SPUTUM RHEOLOGY CHANGES IN CYSTIC-FIBROSIS LUNG-DISEASE FOLLOWING 2 DIFFERENT TYPES OF PHYSIOTHERAPY - FLUTTER VS AUTOGENIC DRAINAGE

Objective: The aim of the present study was to investigate the efficac y of two frequently used physiotherapies (PTs) for the removal of bron chial secretions in cystic fibrosis (CF) lung disease: autogenic drain age (AD) and the Flutter (Desitin iri Germany). AD is believed to impr ove mucus clearance from peripheral to central airways due to airway c aliber changes in combination with a special breathing technique, The Flutter is an easy-to-use physiotherapy device based on oscillations o f a steel ball during expiration through a pipe-type device. Materials and methods: To evaluate the acute and chronic physiotherapy effects of these two techniques, 14 CF patients underwent either twice daily A D or Flutter treatment for 4 consecutive weeks in a randomized crossov er design. Prior to each therapy interval, for a 1-week wash-out perio d, no PT was administered, but patients continued regular medication, At the beginning and end of each 4-week interval, pulmonary function w as measured before and after an acute 30-min therapy. At the end of th e PT session, sputum was collected, weighed, and deep frozen until ana lyzed. The viscoelasticity of the sputum was evaluated using a magneti c microrheometer. Results: No significant changes were noted for FVC, FEV1, or sputum volume throughout the study. Sputum viscoelasticity (r igidity index), however, was significantly lower (p<0.01) after therap y with the Flutter in comparison with AD, predicting improvements in m ucociliary and cough clearability of the secretions, In a companion in vitro experiment, oscillations generated by passing humidified air ov er CF sputum lining an acrylic tube connected to a Flutter device were found to decrease sputum elasticity, as measured by a filancemeter.Th ese findings suggest that applied oscillations are capable of decreasi ng mucus viscoelasticity within the airways at frequencies and amplitu des achievable with the Flutter device, and provide direct evidence th at PT can I educe the viscoelasticity of sputum.