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It is known that chest percussion is the main recommended technique of physiotherapy in our country. In the case of my daughter, aged 6 years and a half, we could apply this method very well so far (plus complementing techniques, such as the flutter, respiration exercises, sports). But my daughter is old enough now to say that she does not want to do percussion, it takes too much because it is boring and even painful, sometimes. I know that there is another method used for the lung clerance, namely vest with high frequency. I would like to know what is your opinion about the vest and if you have a patient who uses it and what is their opinion about the vest.
Dear questioner,

Thank you for your question and interest in ECORN-CF; will try to respond.
Within care of patients with cystic fibrosis, physiotherapy is a compulsory
and important part. Physiotherapy includes:

- Clearance techniques

- Physical exercises

- Inhalation therapy

Postural drainage and percussion are passive techniques which are usually
the mainstay of physiotherapy in infants and small children when active
participation is not possible. These techniques have remained the treatment
of choice in some European countries, however, others regard them as the
"old techniques" which should be replaced by modified postural drainage with
blowing games, physical activities and bubble PEP rather than the passive
techniques. PEP and forced expiratory techniques showed to be equally or
superior to postural drainage plus percussion. Thus many European CF centres
use alternative methods of airway clearance in infants and small children.
Existing evidence to date does not show any of these techniques to be
superior to all others. Therefore the choice of treatment should be dictated
by individual requirements, in your case your daughter should choose
something that makes fun to her.

According to your daughters age you can choose (depending on the child's
preference, the level of technical knowledge): Active Cycle of Breathing ;
Autogenic Dranaige, PEP mask, Flutter, RC Cornet , Acapella, or other newer
techniques, such as therapy by high frequency chest compression. This is
done through a system which consists of a special vest, which has dimensions
corresponding with the patient´s age. Most of the techniques mentioned may
be associated with postural drainage or percussion and chest compression.

Regarding the vest efficiency, some authors consider it superior compared to
conventional techniques, others in exchange showed that efficiency is
similar to other techniques. Most literature summarizing the benefits of the
vest are reviews written by the Manufacturers. Some of these show small
differences to conventional techniques from very short studies. However,
there is also a study (from the Brompton group), which investigated 32 adult
patients over 4 days comparing usual airway clearance techniques to high
frequency chest wall oscillation. This study showed that significantly more
sputum was expectorated with usual airway clearance techniques and also
significantly more patients preferred it. An inconvenient application in
practice is the high price of the equipment for high frequency chest
compressions. We do not have patients who use the vest.

Therefore one would recommend to try the vest in patients who lack the
ability to perform the more active techniques. With the adjuncts like the
acapella, PEP, etc. physiotherapy should also be more convenient for your

Yours sincerely,

Dr. Z. Popa