Beatrice Oberwaldner

EFFECT OF SWIMMING ON FORCED EXPIRATION AND SPUTUM CLEARANCE IN CYSTIC FIBROSIS

Ten children with cystic fibrosis participated in swimming training over 7 weeks. Ventilatory status, assessed by spirometry, had improved significantly after the course. 10 weeks after the end of the training most measurements had returned to their preswimming levels. In the majority of the children sputum production on swimming days was higher than on nonswimming days. Regular swimming can assist in mucus clearance and improve ventilatory function in children with cystic fibrosis.

Cystic fibrosis: physical exercise versus chest physiotherapy.

Twelve children with cystic fibrosis were admitted to a paediatric rehabilitation hospital for 17 days to take part in a training programme of vigorous physical exercise and sport. The daily inhalation-physiotherapy routine was stopped. Ventilatory status was assessed by spirometry and measurement of lung volumes one day before admission, one day after the end of the hospital stay, and 8 weeks later. Flow measurements of forced expiration had improved appreciably by the end of the course, but most of them returned to pretraining levels 8 weeks later. Lung volumes did not change significantly. Daily recordings of peak flow indicated improvement of airways function plus some ventilatory muscle training. Regular physical exercise could replace the inhalation-physiotherapy routine in some children with cystic fibrosis.

Self-administered chest physiotherapy in cystic fibrosis: A comparative study of high-pressure pep and autogenic drainage

Fourteen patients with cystic fibrosis were trained in 2 self-administered chest physiotherapy (PT) techniques: high-pressure PEP-mask physiotherapy (PEP), and autogenic drainage (AD). They then visited the clinic on 5 consecutive days, and, in a random order, performed 1 of the following: PEP, AD, PEP followed by AD (PEP-AD), AD followed by PEP (AD-PEP), and, no PT except for spontaneous coughing. Lung function was measured repeatedly before, during, and after PT; time needed for and sputum produced by each form of PT was recorded. PEP produced the highest amount of sputum, followed by PEP-AD, AD-PEP, and AD; all 4 forms of PT produced significantly more sputum than coughing. Lung function improved significantly after PEP, AD, and PEP-AD, but PEP-induced changes did not exceed those after AD. Within the investigated group, the PEP-induced lung function improvement per milliliter of sputum produced was significantly lower for those patients with airway hyperreactivity. The fact that the highest sputum yield with PEP was not reflected in higher PEP-effected lung function changes might thus be explained by PEP-induced bronchospasm in patients with airway hyperreactivity. PEP clears more sputum than AD or combined techniques; patients with airway hyperreactivity, however, should either prefer AD or should take a bronchodilator premedication before PEP.

Chest physiotherapy: the mechanical approach to antiinfective therapy in cystic fibrosis

SummaryChest physiotherapy is a treatment program that attempts to compensate for impaired mucociliary clearance. By removing mucopurulent secretions, it reduces airway obstruction and its consequences, such as atelectasis and hyperinflation; furthermore, physiotherapy can decrease the rate of proteolytic tissue damage by removing infected secretions. Conventional physiotherapy (clapping, vibration and compression, together with postural drainage and assisted coughing) is the most efficient physiotherapy for sick infants and young children. Later, mechanical chest percussion can reduce the patients dependency on others. The forced expiration technique is another method of self-treatment, employing expiratory techniques to blow secretions out of the bronchi. Autogenic drainage, a special breathing technique, aims at avoiding airway compression by reducing positive expiratory transthoracic pressure. PEP-mask-physiotherapy achieves the same goal by expiring against an external airflow obstruction. Last but not least, physical exercise can clear the lungs of some CF patients and thus offers an attractive adjunct to physiotherapy.ZusammenfassungDie Thoraxphysiotherapie versucht die Auswirkungen der gestörten mukoziliären Reinigung zu reduzieren. Durch die Entfernung mukopurulenter Sekretmassen werden einerseits die mechanischen Folgen der Sekretobstruktion (Atelektase, Überblähung) hintangehalten, andererseits die proteolytische Bronchialwanddestruktion verzögert. Die „konventionelle“ Thoraxphysiotherapie (Thoraxperkussion, -vibration, -kompression mit Drainagelagerung und assistiertem Husten) ist noch immer die wirksamste Behandlungsmethode im Säuglings- und Kleinkindesalter. Später kann dann die maschinelle Thoraxperkussion zur Selbstbehandlung überleiten und dem Patienten größere Unabhängigkeit ermöglichen. Die forcierte Exspirationstechnik ist eine weitere Selbstbehandlungsmethode, die mit besonderen Exspirationsmanövern das Sekret aus den Bronchien „bläst“. Die Autogene Drainage, eine spezielle Atemtechnik, versucht diesen Effekt bei gleichzeitiger Vermeidung eines exspiratorischen Bronchialkollaps zu erreichen. Die PEP-Masken-Physiotherapie entleert die Lunge bei Luftwegsdehnung durch Expiration gegen eine externe Stenose. Nicht zuletzt kann Sport die Lungen mancher Patienten gut säubern und wird damit zu einer wertvollen Ergänzung der Thoraxphysiotherapie.

[Non-invasive and invasive out of hospital ventilation in chronic respiratory failure : Consensus report of the working group on ventilation and intensive care medicine of the Austrian Society of Pneumology].

ZusammenfassungDer vorliegende Konsensusreport, der unter der Patronanz der Österreichischen Gesellschaft für Pneumologie (ÖGP) erstellt wurde, soll einen praxisnahen Leitfaden für die außerklinische Beatmung darstellen mit Bedachtnahme auf die spezifisch österreichischen Rahmenbedingungen und gesetzlichen Grundlagen. Der Leitfaden orientiert sich nach einer Konsensusempfehlung der ÖGP zur Ausstattung deslangzeitbeatmeten Patienten aus dem Jahr 2004 und der S2-Leitlinie der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin über die nichtinvasive und invasive Beatmung bei der chronischen respiratorischen Insuffizienz aus 2010, angepasst an nationale Erfahrungen und aktualisiert durch rezente Literatur.In 11 Kapiteln wird einerseits die Einleitung, Umstellung und Kontrolle der außerklinische Beatmung, die technische Ausstattung sowie der Beatmungszugang, andererseits die verschiedenen Indikationen wie chronisch obstruktive Atemwegserkrankungen, thorakal-restriktive und neuromuskuläre Erkrankungen, das Adipositas-Hypoventilationssyndrom sowie pädiatrische Erkrankungen beschrieben. Weiters wird ausführlich auf die Atemphysiotherapie bei Erwachsenen und Kindern unter invasiver und nichtinvasiver Langzeitbeatmung eingegangen.AbstractThe current consensus report was compiled under the patronage of the Austrian Society of Pneumology (Österreichischen Gesellschaft für Pneumologie, ÖGP) with the intention of providing practical guidelines for out-of-hospital ventilation that are in accordance with specific Austrian framework parameters and legal foundations. The guidelines are oriented toward a 2004 consensus ÖGP recommendation concerning the setup of long-term ventilated patients and the 2010 German Respiratory Society S2 guidelines on noninvasive and invasive ventilation of chronic respiratory insufficiency, adapted to national experiences and updated according to recent literature. In 11 chapters, the initiation, adjustment, and monitoring of out-of-hospital ventilation is described, as is the technical equipment and airway access. Additionally, the different indications—such as chronic obstructive pulmonary diseases, thoracic restrictive and neuromuscular diseases, obesity hypoventilation syndrome, and pediatric diseases—are discussed. Furthermore, the respiratory physiotherapy of adults and children on invasive and noninvasive long-term ventilation is addressed in detail.The current consensus report was compiled under the patronage of the Austrian Society of Pneumology (Österreichischen Gesellschaft für Pneumologie, ÖGP) with the intention of providing practical guidelines for out-of-hospital ventilation that are in accordance with specific Austrian framework parameters and legal foundations. The guidelines are oriented toward a 2004 consensus ÖGP recommendation concerning the setup of long-term ventilated patients and the 2010 German Respiratory Society S2 guidelines on noninvasive and invasive ventilation of chronic respiratory insufficiency, adapted to national experiences and updated according to recent literature. In 11 chapters, the initiation, adjustment, and monitoring of out-of-hospital ventilation is described, as is the technical equipment and airway access. Additionally, the different indications-such as chronic obstructive pulmonary diseases, thoracic restrictive and neuromuscular diseases, obesity hypoventilation syndrome, and pediatric diseases-are discussed. Furthermore, the respiratory physiotherapy of adults and children on invasive and noninvasive long-term ventilation is addressed in detail.

Nichtinvasive und invasive außerklinische Beatmung beim chronisch respiratorischen Versagen

ZusammenfassungDer vorliegende Konsensusreport, der unter der Patronanz der Österreichischen Gesellschaft für Pneumologie (ÖGP) erstellt wurde, soll einen praxisnahen Leitfaden für die außerklinische Beatmung darstellen mit Bedachtnahme auf die spezifisch österreichischen Rahmenbedingungen und gesetzlichen Grundlagen. Der Leitfaden orientiert sich nach einer Konsensusempfehlung der ÖGP zur Ausstattung deslangzeitbeatmeten Patienten aus dem Jahr 2004 und der S2-Leitlinie der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin über die nichtinvasive und invasive Beatmung bei der chronischen respiratorischen Insuffizienz aus 2010, angepasst an nationale Erfahrungen und aktualisiert durch rezente Literatur.In 11 Kapiteln wird einerseits die Einleitung, Umstellung und Kontrolle der außerklinische Beatmung, die technische Ausstattung sowie der Beatmungszugang, andererseits die verschiedenen Indikationen wie chronisch obstruktive Atemwegserkrankungen, thorakal-restriktive und neuromuskuläre Erkrankungen, das Adipositas-Hypoventilationssyndrom sowie pädiatrische Erkrankungen beschrieben. Weiters wird ausführlich auf die Atemphysiotherapie bei Erwachsenen und Kindern unter invasiver und nichtinvasiver Langzeitbeatmung eingegangen.AbstractThe current consensus report was compiled under the patronage of the Austrian Society of Pneumology (Österreichischen Gesellschaft für Pneumologie, ÖGP) with the intention of providing practical guidelines for out-of-hospital ventilation that are in accordance with specific Austrian framework parameters and legal foundations. The guidelines are oriented toward a 2004 consensus ÖGP recommendation concerning the setup of long-term ventilated patients and the 2010 German Respiratory Society S2 guidelines on noninvasive and invasive ventilation of chronic respiratory insufficiency, adapted to national experiences and updated according to recent literature. In 11 chapters, the initiation, adjustment, and monitoring of out-of-hospital ventilation is described, as is the technical equipment and airway access. Additionally, the different indications—such as chronic obstructive pulmonary diseases, thoracic restrictive and neuromuscular diseases, obesity hypoventilation syndrome, and pediatric diseases—are discussed. Furthermore, the respiratory physiotherapy of adults and children on invasive and noninvasive long-term ventilation is addressed in detail.The current consensus report was compiled under the patronage of the Austrian Society of Pneumology (Österreichischen Gesellschaft für Pneumologie, ÖGP) with the intention of providing practical guidelines for out-of-hospital ventilation that are in accordance with specific Austrian framework parameters and legal foundations. The guidelines are oriented toward a 2004 consensus ÖGP recommendation concerning the setup of long-term ventilated patients and the 2010 German Respiratory Society S2 guidelines on noninvasive and invasive ventilation of chronic respiratory insufficiency, adapted to national experiences and updated according to recent literature. In 11 chapters, the initiation, adjustment, and monitoring of out-of-hospital ventilation is described, as is the technical equipment and airway access. Additionally, the different indications-such as chronic obstructive pulmonary diseases, thoracic restrictive and neuromuscular diseases, obesity hypoventilation syndrome, and pediatric diseases-are discussed. Furthermore, the respiratory physiotherapy of adults and children on invasive and noninvasive long-term ventilation is addressed in detail.