Comparison of intrapulmonary percussive ventilation and chest physiotherapy: A pilot study in patients with cystic fibrosis

Study objective: To compare the intrapulmonary percussive ventilator (IPV) to chest physiotherapy (P and PD) with respect to acute changes in (1) pulmonary function and (2) sputum physical properties in patients with cystic fibrosis (CF). Design: Randomized crossover. Setting: Community-based CF referral center. Participants: Nine nonhospitalized persons (range, 7 to 40 years; median, 12.4 years) with moderate to excellent Shwachman scores. Interventions: Three treatment regimens: (1) 2.5 mg albuterol delivered via IPV (internal percussive component activated); (2) 2.5 mg albuterol delivered via IPV (internal percussive component inactivated), followed by P and PD; and (3) 2.5 mg albuterol delivered via updraft nebulizer, followed by P and PD. Measurements and results: Outcome measures included pulmonary function testing (PFTs) and quantitative and qualitative sputum analysis. Among the three treatment groups, there were no significant differences in the change in predicted PFTs 1 h or 4 h after treatment, nor in the volume of sputum expectorated in the first 4 or in the subsequent 20 h. Among patients receiving IPV, more serious disease was associated with greater improvement in FEF25-75 1 h after treatment, but these differences disappeared by 4 h. There were no meaningful differences in viscoelastic characteristics of sputum expectorated after each treatments. Participants reported general satisfaction with no adverse effects while using IPV. Conclusions: This initial pilot study suggests (1) stable patients with CF tolerated one treatment of IPV without adverse sequelae, and (2) IPV was as effective as standard aerosol and P and PD in improving short-term PFT results and enhancing sputum expectoration.