Comparison of flutter device and chest physical therapy in the treatment of cystic fibrosis pulmonary exacerbation

Chest physiotherapy (CPT) is recommended for the clearance of bronchial sec retions in the management of patients with cystic fibrosis (CF). The Flutte r(R) Valve (Scandipharm, Birmingham, AL) has been introduced as an alternat ive method to CPT for airway mucus clearance. The objective of this study w as to compare the short-term effects of CPT and the Flutter(R) valve on pul monary function and exercise tolerance in patients with cystic fibrosis. Tw enty-three patients, 5 to 21 years of age, were randomized to receive one o f two interventions: CPT or the Flutter(R) valve, upon admission to the hos pital for a 2-week treatment of pulmonary exacerbation. Pulmonary function testing (PFTs) and the 6-min walk test were performed on admission, day 7, and day 14 of hospitalization. Data analysis indicated no significant differences between the two groups o n admission. Both groups showed improvement in pulmonary function test resu lts, but the Flutter(R) group had a higher mean forced vital capacity (FVC) and forced expiratory volume in 1 sec(FEV1) ompared to the CPT group after 1 week of intervention. Both groups continued to improve during the 8-week intervention, with no significant difference in FVC or FEV1 between groups by the end of 2 weeks. Mean forced expiratory flow rate between 25-75% of vital capacity (FEF25-75), 6-min walk distance, and resting arterial oxyhem oglobin saturation (SaO(2)) showed little change by day 7, but improved sig nificantly (P < 0.05) by day 14 of hospitalization in both groups, with no significant difference between groups. This study demonstrated that patients using the Flutter(R) device had bette r pulmonary function after 1 week of therapy and similar improvement in pul monary function and exercise tolerance compared to CPT after 2 weeks of the rapy, suggesting that Flutter(R) valve therapy is an acceptable alternative to standard CPT during in-hospital care of patients with CF. (C) 1999 Wile y-Liss, Inc.