Publication: Primer siliyer diskinezili hastalarda konvansiyonel pulmoner rehabilitasyon ile yüksek frekansli göğüs duvari ossilasyonu yönteminin karşılaştırılması
Abstract
Giriş: Primer Siliyer Diskinezili hastalarda erken tanı ve pulmoner rehabilitasyon (PR) ile mukosilyer klirensin arttırılması bronşektazi gelişiminin önlenmesi açısından önemlidir. PSD’de PR yöntemleri arasında en sık ve en etkin kullanılan yöntem konvansiyonel pulmoner rehabilitasyon (KPR) olarak adlandırılan postüral drenaj ve perküsyondur. Yeni bir teknik olan yüksek frekanslı göğüs duvarı ossilasyon (YFGDO) yöntemi kistik fibrozisli hastalarda sık kullanılan bir PR yöntemi olmakla birlikte PSD’de YFGDO kullanımı ile ilgili bir çalışma yoktur. Amaç: PSD’de KPR ve YFGDO yöntemlerinin etkinlik ve güvenilirliğini karşılaştırmaktır. Gereç ve yöntem: Marmara Üniversitesi Hastanesi Çocuk Göğüs Hastalıkları BD’de PSD tanısı ile izlenmekte olan 6 yaş üzerinde 24 hasta araştırmaya dahil edildi. Hastalara hem KPR hem de YFGDO yöntemi randomize olarak uygulandı. KPR grubuna solunum fonksiyon testi (SFT) yapıldıktan sonra çocuk servisine 5 gün süre ile yatırılarak solunum fizyoterapisti tarafından günde 2 kez 30’ar dakika süreyle PR uygulandı. Ardından aynı gruba 5 gün süre ile evde sabah ve akşam 30 dakika süreyle YFGDO yöntemi uygulandı. Diğer gruba ise önce YFGDO ardından KPR uygulandı. Her iki gruba da işlem sırasında satürasyon takibi yapıldı ve 5. günün sonunda SFT tekrarı yapıldı. İki tedavi yöntemi arasında hastaya 2 gün evde bakım vericisi tarafından PR uyguladı.Hastalara her iki yöntemle PR uygulandıktan sonra bu yöntemleri değerlendirmeleri istendi (Konfor 1-5, Etkinlik 1-5 arasında puanlandırıldı). Bulgular: Her iki PR yöntemi sonrasında hastaların SFT değerlerinde anlamlı artış saptandı. Her iki PR yöntemindeki % beklenen FVC, FEV1, PEFve FEF25-75 artış değerleri karşılaştırıldığında anlamlı fark saptanmadı. Cinsiyet, yaş dağılımı, tartı ve boy Z-skor, balgam mikrobiyolojisi ile her iki PR yöntemi sonrası % beklenen FVC, FEV1, PEF ve FEF25-75 değerlerindeki artış arasında anlamlı ilişki saptanmadı. YFGDO yöntemi hastalar tarafından daha konforlu bulundu. Her iki PR yöntemi hastalar tarafından etkin bulundu, PR sırasında desatürasyon gelişmedi. PSD hastalarının 3 ay sonraki takibinde PR’ye uyumu sorgulandığında 8 (%33) hastanın düzenli olarak sabah akşam KPR yaptığı, 13 (%54,2) hastanın ise KPR’yi düzensiz olarak yaptığı, 3 (%12,5) hastanın KPR’yi hiç yapmadığı saptandı. Hastaların çalışma sonrası % beklenen FVC, FEV1, PEF, FEF 25-75 değerlerinde anlamlı düşme oldu ve çalışma öncesi bazal değere döndüğü saptandı. Çalışmadan 3 ay sonra SFT değerleri ile çalışma sonrası SFT değerleri arasında anlamlı fark saptandı. Sonuç: Her iki PR yöntemi sonrasında SFT’de anlamlı artış saptandı. Solunum fonksiyon testleri açısından KPR ile YFGDO yöntemi arasında fark yoktu. YFGDO uygulaması hastalar tarafından daha konforlu bulundu ve iyi tolere edildi. Çalışmadan 3 ay sonra hastalar değerlendirildiğinde hastaların SFT parametrelerinde bazal değere düştüğü görüldü ve hastaların sadece %33’ünün düzenli sabah akşam KPR yaptığı saptandı. PSD’de PR yapılması ile hastalığın klinik gidişinin daha iyi olduğu bilinmekte olup hastaların yaş ve klinik durum özelliklerine göre PR yönteminde değişiklikler yapılması ve kişiye en uygun tedavi yönteminin bulunması PR uyumunu arttıracaktır. mer siliyer diskinezi, konvansiyonel pulmoner rehabilitasyon, yüksek frekanslı göğüs duvarı ossilasyonu, solunum fonksiyon testi, çocuk
Background:Early diagnosis and enhancement of mucociliary clearance by pulmonary rehabilitation (PR) is important to prevent the development of bronchiectasis in primary ciliary dyskinesia (PCD). Percussion and postural drainage are the most commonly used PR methods. High-frequency chest wall oscillation (HFCWO) is a new PR method which creates oscillation on the chest wall and moves the secretions from small airways to the large airways. HFCWO is as effective as conventional pulmonary rehabilitation (CPR) in cystic fibrosis patients. There is no study evaluating the efficacy of HFCWO in PCD patients. Aim: The aim of this study was to evaluate the efficacy and safety of CPR and HFCWO in PCD patients. Methods: Study included 24 patients with PCD older than 6 years old; all followed in our pediatric pulmonology clinic. Both CPR and HFCWO were applied randomly. CPR group patients were hospitalized for 5 days and PR was performed 2 times a day for a period of 30 minutes by respiratory physiotherapist. Then HFCWO was applied to the same group for 5 days at home. HFCWO was applied first to the other group and then hospitalized for CPR. Oxygen saturation was monitored during PR sessions. Pulmonary function tests (PFT) were performed on the 1st and 5th day of both therapies. Patients were asked about the comfort and efficiency level after both methods. Comfort: (1: very uncomfortable, 5: very comfortable) Efficacy (1: minimally efficient, 5: maximally efficient) Results: PFT values of patients increased significantly after both PR methods. There was no significant difference in % predicted FVC, FEV1, PEF and FEF25-75 increased values with CPR and HFCWO. There was no correlation between increased values with CPR and HFCWO. There was no correlation between gender, age, distribution, weight and height Z-score, sputum microbiology and % predicted FVC, FEV1, PEF and FEF25-75 values of both PR methods. HFCWO was found more comfortable. Two PR methods were found efficient and no desaturation was occured during PR. The compliance with CPR was low 3 months after the PR sessions. Eight (33%) patients did CPR regularly morning and evening, 13 (54.2%) patients irregularly, 3 (12.5%) patients had never done CPR after the study. Therefore PFT values was significantly decreased and was returned to baseline after 3 months of CPT sessions (Decline in FVC: p=0.013, FEV1 : p=0.003, PEF: p= 0.007). Conclusion:PFTs were significantly increased after both PR methods. There were no differences in PFTs and SpO2 between the CPR and HFCWO groups. HFCWO was found more comfortable and tolerated well by the patients. Both PR methods were found efficient. When the patients were evaluated 3months afte rthe study, we determined that only 33% of patients did CPR regularly 2 times a day and the PFT values were declined to the baseline. The prognosis of PCD is known to have been better with performing regular PR. Personalized modifications should be done to the method of PR according to age and clinical status of patients. So finding the most appropriate treatment method will improve compliance with CPR. Key words: Primary ciliary dyskinesia, conventional pulmonary rehabilitation, high frequency chest wall ossilation, pulmonary function test, child
Background:Early diagnosis and enhancement of mucociliary clearance by pulmonary rehabilitation (PR) is important to prevent the development of bronchiectasis in primary ciliary dyskinesia (PCD). Percussion and postural drainage are the most commonly used PR methods. High-frequency chest wall oscillation (HFCWO) is a new PR method which creates oscillation on the chest wall and moves the secretions from small airways to the large airways. HFCWO is as effective as conventional pulmonary rehabilitation (CPR) in cystic fibrosis patients. There is no study evaluating the efficacy of HFCWO in PCD patients. Aim: The aim of this study was to evaluate the efficacy and safety of CPR and HFCWO in PCD patients. Methods: Study included 24 patients with PCD older than 6 years old; all followed in our pediatric pulmonology clinic. Both CPR and HFCWO were applied randomly. CPR group patients were hospitalized for 5 days and PR was performed 2 times a day for a period of 30 minutes by respiratory physiotherapist. Then HFCWO was applied to the same group for 5 days at home. HFCWO was applied first to the other group and then hospitalized for CPR. Oxygen saturation was monitored during PR sessions. Pulmonary function tests (PFT) were performed on the 1st and 5th day of both therapies. Patients were asked about the comfort and efficiency level after both methods. Comfort: (1: very uncomfortable, 5: very comfortable) Efficacy (1: minimally efficient, 5: maximally efficient) Results: PFT values of patients increased significantly after both PR methods. There was no significant difference in % predicted FVC, FEV1, PEF and FEF25-75 increased values with CPR and HFCWO. There was no correlation between increased values with CPR and HFCWO. There was no correlation between gender, age, distribution, weight and height Z-score, sputum microbiology and % predicted FVC, FEV1, PEF and FEF25-75 values of both PR methods. HFCWO was found more comfortable. Two PR methods were found efficient and no desaturation was occured during PR. The compliance with CPR was low 3 months after the PR sessions. Eight (33%) patients did CPR regularly morning and evening, 13 (54.2%) patients irregularly, 3 (12.5%) patients had never done CPR after the study. Therefore PFT values was significantly decreased and was returned to baseline after 3 months of CPT sessions (Decline in FVC: p=0.013, FEV1 : p=0.003, PEF: p= 0.007). Conclusion:PFTs were significantly increased after both PR methods. There were no differences in PFTs and SpO2 between the CPR and HFCWO groups. HFCWO was found more comfortable and tolerated well by the patients. Both PR methods were found efficient. When the patients were evaluated 3months afte rthe study, we determined that only 33% of patients did CPR regularly 2 times a day and the PFT values were declined to the baseline. The prognosis of PCD is known to have been better with performing regular PR. Personalized modifications should be done to the method of PR according to age and clinical status of patients. So finding the most appropriate treatment method will improve compliance with CPR. Key words: Primary ciliary dyskinesia, conventional pulmonary rehabilitation, high frequency chest wall ossilation, pulmonary function test, child