Randomised Crossover Study of the Lung Expansion by Negative Pressure and Positive Pressure Therapy in Bronchiectasis

Background: For patients with bronchiectasis, the mechanical mobilization of secretions constitutes a key therapeutic approach. However, the effectiveness of lung expansion therapy to mobilize secretions in bronchiectasis patients has not been extensively investigated. This study compared patients' exercise tolerance and physical assessment outcomes after secretion clearance using intermittent positive pressure breathing (IPPB) or negative pressure ventilation (NPV) as adjuncts to postural drainage (PD).Methods: Eighteen patients with stable bronchiectasis were recruited from December 2010 to October 2011. The participants were randomly divided into one of two groups, namely a NPV group or IPPB group. Each group was administered in a randomized crossover design at the outpatient clinic one hour per week, and lasted four weeks. After lung expansion therapy, all patients were requested to perform PD and active cycle breathing techniques. Pulmonary functions, pulse rate (PR), oxygen saturation, Borg score, cough difficulty, and the use of accessory muscle were obtained before lung expansion and again after PD at the fourth session for several variables. We also measured six-minute walk test (6MWT) as short term outcomes, performed at beginning and end of each type therapy.Results: Patients in the IPPB group appeared to cough more easily after postural drainage. Patients in the NPV group also had a significantly lower pulse rate after postural drainage, as well as less apparent breathlessness and a decreased use of accessory muscles. No significant difference was found for accessory muscle usage between the two techniques. For the outcomes of 6MWT, a significant improvement in walking distance and the change in Borg score during walking was larger after four weeks of NPV compared with baseline. The baseline FVC and FEV1 before NPV and baseline FEV1 before IPPB were all moderately correlated with change in accessory muscle usage after the interventions. Furthermore, one-way analysis of variance found a significant correlation (P = 0.0008) between the changes in FVC and accessory muscle usage after NPV.Conclusions: Weekly lung expansion therapy via NPV adjunct to postural drainage in outpatient clinic is as effective as IPPB in patients with bronchiectasis and has better exercise outcomes.

並列關鍵字

bronchiectasis ； negative pressure ventilation ； intermittent positive pressure breathing ； postural drainage ； lung expansion

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