Short-Term Effects of Elastic Chest Wall Restriction on Pulmonary Function in Children with Cystic Fibrosis.
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BORIS DOI
Date of Publication
August 21, 2018
Publication Type
Article
Division/Institute
Contributor
Subject(s)
Series
Respiration
ISSN or ISBN (if monograph)
0025-7931
Publisher
Karger
Language
English
Publisher DOI
PubMed ID
30130754
Uncontrolled Keywords
Description
BACKGROUND
Elastic chest wall restriction introduced by Chevaillier is thought to reduce existing hyperinflation and improve mucus clearance from peripheral airways. In healthy adults, restriction decreases the functional residual capacity (FRC) and forced vital capacity (FVC), while ventilation inhomogeneity (lung clearance index [LCI]) increases. Pulmonary function response to restriction is unknown in individuals with cystic fibrosis (CF).
OBJECTIVES
To examine short-term effects of elastic chest wall restriction on pulmonary function in children with CF.
METHODS
Pulmonary function was first assessed twice 15 min apart at baseline and then again following 15 min of elastic chest wall restriction in 20 school-aged children with CF (12.3 ± 3.4 years). Primary outcomes were LCI from nitrogen multiple-breath washout, residual volume (RV), and FRC from plethysmography. Secondary outcomes were FVC and end-expiratory lung impedance (EELI) from electrical impedance tomography. Endpoints were test-retest reliability at baseline and lung function response to restriction, both on group and individual levels.
RESULTS
Test-retest reliability was excellent (intra-class correlation coefficients range 0.84-0.99). Following restriction, FRC significantly declined on average (95% CI) by -0.09 (-0.17 to -0.02) L. Similarly, FVC declined while LCI did not change. RV and EELI declined, but this did not reach statistical significance. On the individuals' level, heterogeneous changes in pulmonary function occurred following elastic chest wall restriction.
CONCLUSIONS
These findings indicate that the application of elastic chest wall restriction is safe, induces the intended decline in resting lung volume but does not systematically alter ventilation inhomogeneity in children with CF.
Elastic chest wall restriction introduced by Chevaillier is thought to reduce existing hyperinflation and improve mucus clearance from peripheral airways. In healthy adults, restriction decreases the functional residual capacity (FRC) and forced vital capacity (FVC), while ventilation inhomogeneity (lung clearance index [LCI]) increases. Pulmonary function response to restriction is unknown in individuals with cystic fibrosis (CF).
OBJECTIVES
To examine short-term effects of elastic chest wall restriction on pulmonary function in children with CF.
METHODS
Pulmonary function was first assessed twice 15 min apart at baseline and then again following 15 min of elastic chest wall restriction in 20 school-aged children with CF (12.3 ± 3.4 years). Primary outcomes were LCI from nitrogen multiple-breath washout, residual volume (RV), and FRC from plethysmography. Secondary outcomes were FVC and end-expiratory lung impedance (EELI) from electrical impedance tomography. Endpoints were test-retest reliability at baseline and lung function response to restriction, both on group and individual levels.
RESULTS
Test-retest reliability was excellent (intra-class correlation coefficients range 0.84-0.99). Following restriction, FRC significantly declined on average (95% CI) by -0.09 (-0.17 to -0.02) L. Similarly, FVC declined while LCI did not change. RV and EELI declined, but this did not reach statistical significance. On the individuals' level, heterogeneous changes in pulmonary function occurred following elastic chest wall restriction.
CONCLUSIONS
These findings indicate that the application of elastic chest wall restriction is safe, induces the intended decline in resting lung volume but does not systematically alter ventilation inhomogeneity in children with CF.