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Afflovest®

Question
Hello
Afflovest® is a type of vest available for some time in the US. It seems that the use of this supplement vest of respiratory physiotherapy improves the health of users and their FEV1.
How is it that we do not hear about it in France? Are you aware of the use of this vest by individuals with cystic fibrosis in France and their experience ?
Thank you in advance for your response.
Answer
Hello,

Indeed, there are several brands of jackets that are used for the drainage of the bronchi, especially in cystic fibrosis patients in some countries, mainly in the United States: reimbursement of the total or partial cost is however dependent on the type of health insurance and is very variable from one patient to another. These jackets are little or not distributed in France since the Health Insurance does not support it. Among the arguments that can be advanced:

- In France, unlike the United States, physiotherapist's respiratory care, including doing it at home, is fully supported and is not limited to bronchial drainage;
- It is not possible at present to state, on indisputable scientific evidence that a bronchial drainage technique is more effective than another because of clinical study designs to answer the question posed almost insurmountable practical issues. Indeed, it is not possible to conduct a comparative double blind study as it is the case with a drug test compared to placebo: accordingly, even a comparative study involving a large number of patients over a long period would have low probability to demonstrate a significant benefit of one technique over another (see article referenced Cochrane review).

In conclusion :
- Experts agree to consider that physiotherapy is a basic treatment of cystic fibrosis although its effectiveness is difficult to measure;
- There are many drainage techniques including the use of the jacket in some countries but not in France;
- In practice, the best technique is that the patient adheres the best - this can possibly require to vary the methods used;
- It should be noted the interest of the technique of autogenous drainage, especially for adult patients because of the autonomy it brings.

Hope this answer can help.
Best wishes
Gilles RAULT, MD, Roscoff CF Center
16.04.2016