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Vol. 35. Issue 6.
Pages 275-279 (June 1999)
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Vol. 35. Issue 6.
Pages 275-279 (June 1999)
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Estudio comparativo de la eficacia de dos protocolos de fisioterapia respiratoria en pacientes con fibrosis quística
Comparison of the efficacy of two chest physiotherapy protocols for patients with cystic fibrosis
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H. Sánchez Riera1
Corresponding author
ablucil@mx2.redestb.es

Correspondeneia: Rayo 4. Urb. La Motilla. 41700 Dos Hernianas. Sevilla.
, F. Ortega Ruiz, T. Elías Hernández, T. Montemayor Rubio, J. Castillo Gómez
Servicio de Neumología. Departamento de Rehabilitación. Hospital Universitario Virgen del Rocío. Sevilla
F.J. Dapena Fernández*, F. Gómez Domínguez**
* Departamento de Pediatría. Departamento de Rehabilitación. Hospital Universitario Virgen del Rocío. Sevilla
** Unidad de Fisioterapia. Departamento de Rehabilitación. Hospital Universitario Virgen del Rocío. Sevilla
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Objetivo

Comparar la efectividad a corto plazo de dos protocolos de fisioterapia respiratoria en pacientes con fibrosis quística respecto a una mayor eliminación de secreciones, y su posible repercusión en la funcion pulmonar y en los síntomas.

El tratamiento A comprendía: respiración diafragmática (RD) con espirómetro incentivo (El) en posición de drenaje (PD). El tratamiento B incluía: respiración diafragmática (RD) con presión positiva espiratoria (mascarilla-PPE) en posición de drenaje (PD).

Métodos

Se estudiaron 27 pacientes con fibrosis quística (RD) clínicamente estables. Todos realizaron, de forma aleatoria, los dos protocolos (A y B) en días distintos y separados al menos 48 h. Despues de cada sesión de tratamiento, se midió en gramos la cantidad de expectoracion eliminada. Previo y postratamiento se registraron parámetros de funcion pulmonar (capacidad vital forzada, FEV1, FEV1%, MMEF25–75, ventilación voluntaria maxima y pico espiratorio de flujo). El pico espiratorio de flujo (PEF) se recogió con peak-flow meter. Posteriormente, los pacientes durante la tarde en su casa recogieron el PEF cada hora y rellenaron un cuestionario clínico que comprendía: frecuencia e intensidad de la tos, características de la expectoracion, molestias en tórax y disnea.

Resultados

Durante el tratamiento A (con espirómetro incentivo) se eliminaron 14,6±13,7 g de expectoración y durante el tratamiento B 9,8±10,2 g (p<0,05). Las diferencias del pico espiratorio de flujo postratamiento A y B en relación a sus valores basales fueron +19,3 1/min y -0,20 1/min, respectivamente (p<0,01). En el tratamiento A el pico espiratorio de flujo se mantuvo elevado durante la tarde con respecto a su basal (p<0,02). En el tratamiento B no hubo cambios en el pico espiratorio de flujo al finalizar la tarde en relacion a su valor basal (p=0,49). El cuestionario clínico no experimentó cambios significativos con ningún tratamiento.

Conclusiones

En pacientes con fibrosis quística, la fisioterapia respiratoria con espirómetro incentivo aumentó significativamente la eliminación de secreciones, sin repercusion inmediata en la función pulmonar ni en los síntomas.

Palabras clave:
Fisioterapia respiratoria
Fibrosis quística
Presión espiratoria positiva
Espirómetro incentivo
Objective

To compare the short-term efficacy of two respiratory physiotherapy protocols on sputum clearance, lung function and symptoms in patients with cystic fibrosis. Treatment A consisted of diaphragm breathing with incentive spirometry and postural drainage. Treatment B consisted of diaphragm breathing with positive expiratory pressure (PEP-mask) and postural drainage.

Methods

Twenty-seven cystic fibrosis patients in stable condition followed both protocols (A and B) in random order on different days separated by at least 48 hours. After each treatment session the amount of sputum removed was weighed. Lung function variables (FVC, FEV1, FEV1%, MMEFwt-75, MW and PEF) were measured preand postreatment. PEF was measured with a peak flow meter. The patients later recorded PEF every hour at home and filled in a questionnaire on frequency and intensity of coughing, sputum characteristics, chest discomfort and dyspnea.

Results

During treatment A with incentive spirometry, 14.6±13.7 g of sputum was removed, whereas 9.8±10,2 g was eliminated during treatment B (p<0.05). The differences in PEF after treatments A and B in comparison with baseline values were +19.3 1/min and -0.2 1/min, respectively (p<0.01). PEF stayed high during the afternoon, in comparison with baseline, with treatment A (p<0.02). After treatment B, no changes in PEF in comparison with baseline were observed (p=0.49). Neither treatment led to significant differences in symptoms reported on the clinical questionnaire.

Conclusions

Respiratory physiptherapy with incentive spirometry significantly increases sputum clearance in cystic fibrosis patients, with no inmediate repercussions on lung function or symptoms.

Key words:
Respiratory physiotherapy
Cystic fibrosis
Positive expiratory pressure
Incentive spirometry
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Copyright © 1999. Sociedad Española de Neumología y Cirugía Torácica
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