Kistik Fibrozisli Hastalarda Yüksek Frekanslı Göğüs Duvarı Ossilasyonu Uygulamasının Etkileri

Öz

Amaç: Kistik fibrozisli (KF) hastalarda kısa süreli yüksek frekanslı göğüs duvarı ossilasyonu (YFGDO) uygulamasının etkilerinin ve kişisel kullanımının değerlendirilmesiydi.

Yöntemler: Klinik olarak stabil 9 KF’li hasta (yaş ortalamaları 15.0±3.9 yıl) çalışmaya alındı. YFGDO uygulaması 15 seans boyunca günde bir kez 30 dakika süre ile yapıldı. Tedavi öncesi ve sonrası hastaların solunum fonksiyonları ve fonksiyonel egzersiz kapasiteleri (6 dakika yürüme testi) değerlendirildi. Hastaların daha önce uyguladıkları tedavi yöntemleri ve uygulanan yöntemler arasındaki tercihleri, görsel analog skalasına göre YFGDO uygulaması memnuniyet düzeyleri ve tedavinin etkinliği hakkındaki görüşleri kaydedildi.

Sonuçlar: Tedavi öncesi ve sonrası solunum fonksiyon testi ve 6 dakika yürüme testi mesafesinde istatistiksel olarak anlamlı bir fark bulunmadı (p>0.05). Bununla birlikte, tedavi sonrası hastaların zorlu vital kapasitenin %25-75 akım hızı yüzde değerlerinde anlamlı bir

artış saptandı (p<0.05). Görsel analog skalasına göre, olguların YFGDO tedavi memnuniyeti 6.7±3.2 puan, uygulamanın etkinliği ise 6.9±3.3 puandı. Hastaların % 87.5’i, YFGDO yöntemini, havayolu temizleme teknikleri arasında ilk tercih sırasına aldı.

Tartışma: YFGDO uygulaması sonrası, solunum fonksiyonları ve fonksiyonel kapasite korunmaktadır. YFGDO olgularımız tarafından tercih edilen, memnun kalınan ve etkin bulunan bir yöntemdir. Bu konuda çok sayıda olguda ve uzun dönem yapılacak yüksek kaliteli randomize kontrollü çalışmalar, YFGDO’nun havayolu temizleme teknikleri içindeki önemi hakkında fizyoterapistlere ve hastaların ailelerine ışık tutacaktır.

Anahtar Kelimeler

• Kistik fibrozis,solunum terapisi,solunum fonksiyon testleri

THE EFFECTS OF HIGH FREQUENCY CHEST WALL OSCILLATION IMPLEMENTATION IN PATIENTS WITH CYCTIC FIBROSIS

Abstract

Purpose: The aim of the study was to evaluate the effects and personal use of short-term high frequency chest wall oscillation (HFCWO) implementation in patients with cystic fibrosis (CF).

Methods: Nine clinically stable patients with CF (mean age:15.0 ± 3.9 years) were enrolled in the study. HFCWO implementation was performed 15 sessions, daily for 30 minutes. Respiratory function and functional exercise capacity (6-minute walk test) of patients were assessed before and after treatment. Patients’ treatment methods that applied previously and preferences between the applied methods, their opinions about satisfaction level and the treatment efficacy of HFCWO implementation according to the visual analog scale were recorded.

Results: There were not statistically significant difference in pulmonary function test and 6-minute walk test distance before and after treatment (p>0.05). However, there was a significant increase in flow rate of 25-75% of vital capacity - percent values of patients after

treatment (p<0.05). According to visual analogue scale, HFCWO treatment satisfaction of patients was 6.7±3.2 points, implementation efficacy was 6.9±3.3 points. HFCWO method was first preference among airway clearance techniques in 87.5% of patients.

Discussion: Pulmonary functions and functional capacity is preserved after the HFCWO implementation. HFCWO is a method preferred by our patients, which is satisfactory and effective. Long term high-quality randomized controlled trials that will be carried out on larer samples about this topic will shed light on physiotherapists and patients’ families about the importance of HFCWO in airway clearance techniques.

Keywords

• Cystic fibrosis,respiratory therapy,respiratory function tests

Kaynakça

1. 1. Bell SC, Robinson PJ . Cystic Fibrosis Standards of Care. Fitzgerald AD, editör. Cystic Fibrosis Australia:Sydney, NSW, 2008.
2. 2. Mason RJ, Broaddus VC, Murray JF, Nadel JA. Textbook of Respiratory Medicine. 1st ed. Philadelphia: Elsevier Saunders, 2005.
3. 3. Shale DJ. Predicting survival in cystic fibrosis. Thorax. 1997;52(4):309.
4. 4. Coakley RD, Boucher RC. Pathophysiology: epithelial cell biology and ion channel function in the lung, sweat gland and pancreas. In: Hodson M, Geddes D, Bush A, editors. Cystic fibrosis. 3rd ed. London: Hodder Arnold, 2007;p. 59-68.
5. 5. Dodd ME, Prasad SA. Physiotherapy management of cystic fibrosis. Chron Respir Dis. 2005;2(3):139-49.
6. 6. Gross D, Zidulka A, O’Brien C, Wight D, Fraser R, Rosenthal R, et al. Peripheral mucociliary clearance with high frequency chest wall compression. J Appl Physiol. 1985;58(4):1157-63.
7. 7. Hansen LG, Warwick WJ. High frequency chest compression system to aid in mucous clearance in the lung. Biomed Instrum Technol. 1990;24(4):289-94.
8. 8. Dosman CF, Jones RL. High frequency chest compression. A summary of the literature. Can Res J. 2005;12(1):37–41.

9. 9. Bradley JM. High frequency chest wall ossilation in cystic fibrosis. Thorax. 2010;65(3):189-90.
10. Darbee JC, Kanga JF, Ohtake PJ. Physiologic evidence for high frequency chest wall ossilation and positive expiratory pressure breathing in hospitalized subjects with cystic fibrosis. Phys Ther. 2005;85(12):1278-89.
11. 11. Oermann CM, Sockrider MM, Giles D, Sontag MK, Accurso FJ, Castile RG. Comparison of high frequency chest wall ossilation and ossilating positive expiratory pressure in the home management of cystic fibrosis: a pilot study. Pediatr Pulmonol. 2001;32(5):372-7.
12. 12. Phillips GE, Pike SE, Jaffe A, Bush A. Comparison of active cycle of breathing and high-frequency ossilation jacket in children with cystic fibrosis. Pediatr Pulmonol. 2004;37(1):71-5.
13. 13. World Health Organization, Physical status: the use and interpretation of anthropometry, report of the WHO Expert Committee, (WHO Technical Report Series, No: 854), Geneva, World Health Organization, 1995.
14. 14. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54(7):581-6.
15. 15. Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, et al. ATS/ERS Task Force. General considerations for lung function testing. Eur Respir J. 2005;26(1):153-61.
16. 16. ATS committee on proficiency standarts for clinical pulmonary function laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111-7.
17. Kempainen RR, Milla C, Dunitz J, Savik K, Hazelwood A, Williams C, Rubin BK, Billings JL. Comparison of settings used for high-frequency chest-wall compression in cystic fibrosis. Respir Care. 2010;55(6):695-701.
18. 18. Green SB, Salkind NJ. Using SPSS for Windows and Macintosh. 5th ed. New Jersey: Prentice Hall; 2008.
19. 19. Hayran M, Hayran M. 1st ed. Sağlık Araştırmaları İçin Temel İstatistik. Ankara: Omega yayınları; 2011.
20. 20. King M, Phillips DM, Gross D, Vartian V, Chang HG, Zidulka A. Enhanced tracheal mucus clearance with high frequency chest wall compression. Am Rev Respir Dis. 1983;128(3):511-5.
21. 21. Hansen LG, Warwick WJ, Hansen KL. Mucus transport mechanisms in relation to the effect of high frequency chest wall compression (HFCC) on mucus clearance. Pediatr Pulmonol. 1994;17(2):113-8.
22. 22. Milla CE, Hansen LG, Weber A, Warwick WJ. High- frequency chest compression: effect of the third generation compression waveform. Biomed Instrum Technol. 2004;38(4):322-8.
23. 23. Milla CE, Hansen LG, Warwick WJ. Different frequencies should be prescribed for different high- frequency chest compression machines. Biomed Instrum Technol. 2006;40(4):319-24.
24. 24. Gokdemir Y, Karadag-Saygi E, Erdem E, Bayindir O, Ersu R, Karadag B, et al. Comparison of conventional pulmonary rehabilitation and high-frequency chest wall oscillation in primary ciliary dyskinesia. Pediatr Pulmonol. 2014;49(6):611-6.
25. 25. Nicolini A, Cardini F, Landucci N, Lanata S, Ferrari-Bravo M, Barlascini C. Effectiveness of treatment with high-frequency chest wall oscillation in patients with bronchiectasis. BMC Pulm Med. 2013;13(21):1-8.
26. Yuan N, Kane P, Shelton K, Matel J, Becker BC, Moss RB. Safety, tolerability, and efficacy of high-frequency chest wall oscillation in pediatric patients with cerebral palsy and neuromuscular diseases: an exploratory randomized controlled trial. J Child Neurol. 2010;25(7):815-21.
27. 27. McIlwaine MP, Alarie N, Davidson GF, Lands LC, Ratjen F, Milner R, et al. Long-term multicentre randomised controlled study of high frequency chest wall oscillation versus positive expiratory pressure mask in cystic fibrosis. Thorax. 2013;68(8):746-51.
28. 28. Sontag MK, Quittner AL, Modi AC, Koenig JM, Giles D, Oermann CM, et al. Investigators and coordinators of the Airway Secretion Clearance Trial. Lessons learned from a randomized trial of airway secretion clearance techniques in cystic fibrosis. Pediatr Pulmonol. 2010;45(3):291–300.
29. 29. Kıyan E. Spirometrik ölçümler. In: Bartu Saryal S, Ulubay G, editors. Solunum fonksiyon testleri. 1st ed. İstanbul: Aves Yayıncılık, 2012; p.40-55.
30. 30. Arora NS, Rochester DF. Respiratory muscle strength and maximum voluntary ventilation in undernourished patients. Am Rev Respir Dis. 1982;126(1):5-8.
31. 31. Ionescu AA, Chatham K, Davies CA, Nixon LS, Enright S, Shale DJ. Inspiratory muscle function and body composition in cystic fibrosis. Am J Respir Crit Care Med. 1998;158(4):1271-6.
32. 32. Osman LP, Roughton M, Hodson ME, Pryor JA. Short-term comparative study of high frequency chest wall ossilation and European airway clearance techniques in patients with cystic fibrosis. Thorax.2010;65(3):196-200.