title: The Short-Term Effect of Breathing Tasks Via an Incentive Spirometer on Lung Function Compared With Autogenic Drainage in Subjects With Cystic Fibrosis.
abstract: BACKGROUND
  Forced expiration may assist secretion movement by manipulating airway dynamics in patients with cystic fibrosis (CF). Expiratory resistive breathing via a handheld incentive spirometer has the potential to control the expiratory flow via chosen resistances (1-8 mm) and thereby mobilize secretions and improve lung function. Our objective was to explore the short-term effect of using a resistive-breathing incentive spirometer on lung function in subjects with CF compared with the autogenic drainage technique.
  
  
  METHODS
  This was a retrospective study. Subjects with CF performed 30-45 min of either the resistive-breathing incentive spirometer (n = 40) or autogenic drainage (n = 32) technique on separate days. The spirometer encourages the patient to exhale as long as possible while maintaining a low lung volume. The autogenic drainage technique includes repetitive inspiratory and expiratory maneuvers at various tidal breathing magnitudes while exhalation is performed in a sighing manner. Spirometry was performed before and 20-30 min after the therapy.
  
  
  RESULTS
  Use of a resistive-breathing incentive spirometer improved FVC and FEV1 by 5-42% in 26 subjects. The forced expiratory flow during the middle half of the FVC maneuver (FEF25-75%) improved by >20% in 9 (22%) subjects. FVC improved the most in subjects with an FEV1 of 40-60% of predicted. Improvements negatively correlated with baseline percent-of-predicted FVC values provided improvements were above 10% (r(2) = 0.28). Values improved in a single subjects using the autogenic drainage technique.
  
  
  CONCLUSIONS
  These 2 techniques may allow lower thoracic pressures and assist in the prevention of central airway collapse. The resistive-breathing incentive spirometer is a self-administered simple method that may aid airway clearance and has the potential to improve lung function as measured by FVC, FEV1, and FEF25-75% in patients with CF.
authors.affiliation: Pediatric Pulmonary Unit and the Cystic Fibrosis National Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Gil
authors.initials: G
authors.lastname: Sokol
authors.affiliation: Pediatric Pulmonary Unit and the Cystic Fibrosis National Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel. daphna.vilozni@sheba.health.gov.il.
authors.forename: Daphna
authors.initials: D
authors.lastname: Vilozni
authors.affiliation: Pediatric Pulmonary Unit and the Cystic Fibrosis National Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ran
authors.initials: R
authors.lastname: Hakimi
authors.affiliation: Pediatric Pulmonary Unit and the Cystic Fibrosis National Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Moran
authors.initials: M
authors.lastname: Lavie
authors.affiliation: Pediatric Pulmonary Unit and the Cystic Fibrosis National Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ifat
authors.initials: I
authors.lastname: Sarouk
authors.affiliation: Pediatric Pulmonary Unit and the Cystic Fibrosis National Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
authors.lastname: Bat-El Bar
authors.affiliation: Pediatric Pulmonary Unit and the Cystic Fibrosis National Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Dagan
authors.affiliation: Pediatric Pulmonary Unit and the Cystic Fibrosis National Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Miryam
authors.initials: M
authors.lastname: Ofek
authors.affiliation: Pediatric Pulmonary Unit and the Cystic Fibrosis National Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, affiliated with the Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ori
authors.initials: O
authors.lastname: Efrati
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003550:Cystic Fibrosis / Q000503:physiopathology* / Q000628:therapy; D015916:Drainage, Postural / Q000379:methods* / Q000523:psychology; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D009042:Motivation; D012119:Respiration; D012138:Respiratory Therapy / Q000295:instrumentation / Q000379:methods* / Q000523:psychology; D012189:Retrospective Studies; D013147:Spirometry / Q000295:instrumentation / Q000379:methods* / Q000523:psychology; D014797:Vital Capacity / Q000502:physiology; D055815:Young Adult
keywords: cystic fibrosis; lung function; respiratory physiotherapy