0.05). Different PEP levels increased the usual volume in chest wall and its compartments in both groups; however, this volume was significantly higher in the control group compared with the CF group during PEP20 (CW: 0.77±0.25 L vs. 0.44±0.16 L; RCp: 0.3±0.13 L vs. 0.18±0.1 L; RCa: 0.21±0.1 L vs. 0.12±0.1 L; AB: 0.25±0.1 L vs. 0.15±0.1 L; p<0.05 for all variables). Minute ventilation was significantly higher during PEP compared with breathing at rest in both groups (p<0.005). End-expiratory volume was also higher during PEP compared with breathing at rest for chest wall and pulmonary rib cage in both groups (p<0.05). Different PEP levels may increase chest wall volumes in CF patients.Downloads
References
Ramsey BW. Management of pulmonary disease in patients
with cystic fibrosis. N Engl J Med. 1996;335(3):179-88.
doi: 10.1056/NEJM199607183350307.
Knowles MR, Stutts MJ, Yankaskas JR, Gatzy JT, Boucher
RC Jr. Abnormal respiratory epithelial ion transport in cystic
fibrosis. Clin Chest Med. 1986;7(2):285-97.
Phelan PD, Olinski A, Robertson CF. Respiratory ilness in
children. Oxford: Blackwell; 1994.
Lannefors L, Button BM, McIlwaine M. Physiotherapy in infants
and young children with cystic fibrosis: current practice and
future developments. J R Soc Med [Internet]. 2004 [acesso
em 17 ago. 2017];97(Suppl. 44):S8-25. Disponível em: https://
goo.gl/GZ63FG
Bradley JM, Moran FM, Elborn JS. Evidence for physical
therapies (airway clearance and physical training) in
cystic fibrosis: an overview of five Cochrane systematic
reviews. Respir Med. 2006;100(2):191-201. doi: 10.1016/j.
rmed.2005.11.028.
Pisi G, Chetta A. Airway clearance therapy in cystic fibrosis
patients. Acta Biomed [Internet]. 2009 [acesso em 17 ago.
;80(2):102-6. Disponível em: https://goo.gl/bqEz1s
Main E, Prasad A, Schans C. Conventional chest physiotherapy
compared to other airway clearance techniques for cystic
fibrosis. Cochrane Database Syst Rev. 2005;(1):CD002011.
doi: 10.1002/14651858.
Warnock L, Gates A, van der Schans CP. Chest physiotherapy
compared to no chest physiotherapy for cystic fibrosis.
Cochrane Database Syst Rev. 2013;(2):CD001401.
doi: 10.1002/14651858.CD001401.pub2.
Prasad SA, Tannenbaum E-L, Mikelsons, C. Physiotherapy in
cystic fibrosis. J R Soc Med [Internet]. 2000 [acesso em 17
ago. 2017];93(Suppl. 38):27-38. Disponível em: https://goo.
gl/V7TfVo
Laube BL, Geller DE, Lin TC, Dalby RN, Diener-West M, Zeitlin
PL. Positive expiratory pressure changes aerosol distribution
in patients with cystic fibrosis. Respir Care [Internet]. 2005
[acesso em 17 ago. 2017];50(11):1438-44. Disponível em:
Hunter JM, Sperry EE, Ravilly S, Colin AA. Thoracoabdominal
asynchrony and ratio of time to peak tidal expiratory flow
over total expiratory time in adolescents with cystic fibrosis.
Pediatr Pulmonol. 1999;28(3):199-204.
Allen JL, Wolfson MR, McDowell K, Shaffer TH.
Thoracoabdominal asynchrony in infants with airflow
obstruction. Am Rev Respir Dis. 1990;141(2):337-42.
doi: 10.1164/ajrccm/141.2.337.
Mayer OH, Clayton RG Sr, Jawad AF, McDonough JM, Allen
JL. Respiratory inductance plethysmography in healthy 3- to
-year-old children. Chest 2003;124(5): 1812-9. doi: 10.1378/
chest.124.5.1812.
Reber A, Geiduschek JM, Bobbià SA, Bruppacher HR,
Frei FJ. Effect of continuous positive airway pressure on
the measurement of thoracoabdominal asynchrony and
minute ventilation in children anesthetized with sevoflurane
and nitrous oxide. Chest. 2002;122(2):473-8. doi: 10.1378/
chest.122.2.473.
Capria ME, D’Nedri C, De Vito EL. Relationship between
Hoover sign, functional and variables, and curvature radius
in patients with obstructive pulmonary disease. Medicina (B
Aires). 2003;63(5):369-76.
Garcia-Pachon E, Padilla-Navas I. Frequency of
Hoover’s sign in stable patients with chronic obstructive
pulmonary disease. Int J Clin Pract. 2006;60(5):514-7.
doi: 10.1111/j.1368-5031.2006.00850.x.
Aliverti A, Pedotti A. Opto-electronic plethysmography. 18. World Health Organization. Declaration of Helsinki: ethical
principals for research involving human subjects. Bull
World Health Organ [Internet]. 2001 [acesso em 17 ago.
;79(4):373-4. Disponível em: https://goo.gl/4rCKZp
World Health Organization. Child growth standards based on
lenght/height, weight and age. Acta Paediatr. 2007;95:76-
doi: 10.1111/j.1651-2227.2006.tb02378.x.
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R,
Coates A, et al. Standardisation of spirometry. Eur Respir J.
;26(2):319-38. doi: 10.1183/09031936.05.00034805.
Mallozi MC. Valores de referência para espirometria em
crianças e adolescentes, calculados a partir de uma amostra
da cidade de São Paulo [Tese]. São Paulo: Escola Paulista de
Medicina; 1995.
American Thoracic Society, European Respiratory Society.
ATS/ERS Statement on respiratory muscle testing. Am J
Respir Crit Care Med. 2002;166(4):518-624.. doi: 10.1164/
rccm.166.4.518.
Lanza FC, Santos MLM, Selman JPR, Silva JC, Marcolin N,
Santos J, et al. Reference equation for respiratory pressures
in pediatric population: a multicenter study. PLoS One.
;10(8):e0135662. doi: 10.1371/journal.pone.0135662.
Cala SJ, Kenyon CM, Ferrigno G, Carnevali P, Aliverti A,
Pedotti A, et al. Chest wall and lung volume estimation by
optical reflectance motion analysis. J Appl Physiol [Internet].
[acesso em 17 ago. 2017];81(6):2680-9. Disponível em:
Aliverti A, Cala SJ, Duranti R, Ferrigno G, Kenyon CM, Pedotti
A, et al. Human respiratory muscle actions and control during
exercise. J Appl Physiol [Internet]. 1997 [acesso em 17 ago.
;83(4):1256-69. Disponível em: https://goo.gl/HW7vgc
Aliverti A, Uva B, Laviola M, Bovio D, Lo Mauro A, Tarperi
C, et al. Concomitant ventilatory and circulatory functions
of the diaphragm and abdominal muscles. J App Physiol.
;109(5):1432-40. doi: 10.1152/japplphysiol.00576.2010.
Cohen J. Statistical power analysis for the behavioral
sciences. 2. ed. Hillsdale: Lawrence Erbaum; 1988.
Hoo ZH, Daniels T, Wildman MJ, Teare MD, Bradley JM. Airway
clearance techniques used by people with cystic fibrosis
in the UK. Physiotherapy. 2015;101(4):340-8. doi: 10.1016/j.
physio.2015.01.008.
van Winden CMQ, Visser A, Hop W, Sterk PJ, Beckers S,
Jongste JC. Effects of flutter and PEP mask physiotherapy on
symptoms and lung function in children with cystic fibrosis. Eur
Respir J. 1998;12(1):143-7. doi: 10.1183/09031936.98.12010143.
McIlwaine MP, Alarie N, Davidson GF, Lands LC, Ratjen F,
Milner R, et al. Long-term multicentre randomised controlled
study of high frequency chest wall oscillation versus
positive expiratory pressure mask in cystic fibrosis. Thorax.
;68(8):746-51. doi: 10.1136/thoraxjnl-2012-202915.
Downloads
Published
Issue
Section
License
Copyright (c) 2017 Fisioterapia e Pesquisa
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
