S100 7.
Physiotherapy
163 Phoniatric voice rehabilitation in cystic brosis
L. Graziano1 , M. Tornaghi2 , B. Giacomodonato1 , M. Curzi1 , T. Perelli1 ,
S. De Sanctis1 , M. Varchetta1 , F. Alatri1 . 1 Sapienza University of Rome,
Pediatrics, Rome, Italy; 2 Sapienza University of Rome, Medical Administration
Ofce, Rome, Italy
Objectives: Patients with cystic brosis (CF) may present a progressive quality
alteration of voice which appears with increased fatigue and relational discomfort.
To describe our experience in treating voice disorders in seven patients with CF.
Methods: 7 patient with CF (3F) age 2046 years had otolaryngological visit,
rhinolaryngoscopic examination and functional assessment of the voice. Three dif-
ferent conditions were found: 3 double lung transplantation patients with unilateral
vocal cord paralysis due to surgery and with timbre of voice blown; 1 patient with
gastroesophageal reux with bilateral vocal cord edema and with timbre of voice
veiled; 3 patients with bilateral hypotonia of the true vocal chords and with timbre
of voice hoarse. Patients started a six months phoniatric voice rehabilitation
program. Exercises consisted in breathing exercises to relax thoracic outlet and
to increase vocal cord rmness and phonation time.
Results: All patients achivied their physiological timbre of voice, a detension of
the thoracic outlet, an increased phonation time, an effective compensation by the
contralateral vocal fold on that in paralysis, a regression of vocal cord edema
(laryngoscopy).
Conclusion: A multidisciplinary program of phoniatric voice rehabilitation allowed
the resolution of a functional disturbance and the relational discomfort in our
patients with dysphonia.
164 Autogenic drainage and assisted autogenic drainage in children
with cystic brosis: A systematic review
L. Corten1 , J. Jelsma2 , B.M. Morrow3 . 1 University of Cape Town, Health and
Rehabilitation Sciences (Physiotherapy), Observatory, Cape Town, South Africa;
2 University of Cape Town, Health and Rehabilitation Sciences, Cape Town, South
Africa; 3 University of Cape Town, Paediatrics and Child Health, Cape Town,
South Africa
Chest physiotherapy is considered an essential part of symptomatic, multidisci-
plinary management in cystic brosis (CF), as it facilitates clearance of viscous
pulmonary secretions.
Objectives: To determine the effect of autogenic drainage (AD) and assisted auto-
genic drainage (AAD) compared to no; sham; or other types of chest physiotherapy
in children with CF.
Methods: Six databases, clinicaltrials.gov and pactr.org were searched. We included
randomized controlled trials, quasi-randomized controlled trials and randomized
cross-over trials on AD and AAD in children younger than 18 years, diagnosed
with CF. One author conducted the database search. Titles, abstracts and data
were evaluated by two independent reviewers with agreement by discussion and
consensus.
Results: A total of 126 titles were screened, of which seven were eligible. However,
only two studies made a clear distinction between pediatric (ntotal = 47; n1 = 36 &
n2 = 9) and adult data, and were therefore analyzed. We were unable to perform a
meta-analysis, as only one study clearly indicated separate results for the different
periods of the cross-over. Based on the pediatric data of this one study, participants
who received AD had a signicant improvement in Huang scores; a tendency to have
fewer hospital admissions during one year when compared to postural drainage; and
a clear preference for AD by participants. One other study reported pediatric data,
however no signicance levels were provided.
Conclusion: Due to the lack of pediatric-specic randomized controlled trials, small
sample sizes and unclear risk of bias of most studies, we were unable to determine
the efcacy and/or safety of AD and AAD in children with CF.
Posters
165 Real world introduction of tobramycin inhalation powder TIP in
adults with cystic brosis
H.B. Langman1 , A.L. Brennan1 , R.J. Bright-Thomas1 , A.M. Jones1 , D.W. Riley1 ,
S.C. Johnson1 . 1 Manchester Adult Cystic Fibrosis Centre, Manchester, United
Kingdom
Objectives: To evaluate the introduction of TIP in adult patients attending Manchester
Adult Cystic Fibrosis Centre.
Methods: In December 2012 TIP was introduced in line with NICE recommendations.
Tolerance prior to prescription was assessed at test dose followed by 1 month trial
of treatment. Outcome measures included spirometry, 7 day symptom score (Bennett
et al, 2010 JCF) and perceived treatment burden (110 scale, 10 = overwhelming).
IV antibiotic days were calculated for patients who completed 12 months of treatment.
12 month follow up is ongoing.
Results: Values are median (range)unless stated otherwise. 92 patients received a test
dose of TIP, mean age 28 years (1750), baseline FEV1 1.55 (0.584.3), baseline
FEV1 % predicted 43 (21112). 68 patients completed 1 month trial. 60/68 patients
who completed trial continued treatment. 36/60 (60%) continued for >12 months.
23/36 have received 12 month clinical follow up.
Table 1. Comparison of baseline and 1 month data
Baseline (n = 60) 1 month follow up (n = 60)
FEV1 (litres) 1.625 (0.5753.69) 1.875 (0.624.15)
FEV1 % predicted 46 (21112) 48.5 (21116)
Symptom score 5 (016) 4 (08)
Treatment burden 5 (010) 2 (08)
Values are median (range).
Table 2. 12 month follow up data (n = 23)
pre post
FEV1 1.7 (0.5753.65) 1.71 (0.553.73)
FEV1 % predicted 48 (2180) 46 (2085)
IV days 26 (071) 15 (056)
Conclusion: In real world use TIP appears to be associated with reduction in
perceived symptom scores and treatment burden; improvement in spirometry and
reduction in IV days. Only 60% patients continued TIP for >12 months. Reasons
for this need further evaluation.
166 Improvements in inhalational treatment amongst children using
the Philips I-neb insight online software
C. Yonge1 , V. Keenan1 , S. Payne1 , G. Connett1 . 1 Southampton University
Hospitals NHS Trust, Regional Paediatric CF Unit, Southampton, United Kingdom
Objectives: The Philips I-neb Adaptive Aerosol Delivery system is a portable drug
delivery device using vibrating mesh technology. I-neb insight on-line software
collects detailed data about I-neb usage. These data have previously assessed
adherence. In this study we have utilised data to identify individuals with poor
inhalation techniques to assess the effectiveness of an active intervention.
Methods: Data for nebuliser use over a recent two month period from 13 I-nebs
in children age 516 yrs were analysed to identify individuals with poor and/or de-
clining inhalational techniques according to examination of total I-neb nebulisation
time, inhalation time/breath and rest time. All patients had been previously assessed
in their use of a TIM mouthpiece to achieve >2 s inhalation. Those identied with
poor and/or declining inhalation techniques received tailored interventions. Further
data were obtained over the following month. Parameters for the most recent two
weeks were compared with those obtained in the two weeks prior to intervention.
Results: Six children were identied with poor inhalation techniques. In most, short
comings occurred for all parameters. Median total nebulisation time decreased from
3 min 25 s to 2 min 38 s. Median inhalation time/breath increased from 3.45 s to
3.65 s. Rest time as a % of total treatment time decreased from 39% to 31%.
Conclusion: This study indicates how software generated data about routine
nebuliser inhalation techniques can be used to optimise patient performance and
decrease burden of care using patient specic feedback and education. Further
studies might usefully determine how inhalational techniques are maintained in the
long term.