Re: PeP - therapy or flutter?

Question

Dear Mrs. Koenecke
Many thanks for your quick answer.
Unfortunately the physiotherapists of my daughter are not agreed. In the center for CF in Verona, where my daughter is cared for, they say we should use the PeP-mask. We do this, but it does not seem too efficient to me. My daughter has actually never secretions, since she has started an antibiotic permanent therapy (every 2 days Azithromycin) and since we inhale 2 times a day cortinsone and salbutamol. Before, we did not have to inhale, neither to take antibiotics. Only since the springtime this is necessary, as she had often infections. We are now insecured, as our physiotherapist in South Tyrol regards the flutter method as more efficient.
Also the percussion has been taught to us in Verona, but she does not like it at all and our therapist here says, this is not efficient at all. So now we have 3 forms to choose: flutter, PeP and percussion.
What is the pursed lips breathing?
I thank you very much for your efforts. I just want to make myself a more detaild picture....

Answer

Dear lady and dear gentleman,
I can understand very well, that you are insecured after the diverse staements. Percussion is in Germany after introducing of the autogenic drainage for CF patients not relevant anymore. Probably the Italian collegues do not know this very effective breathing technique. It makes the independence of the patient in the field of every day and therapeutic management just possible. There are no studies on it available. However, trained CF-patients report with exitement of the autogenic drainage. In case your daughter is fit, you should do sports, that supports the mobilization of secretions probably in your described case the best. Probably an inhalation before strain makes sense. That has to be decided however by your doctor in charge.
If your daughter can handle the flutter better, I would use it then. The PeP (if with mask or the PARI-PEP system) is an alternative to the flutter. According to the findings the one or the other method can be used. From far away, I can not tell it to you more concrete unfortunately. The persued lip breathing has an effect like the PeP. Just without a breathing therapy device.
Yours sincerely,
K. Könecke

11.08.2009