Clinically useful outcome measures for physiotherapy airway clearance techniques: a review

Abstract A lack of good outcome measures has been a barrier to the development of an evidence base for all areas of respiratory physiotherapy. Many of the clinically available outcome measures are not specifically related to the physiotherapy intervention employed and may be affected by other factors. In this paper, the outcome measures currently clinically available to UK NHS physiotherapists to assess the response to alveolar recruitment and airway clearance interventions have been reviewed. It is clear that there is an urgent need to increase the accuracy, reliability, and sensitivity of the outcome measures employed, or to develop new measures to assess the effectiveness of respiratory physiotherapy. Lung sounds provide useful, specific information, but standard auscultation is too subjective to allow them to be used as an outcome measure. Computer Aided Lung Sound Analysis (CALSA) is proposed as a new objective, non-invasive, bedside clinical measure with the potential to monitor and assess the effects of airway clearance therapy.

[1]  J. Pryor,et al.  Physiotherapy for Respiratory and Cardiac Problems: Adults and Paediatrics , 2008 .

[2]  E. M. Williams,et al.  Expiratory airflow patterns in children and adults with cystic fibrosis. , 2000, Chest.

[3]  S. Soong,et al.  The chest roentgenogram in cystic fibrosis: a new scoring system. , 1979, Pediatrics.

[4]  J. Hankinson,et al.  Standardisation of spirometry , 2005, European Respiratory Journal.

[5]  K. Doi,et al.  Improved detection of lung nodules on chest radiographs using a commercial computer-aided diagnosis system. , 2004, AJR. American journal of roentgenology.

[6]  M. King,et al.  Sputum rheology changes in cystic fibrosis lung disease following two different types of physiotherapy: flutter vs autogenic drainage. , 1998, Chest.

[7]  P Piirilä,et al.  Changes in crackle characteristics during the clinical course of pneumonia. , 1992, Chest.

[8]  A. Nath,et al.  Inspiratory crackles and mechanical events of breathing , 1974, Thorax.

[9]  M. Williams,et al.  Energy expenditure during physiotherapist-assisted and self-treatment in cystic fibrosis , 2000 .

[10]  L. Wong,et al.  Long-term comparative trial of conventional postural drainage and percussion versus positive expiratory pressure physiotherapy in the treatment of cystic fibrosis. , 1997, The Journal of pediatrics.

[11]  Julia Bott Mcsp Guidelines for Pulmonary Rehabilitation Programs , 1999 .

[12]  A. Pfleger,et al.  Self-administered chest physiotherapy in cystic fibrosis: A comparative study of high-pressure pep and autogenic drainage , 2004, Lung.

[13]  P. Munt,et al.  Physiologic effects of chest percussion and postural drainage in patients with stable chronic bronchitis. , 1979, Chest.

[14]  M T Antonini,et al.  Acoustic properties of the normal chest. , 1995, The European respiratory journal.

[15]  J. E. Earis,et al.  Current methods used for computerized respiratory sound analysis , 2004 .

[16]  R. Baughman,et al.  Lung sound analysis for continuous evaluation of airflow obstruction in asthma. , 1985, Chest.

[17]  M Nissan,et al.  Respiratory health screening using pulmonary function tests and lung sound analysis. , 1994, The European respiratory journal.

[18]  J. Georg [Lung function tests]. , 1958, Ugeskrift for laeger.

[19]  P Piirilä,et al.  Crackles in patients with fibrosing alveolitis, bronchiectasis, COPD, and heart failure. , 1991, Chest.

[20]  P. Jones,et al.  Outcomes and markers in the assessment of chronic obstructive pulmonary disease , 2006, European Respiratory Journal.

[21]  Aintree Chest,et al.  Current methods used for computerized respiratory sound analysis , 2000 .

[22]  Hans Pasterkamp,et al.  Volume-dependent variations of regional lung sound, amplitude, and phase. , 2002, Journal of applied physiology.

[23]  C A Britton,et al.  Interobserver reliability of the chest radiograph in community-acquired pneumonia. PORT Investigators. , 1996, Chest.

[24]  Murray D. Altose,et al.  Dyspnea. Mechanisms, assessment, and management: a consensus statement. American Thoracic Society. , 1999, American journal of respiratory and critical care medicine.

[25]  A. Bellone,et al.  Chest physical therapy in patients with acute exacerbation of chronic bronchitis: effectiveness of three methods. , 2000, Archives of physical medicine and rehabilitation.

[26]  R L Smyth,et al.  Validity and reliability of acoustic analysis of respiratory sounds in infants , 2004, Archives of Disease in Childhood.

[27]  S. Sehati,et al.  Effect of changes in lung volume on acoustic transmission through the human respiratory system. , 2001, Physiological measurement.

[28]  C. Galloni,et al.  Clinical evaluation of oscillating positive expiratory pressure for enhancing expectoration in diseases other than cystic fibrosis. , 1995, Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace.

[29]  P G Herman,et al.  Accuracy and its relationship to experience in the interpretation of chest radiographs. , 1975, Investigative radiology.

[30]  H. Pasterkamp,et al.  Nomenclature used by health care professionals to describe breath sounds in asthma. , 1987, Chest.

[31]  E. Hiller,et al.  Face mask physiotherapy in cystic fibrosis. , 1986, Archives of disease in childhood.

[32]  Cynthia A. Britton,et al.  Clinical Investigations: InfectionInterobserver Reliability of the Chest Radiograph in Community-Acquired Pneumonia , 1996 .

[33]  P Piirilä,et al.  Changes in frequency spectra of breath sounds during histamine challenge test in adult asthmatics and healthy control subjects. , 1994, Chest.

[34]  H. Pasterkamp,et al.  Respiratory sounds. Advances beyond the stethoscope. , 1997, American journal of respiratory and critical care medicine.

[35]  H. Pasterkamp,et al.  Auditory detection of simulated crackles in breath sounds. , 2001, Chest.

[36]  K. Chang,et al.  Accuracy of auscultation in the detection of haemopneumothorax. , 2003, The European journal of surgery = Acta chirurgica.

[37]  P. Robinson,et al.  Variation between experienced observers in the interpretation of accident and emergency radiographs. , 1999, The British journal of radiology.

[38]  W. Knowler,et al.  Visual lung-sound characterization by time-expanded wave-form analysis. , 1977, The New England journal of medicine.

[39]  J. Hankinson,et al.  General considerations for lung function testing , 2005, European Respiratory Journal.

[40]  K. Stiller,et al.  The role of thoracic expansion exercises during the active cycle of breathing techniques , 1997 .

[41]  A. Hakemi,et al.  Understanding Pulse Oximetry, Advantages, and Limitations , 2005 .

[42]  O. Paltiel,et al.  Chest radiographs in the emergency department: is the radiologist really necessary? , 2003, Postgraduate medical journal.

[43]  I. Sánchez,et al.  Tracheal and lung sounds repeatability in normal adults. , 2003, Respiratory medicine.

[44]  M Kompis,et al.  Acoustic imaging of the human chest. , 2001, Chest.

[45]  D. Newton,et al.  Physiotherapy and intermittent positive-pressure ventilation of chronic bronchitis. , 1978, British medical journal.

[46]  N Gavriely,et al.  The reproducibility of forced expiratory wheezes. , 1990, The American review of respiratory disease.

[47]  P D Welsby,et al.  The stethoscope: some preliminary investigations. , 2003, Postgraduate medical journal.

[48]  D. Pavia,et al.  Assessment of the forced expiration technique, postural drainage and directed coughing in chest physiotherapy. , 1983, European journal of respiratory diseases.

[49]  D. Brooks,et al.  Interrater reliability of auscultation of breath sounds among physical therapists. , 1995, Physical therapy.

[50]  L. Wong,et al.  Long-term comparative trial of positive expiratory pressure versus oscillating positive expiratory pressure (flutter) physiotherapy in the treatment of cystic fibrosis. , 2001, The Journal of pediatrics.

[51]  Robert J Pierce,et al.  Respiratory function tests and their application , 2005, Respirology.

[52]  Raimon Jané,et al.  Detection of wheezing during maximal forced exhalation in patients with obstructed airways. , 2002, Chest.

[53]  D. Brooks,et al.  Accuracy and reliability of 'specialized' physical therapists in auscultating tape-recorded lung sounds. , 1993, Physiotherapy Canada. Physiotherapie Canada.

[54]  J Vanderschoot,et al.  Abnormal lung sounds in patients with asthma during episodes with normal lung function. , 1994, Chest.

[55]  R. Castile,et al.  Comparison of high‐frequency chest wall oscillation and oscillating positive expiratory pressure in the home management of cystic fibrosis: A pilot study * , 2001, Pediatric pulmonology.

[56]  M. Hodson,et al.  Evaluation of positive expiratory pressure as an adjunct to chest physiotherapy in the treatment of cystic fibrosis. , 1986, Thorax.

[57]  D. Homnick,et al.  Comparison of the flutter device to standard chest physiotherapy in hospitalized patients with cystic fibrosis: a pilot study. , 1998, Chest.

[58]  P Caminal,et al.  Analysis of tracheal sounds during forced exhalation in asthma patients and normal subjects: bronchodilator response effect. , 1999, Chest.

[59]  A. Ionescu,et al.  A short-term comparison of two methods of sputum expectoration in cystic fibrosis , 2004, European Respiratory Journal.

[60]  H S Hira,et al.  LUNG SOUNDS , 1978, The Journal of the Association of Physicians of India.

[61]  F. Dalmasso,et al.  Definition of terms for applications of respiratory sounds , 2000 .

[62]  F. Cerny,et al.  Relative effects of bronchial drainage and exercise for in-hospital care of patients with cystic fibrosis. , 1989, Physical therapy.

[63]  Toru Oga,et al.  Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. , 2002, Chest.

[64]  P. Piirilä,et al.  Crackles: recording, analysis and clinical significance. , 1995, The European respiratory journal.

[65]  P. Wollmer,et al.  Chest physiotherapy in chronic obstructive pulmonary disease: forced expiratory technique combined with either postural drainage or positive expiratory pressure breathing. , 1994, Respiratory medicine.

[66]  Andrey Vyshedskiy,et al.  Automated lung sound analysis in patients with pneumonia. , 2004, Respiratory care.

[67]  J. W. Wong,et al.  Mucociliary clearance in cystic fibrosis. , 1976, Modern problems in paediatrics.

[68]  D. Gozal,et al.  Comparison of high frequency chest compression and conventional chest physiotherapy in hospitalized patients with cystic fibrosis. , 1994, American journal of respiratory and critical care medicine.

[69]  R. Zuwallack,et al.  Pulmonary rehabilitation - 1999 , 1999 .

[70]  P D Welsby,et al.  Some high pitched thoughts on chest examination , 2001, Postgraduate medical journal.

[71]  M. Gappa The infant with cystic fibrosis: lung function. , 2004, Paediatric respiratory reviews.

[72]  H. Melbye,et al.  [Auscultation of the lungs--still a useful examination?]. , 2001, Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke.

[73]  A. Wanner,et al.  Effect of high-frequency oral airway and chest wall oscillation and conventional chest physical therapy on expectoration in patients with stable cystic fibrosis. , 1998, Chest.

[74]  S. Støvring,et al.  Improving the ketchup bottle method with positive expiratory pressure, PEP, in cystic fibrosis. , 1984, European journal of respiratory diseases.

[75]  D. Brooks,et al.  Chest physical therapy management of patients with cystic fibrosis. A meta-analysis. , 1995, American journal of respiratory and critical care medicine.

[76]  T. Marrie,et al.  Interobserver variability in the interpretation of chest roentgenograms of patients with possible pneumonia. , 1994, Archives of internal medicine.

[77]  L. Zanolla,et al.  Short‐term effects of three chest physiotherapy regimens in patients hospitalized for pulmonary exacerbations of cystic fibrosis: A cross‐over randomized study , 1995, Pediatric pulmonology.

[78]  S. Kudoh,et al.  Crackles in asbestos workers: auscultation and lung sound analysis. , 1981, British journal of diseases of the chest.

[79]  R. Pierce,et al.  Pulmonary artery pressure and blood flow as predictors of outcome from lung cancer resection , 2005, Respirology.

[80]  M. Falk,et al.  The effects of postural drainage and positive expiratory pressure physiotherapy on tracheobronchial clearance in cystic fibrosis. , 1991, Chest.

[81]  R. Baughman,et al.  Quantitation of wheezing in acute asthma. , 1984, Chest.

[82]  H. Chaney,et al.  A comparison of bronchial drainage treatments in cystic fibrosis , 1996, Pediatric pulmonology.

[83]  A. Coates,et al.  Immediate and long-term effects of chest physiotherapy in patients with cystic fibrosis. , 1983, The Journal of pediatrics.

[84]  R. Urquhart,et al.  The diagnostic value of pulmonary sounds: a preliminary study by computer-aided analysis. , 1981, Computers in biology and medicine.

[85]  J. Pryor,et al.  Physiotherapy for airway clearance in adults. , 1999, The European respiratory journal.

[86]  Z. Mohsenifar,et al.  Mechanical vibration and conventional chest physiotherapy in outpatients with stable chronic obstructive lung disease. , 1985, Chest.

[87]  P Piirilä,et al.  Averaged and time-gated spectral analysis of respiratory sounds. Repeatability of spectral parameters in healthy men and in patients with fibrosing alveolitis. , 1996, Chest.

[88]  A. K. Majumder,et al.  Frequency analysis of adventitious lung sounds. , 1982, Journal of biomedical engineering.

[89]  J. Fleg,et al.  The effect of anthropometric and socioeconomic factors on the racial difference in lung function. , 2001, American journal of respiratory and critical care medicine.

[90]  S. Jenkins,et al.  Accuracy and reliability of physiotherapists in the interpretation of tape-recorded lung sounds. , 1995, The Australian journal of physiotherapy.

[91]  T. Boat,et al.  Outcome measures for clinical trials in cystic fibrosis. Summary of a Cystic Fibrosis Foundation consensus conference. , 1994, The Journal of pediatrics.