title: Long-term comparative trial of positive expiratory pressure versus oscillating positive expiratory pressure (flutter) physiotherapy in the treatment of cystic fibrosis.
abstract: OBJECTIVE
  The objective was to evaluate the long-term effects of physiotherapy with an oscillating positive pressure device ("flutter") compared with physiotherapy with the use of a positive expiratory pressure (PEP) mask in patients with cystic fibrosis (CF).
  
  
  METHODS
  Forty children with CF were randomly assigned to performing physiotherapy with the PEP mask or the flutter device for 1 year. Clinical status, pulmonary function, and compliance were measured at regular intervals throughout the study.
  
  
  RESULTS
  The flutter group demonstrated a greater mean annual rate of decline in forced vital capacity compared with the PEP group (-8.62 +/- 15.5 vs 0.06 +/- 7.9; P =.05) with a similar trend in forced expiratory volume in 1 second (-10.95 +/- 19.96 vs -1.24 +/- 9.9; P =.08). There was a significant decline in Huang scores (P =.05), increased hospitalizations (18 vs 5; P =.03), and antibiotic use in the flutter group.
  
  
  CONCLUSIONS
  Flutter was not as effective in maintaining pulmonary function in this group of patients with CF compared with PEP and was more costly because of the increased number of hospitalizations and antibiotic use.
authors.affiliation: Department of Paediatrics, University of British Columbia, B.C.'s Children's Hospital, 4480 Oak Street, Vancouver, British Columbia V6H 3V4, Canada.
authors.forename: P M
authors.initials: PM
authors.lastname: McIlwaine
authors.forename: L T
authors.initials: LT
authors.lastname: Wong
authors.forename: D
authors.initials: D
authors.lastname: Peacock
authors.forename: A G
authors.initials: AG
authors.lastname: Davidson
mesh_terms: D000293:Adolescent; D002648:Child; D003550:Cystic Fibrosis / Q000628:therapy*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008170:Lung Compliance; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods*; D012129:Respiratory Function Tests; D014797:Vital Capacity