title: Application of positive expiratory pressure *PEP* in cystic fibrosis patient inhalations.
abstract: Inhalations, whose aim is the liquefaction of dense viscous secretions and preparing them for evacuation from the bronchial tree by means of drainage techniques, are standard treatment procedures in cystic fibrosis. Numerous studies showed that during inhalation only a small percentage of the drug was deposited in the bronchi. The use of the so-called elevated positive expiratory pressure, or PEP system, can improve the drug deposition in the lungs and consequently have the effect of increasing the effects of physiotherapy and delay the progression of the disease. The aim of the study was a retrospective evaluation of the applicability of the PEP system in mucolytic drug inhalations in CF patients.
  
  
  METHODS
  Analysis of the variation of selected spirometry indicators over time: FEV1, FVC, MEF 75%, 50%, 25%, performed in two groups of patients with cystic fibrosis: group I using PEP (n 29), group II without PEP (n 38). The analysis of parameter variance in time, as well as of the course taken by the changes and the difference in this respect regarding the PEP and no PEP group of patients was made by means of the analysis of linear regression for correlated data (generalized estimating equation).
  
  
  RESULTS
  The use of the PEP system for inhalation in patients with cystic fibrosis had the greatest impact on improving the values of MEF 75%, 50%, 25%. After 18 months, observations indicated the improvement of the values by 8.1%, 10.4% and 13% respectively in the group of PEP and reduction by 6%, 4.6% and 4.5% in the group without PEP. The differences in the level of change observed between the two groups proved to be statistically significant (p=0.033, p = 0.019, p=0.006). After 18 months compared to the initial visit, the analysis of variation over time in the PEP group showed significant improvement only in the case of MEF 25% (p=0.024).
  
  
  CONCLUSIONS
  1) The PEP system may be applied in inhalations of mucolytic drugs in cystic fibrosis patients. 2) the application of the PEP system for inhalations in cystic fibrosis patients showed the greatest improvement in the values of MEF 75%50%25% 3) the use of PEP for inhalation of mucolytic drugs in patients with cystic fibrosis may be one of the factors affecting the delay of progression of functional changes in the lungs. 4) Long-term randomized observation should be carried out in order to confirm the retrospective study results. .
authors.affiliation: Department of Rehabilitation Institute of Mother and Child, Kasprzaka Street 17a, 01-211 Warsaw, Poland, tel. (22) 32-77-427, e-mail: zakład.usprawnienia@imid.med.pl.
authors.forename: Teresa
authors.initials: T
authors.lastname: Orlik
authors.forename: Dorota
authors.initials: D
authors.lastname: Sands
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D002648:Child; D003550:Cystic Fibrosis / Q000382:microbiology / Q000503:physiopathology* / Q000628:therapy*; D005100:Expectorants / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D011175:Positive-Pressure Respiration; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D013147:Spirometry; D013183:Sputum / Q000382:microbiology; D055815:Young Adult
chemical_list: D005100:Expectorants