We studied the effectiveness of some of the components of a physiotherapy regimen on the removal of mucus from the lungs of 6 subjects with
cystic fibrosis. On 5 randomized study days, after inhalation of a
99mTc-human serum albumin aerosol to label primarily the large airways, the removal of lung radioactivity was measured during 40 min of (a) spontaneous
cough while at rest (control), (b)
postural drainage, (c)
postural drainage plus mechanical percussion, (d) combined maneuvers (
postural drainage, deep breathing with vibrations, and percussion) administered by a physiotherapist, (e) directed vigorous
cough. Measurements continued for an additional 2 h of quiet rest. Compared with the control day, all forms of intervention significantly improved the removal of mucus:
cough (p less than 0.005), physiotherapy maneuvers (0.005 less than or equal to p less than 0.01),
postural drainage (p less than 0.05), and
postural drainage plus percussion (p less than 0.01). However, there was no significant difference between regimented
cough alone and therapist-administered combined maneuvers, nor between
postural drainage alone and with mechanical percussion. We conclude that in
cystic fibrosis, vigorous, regimented
cough sessions may be as effective as therapist-administered physiotherapy in removing pulmonary secretions.
Postural drainage, although better than the control maneuver, was not as effective as
cough and was not enhanced by mechanical percussion. Frequent, vigorous self-directed
cough sessions are potentially as useful as more complex measures for effective bronchial
toilet.