CPAP Has No Effect on Clearance, Sputum Properties, or Expectorated Volume in Cystic Fibrosis

• Published in: Respiratory care 2012-11, Vol.57 (11), p.1914-1919
• Main Authors: SILVA AQUINO, Evanirso, SHIMURA, Francine, SILVEIRA SANTOS, Adriana, MIYUKI GOTO, Danielle, CENACHI COELHO, Cristiane, BICALHO DE FUCCIO, Marcelo, HILARIO NASCIMENTO SALDIVA, Paulo, LORENZI-FILHO, Geraldo, RUBIN, Bruce K, KONDO NAKAGAWA, Naomi
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Analysis; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Care and treatment; Child; Continuous Positive Airway Pressure; Cough; Cross-Over Studies; Cystic fibrosis; Cystic Fibrosis - physiopathology; Female; Health aspects; Humans; Intensive care medicine; Male; Medical sciences; Mucociliary Clearance - physiology; Pharmacology. Drug treatments; Physical therapy; Physiological aspects; Respiratory Function Tests; Shortness of breath; Sputum; Sputum - physiology; Therapeutics, Physiological; Treatment Outcome
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.01705

Positive expiratory pressure (PEP) is used for airway clearance in cystic fibrosis (CF) patients. Hypertonic saline (HTS) aerosol increases sputum expectoration volume and may improve respiratory secretion properties. CPAP may also be used to maintain airway patency and mobilize secretions. To evaluate if CPAP would increase the beneficial clearance effect of HTS in subjects with CF, we investigated the effects of CPAP alone and CPAP followed by HTS on sputum physical properties and expectoration volume in CF subjects. In this crossover study, 15 CF subjects (mean age 19 y old) were randomized to interventions, 48 hours apart: directed coughs (control), CPAP at 10 cm H(2)O, HTS 7%, and both CPAP and HTS (CPAP+HTS). Sputum collection was performed at baseline and after interventions. Expectorated volume was determined and in vitro sputum properties were analyzed for contact angle and cough clearability. There were no significant differences between any treatment in arterial blood pressure, heart rate, or pulse oximetry, between the 2 time points. HTS and CPAP+HTS improved cough clearability by 50% (P = .001) and expectorated volume secretion by 530% (P = .001). However, there were no differences between control and CPAP on sputum contact angle, cough clearability, or volume of expectorated secretion. CPAP alone had no effect on mucus clearance, sputum properties, or expectorated volume, and did not potentiate the effect of HTS alone in CF subjects.