Functional respiratory re-education interventions in people with respiratory disease: a systematic literature review

Dias, Pedro Miguel Martins; Teixeira, Helena Margarida dos Santos; Palma, Magali Cavaco; Messias, Patrícia Alexandra Lopes; Vieira, João Vítor da Silva; Ferreira, Rogério Manuel Ferrinho

doi:10.1590/0034-7167-2021-0654

Pedro Miguel Martins Dias Corresponding author: Pedro Miguel Martins Dias E-mail: pedrodias_vrsa@hotmail.com

Centro Hospitalar do Algarve EPE. Faro, Algarve, Portugal.

http://orcid.org/0000-0002-2351-6961

Helena Margarida dos Santos Teixeira

Centro Hospitalar do Algarve EPE. Faro, Algarve, Portugal.

http://orcid.org/0000-0002-3362-2215

Magali Cavaco Palma

Centro Hospitalar do Algarve EPE. Faro, Algarve, Portugal.

http://orcid.org/0000-0002-9458-6246

Patrícia Alexandra Lopes Messias

Centro Hospitalar do Algarve EPE. Faro, Algarve, Portugal.

http://orcid.org/0000-0001-5336-2396

João Vítor da Silva Vieira

Instituto Politécnico de Beja. Beja, Baixo Alentejo, Portugal.

http://orcid.org/0000-0002-3905-4802

Rogério Manuel Ferrinho Ferreira

Instituto Politécnico de Beja. Beja, Baixo Alentejo, Portugal.

http://orcid.org/0000-0001-5180-2036

Corresponding author: Pedro Miguel Martins Dias E-mail: pedrodias_vrsa@hotmail.com

EDITOR IN CHIEF: Antonio José de Almeida Filho

ASSOCIATE EDITOR: Maria Itayra Padilha

Population	Intervention	Outcomes
People with respiratory disease	Rehabilitation nursing interventions under the FRR	To improve respiratory function

Title, authors and year	Evidence level	Methodological quality
T1: Long-term benefits of airway clearance in bronchiectasis: a randomized placebo-controlled trial. Muñoz et al., 2018(¹⁴14 Muñoz G, Gracia J, Buxó M, Alvarez A, Vendrell M. Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial. Eur Respir J. 2018;51(1):1701926. https://doi.org/10.1183/13993003.01926-2017 https://doi.org/10.1183/13993003.01926-2... ).	1.c - RCT	12/13
T2: High-intensity inspiratory muscle training in bronchiectasis: a randomized controlled trial. Ozalp et al., 2018(¹⁵15 Ozalp O, Inal-Ince D, Cakmak A, Calik-Kutukcu E, Saglam M, Savci S, et al. High-intensity inspiratory muscle training in bronchiectasis: a randomized controlled trial. Respirology. 2018;24(3):246-53. https://doi.org/10.1111/resp.13397 https://doi.org/10.1111/resp.13397... ).	1.c - RCT	11/13
T3: Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Liao et al., 2015(¹⁶16 Liao L-Y, Chen K-M, Chung W-S, Chien J-Y. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Int J Chron Obstruct Pulmon Dis. 2015;10(1):1703-9. http://doi.org/10.2147/COPD.S90673 http://doi.org/10.2147/COPD.S90673... ).	1.c - RCT	12/13
T4: Effects of treadmill exercise versus Flutter^®on respiratory flow and sputum properties in adults with cystic fibrosis: a randomized, controlled, cross-over trial. Dwyer et al., 2017(¹⁷17 Dwyer TJ, Zainuldin R, Daviskas E, Bye PTP, Alison JA. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17(14):14. https://doi.org/10.1186/s12890-016-0360-8 https://doi.org/10.1186/s12890-016-0360-... ).	1.c - RCT	10/13
T5: Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Nicolini et al., 2018(¹⁸18 Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:617-25. http://doi.org/10.2147/COPD.S145440 http://doi.org/10.2147/COPD.S145440... ).	1.c - RCT	10/13
T6: A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections. Marques et al., 2020(¹⁹19 Marques A, Pinho C, Francesco S, Martins P, Neves J, Oliveira A. A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections. Respir Med. 2020;162:105861. https://doi.org/10.1016/j.rmed.2019.105861 https://doi.org/10.1016/j.rmed.2019.1058... ).	1.c - RCT	10/13
T7: Comparison of effectiveness of temporary positive expiratory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Nicolini et al., 2017(²⁰20 Nicolini A, Mascardi V, Grecchi B, Ferrari-Bravo M, Banfi P, Barlascini C. Comparison of effectiveness of temporary positive expirayory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Clin Respir J. 2017;12(3):1274-82. https://doi.org/10.1111/crj.12661 https://doi.org/10.1111/crj.12661... ).	1.c - RCT	11/13
T8: Effects of exercise and airway clearance (PEP) on mucus clearance in cystic fibrosis: a randomized cross-over trial. Dwyer et al., 2019(²¹21 Dwyer TJ, Daviskas E, Zainuldin R, Verschuer J, Eberl S, Bye PTP, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53(4):1801793. https://doi.org/10.1183/13993003.01793-2018 https://doi.org/10.1183/13993003.01793-2... ).	1.c - RCT	10/13
T9: Acute effects of oscillatory PEP and thoracic compression on secretion removal and impedance of the respiratory system in non-cystic fibrosis bronchiectasis. Simoni et al., 2019(²²22 Simoni LHS, Santos DO, Souza HCD, Baddini-Martinez JA, Santos MK, Gastaldi AC. Acute effects of oscillatory PEP and thoracic compression on secretion removal and impedance of the respiratory system in non-cystic fibrosis bronchiectasis. Respir Care. 2019;64(7):818-27. https://doi.org/10.4187/respcare.06025 https://doi.org/10.4187/respcare.06025... ).	1.c - RCT	10/13

Trial identification	Trial objective and participants	Highlighted interventions	Results obtained
T1: Muñoz et al., 2018(¹⁴14 Muñoz G, Gracia J, Buxó M, Alvarez A, Vendrell M. Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial. Eur Respir J. 2018;51(1):1701926. https://doi.org/10.1183/13993003.01926-2017 https://doi.org/10.1183/13993003.01926-2... ) Randomized controlled trial	Evaluate the effectiveness of the ELTGOL technique in respiratory function and elimination of secretions(¹⁴14 Muñoz G, Gracia J, Buxó M, Alvarez A, Vendrell M. Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial. Eur Respir J. 2018;51(1):1701926. https://doi.org/10.1183/13993003.01926-2017 https://doi.org/10.1183/13993003.01926-2... ). n = 44. Experimental group (EG): n = 22; age: 63.1±13.5 years. Control (CG)/placebo group: n = 22; age: 66.8±8.4 years(¹⁴14 Muñoz G, Gracia J, Buxó M, Alvarez A, Vendrell M. Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial. Eur Respir J. 2018;51(1):1701926. https://doi.org/10.1183/13993003.01926-2017 https://doi.org/10.1183/13993003.01926-2... ).	EG: ELTGOL technique with thoracoabdominal compressions(¹⁴14 Muñoz G, Gracia J, Buxó M, Alvarez A, Vendrell M. Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial. Eur Respir J. 2018;51(1):1701926. https://doi.org/10.1183/13993003.01926-2017 https://doi.org/10.1183/13993003.01926-2... ). CG / placebo: stretching exercises for the upper limbs(¹⁴14 Muñoz G, Gracia J, Buxó M, Alvarez A, Vendrell M. Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial. Eur Respir J. 2018;51(1):1701926. https://doi.org/10.1183/13993003.01926-2017 https://doi.org/10.1183/13993003.01926-2... ).	- Greater clearance of secretions within 24 hours after the first assessment and fewer exacerbations in the EG; - Significant improvement in quality of life (QL) and impact of coughing on the EG(¹⁴14 Muñoz G, Gracia J, Buxó M, Alvarez A, Vendrell M. Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial. Eur Respir J. 2018;51(1):1701926. https://doi.org/10.1183/13993003.01926-2017 https://doi.org/10.1183/13993003.01926-2... ).
T2: Ozalp et al., 2018(¹⁵15 Ozalp O, Inal-Ince D, Cakmak A, Calik-Kutukcu E, Saglam M, Savci S, et al. High-intensity inspiratory muscle training in bronchiectasis: a randomized controlled trial. Respirology. 2018;24(3):246-53. https://doi.org/10.1111/resp.13397 https://doi.org/10.1111/resp.13397... ) Randomized controlled trial	Evaluate the impact of high intensity inspiratory muscle training (H-IMT)(¹⁵15 Ozalp O, Inal-Ince D, Cakmak A, Calik-Kutukcu E, Saglam M, Savci S, et al. High-intensity inspiratory muscle training in bronchiectasis: a randomized controlled trial. Respirology. 2018;24(3):246-53. https://doi.org/10.1111/resp.13397 https://doi.org/10.1111/resp.13397... ). n = 45. EG: n = 23; age: 42.22±14.3 years. CG: n=22; age: 45.95±11.26 years old(¹⁵15 Ozalp O, Inal-Ince D, Cakmak A, Calik-Kutukcu E, Saglam M, Savci S, et al. High-intensity inspiratory muscle training in bronchiectasis: a randomized controlled trial. Respirology. 2018;24(3):246-53. https://doi.org/10.1111/resp.13397 https://doi.org/10.1111/resp.13397... ).	Experimental group: H-IMT with gradual increase in intensity throughout training(¹⁵15 Ozalp O, Inal-Ince D, Cakmak A, Calik-Kutukcu E, Saglam M, Savci S, et al. High-intensity inspiratory muscle training in bronchiectasis: a randomized controlled trial. Respirology. 2018;24(3):246-53. https://doi.org/10.1111/resp.13397 https://doi.org/10.1111/resp.13397... ). Control group: low intensity inspiratory muscle training, maintaining the same intensity(¹⁵15 Ozalp O, Inal-Ince D, Cakmak A, Calik-Kutukcu E, Saglam M, Savci S, et al. High-intensity inspiratory muscle training in bronchiectasis: a randomized controlled trial. Respirology. 2018;24(3):246-53. https://doi.org/10.1111/resp.13397 https://doi.org/10.1111/resp.13397... ).	- Lower values on the dyspnea scale; higher values in the social aspects of the QoL scale and higher number of hospitalizations in the EG; - Decrease in fatigue in both groups(¹⁵15 Ozalp O, Inal-Ince D, Cakmak A, Calik-Kutukcu E, Saglam M, Savci S, et al. High-intensity inspiratory muscle training in bronchiectasis: a randomized controlled trial. Respirology. 2018;24(3):246-53. https://doi.org/10.1111/resp.13397 https://doi.org/10.1111/resp.13397... ).
T3: Liao et al., 2015(¹⁶16 Liao L-Y, Chen K-M, Chung W-S, Chien J-Y. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Int J Chron Obstruct Pulmon Dis. 2015;10(1):1703-9. http://doi.org/10.2147/COPD.S90673 http://doi.org/10.2147/COPD.S90673... ) Randomized controlled trial	Evaluate the effects of FRR regarding dyspnea, cough, exercise tolerance, and sputum production(¹⁶16 Liao L-Y, Chen K-M, Chung W-S, Chien J-Y. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Int J Chron Obstruct Pulmon Dis. 2015;10(1):1703-9. http://doi.org/10.2147/COPD.S90673 http://doi.org/10.2147/COPD.S90673... ). n = 61. EG: n = 30; age: 68 years (44%-89%). CG: n=31; age: 70 years (52%-91%)(¹⁶16 Liao L-Y, Chen K-M, Chung W-S, Chien J-Y. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Int J Chron Obstruct Pulmon Dis. 2015;10(1):1703-9. http://doi.org/10.2147/COPD.S90673 http://doi.org/10.2147/COPD.S90673... ).	Experimental group (components of FRR): health education, postural drainage associated with percussion, breathing with semi-closed lips, mobilization of the upper limbs and walking training / mobilization of the lower limbs with breathing control(¹⁶16 Liao L-Y, Chen K-M, Chung W-S, Chien J-Y. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Int J Chron Obstruct Pulmon Dis. 2015;10(1):1703-9. http://doi.org/10.2147/COPD.S90673 http://doi.org/10.2147/COPD.S90673... ). Control group: usual health care and health education sessions(¹⁶16 Liao L-Y, Chen K-M, Chung W-S, Chien J-Y. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Int J Chron Obstruct Pulmon Dis. 2015;10(1):1703-9. http://doi.org/10.2147/COPD.S90673 http://doi.org/10.2147/COPD.S90673... ).	- Dyspnea and coughing spells decreased, and exercise tolerance and the ability to expectorate increased in the EG(¹⁶16 Liao L-Y, Chen K-M, Chung W-S, Chien J-Y. Efficacy of a respiratory rehabilitation exercise training package in hospitalized elderly patients with acute exacerbation of COPD: a randomized control trial. Int J Chron Obstruct Pulmon Dis. 2015;10(1):1703-9. http://doi.org/10.2147/COPD.S90673 http://doi.org/10.2147/COPD.S90673... ).
T4: Dwyer et al., 2017(¹⁷17 Dwyer TJ, Zainuldin R, Daviskas E, Bye PTP, Alison JA. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17(14):14. https://doi.org/10.1186/s12890-016-0360-8 https://doi.org/10.1186/s12890-016-0360-... ) Randomized controlled crossover trial	Evaluate the effects of exercises performed on a treadmill and with the Flutter^®for airway clearance(¹⁷17 Dwyer TJ, Zainuldin R, Daviskas E, Bye PTP, Alison JA. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17(14):14. https://doi.org/10.1186/s12890-016-0360-8 https://doi.org/10.1186/s12890-016-0360-... ). n = 25. Age: 30±8 years (19%-48%)(¹⁷17 Dwyer TJ, Zainuldin R, Daviskas E, Bye PTP, Alison JA. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17(14):14. https://doi.org/10.1186/s12890-016-0360-8 https://doi.org/10.1186/s12890-016-0360-... ).	Treadmill intervention: 20 minutes of constant exercise(¹⁷17 Dwyer TJ, Zainuldin R, Daviskas E, Bye PTP, Alison JA. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17(14):14. https://doi.org/10.1186/s12890-016-0360-8 https://doi.org/10.1186/s12890-016-0360-... ). Flutter^®intervention: breathing 15 times through the device, followed by deep breathing, coughing and huffing. Cycle repeated 6 times(¹⁷17 Dwyer TJ, Zainuldin R, Daviskas E, Bye PTP, Alison JA. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17(14):14. https://doi.org/10.1186/s12890-016-0360-8 https://doi.org/10.1186/s12890-016-0360-... ). Control intervention: sitting quietly for 20 minutes(¹⁷17 Dwyer TJ, Zainuldin R, Daviskas E, Bye PTP, Alison JA. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17(14):14. https://doi.org/10.1186/s12890-016-0360-8 https://doi.org/10.1186/s12890-016-0360-... ). Participants were randomly assigned to the three interventions, performing them(¹⁷17 Dwyer TJ, Zainuldin R, Daviskas E, Bye PTP, Alison JA. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17(14):14. https://doi.org/10.1186/s12890-016-0360-8 https://doi.org/10.1186/s12890-016-0360-... ).	- The treadmill and Flutter^®intervention revealed identical and significant improvements in the expiratory flow peak and in the reduction of the mechanism preventing expectoration; - The Flutter^®created a expiratory air flow trend; - The treadmill intervention promoted sputum hydration(¹⁷17 Dwyer TJ, Zainuldin R, Daviskas E, Bye PTP, Alison JA. Effects of treadmill exercise versus Flutter® on respiratory flow and sputum properties in adults with cystic fibrosis: a randomised, controlled, cross-over trial. BMC Pulm Med. 2017;17(14):14. https://doi.org/10.1186/s12890-016-0360-8 https://doi.org/10.1186/s12890-016-0360-... ).
T5: Nicolini et al., 2018(¹⁸18 Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:617-25. http://doi.org/10.2147/COPD.S145440 http://doi.org/10.2147/COPD.S145440... ) Randomized controlled trial	Evaluate whether pharmacological therapy in combination with two percussion techniques produce additional benefits in terms of respiratory function and performance of activities of daily living (ADL)(¹⁸18 Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:617-25. http://doi.org/10.2147/COPD.S145440 http://doi.org/10.2147/COPD.S145440... ). n = 63. IPV group: n = 20; age 72.8±6.1 years. HFCWO group: n=21; age: 73.8±5.9 years. GC: n=22; age: 74.9±2.7 years(¹⁸18 Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:617-25. http://doi.org/10.2147/COPD.S145440 http://doi.org/10.2147/COPD.S145440... ).	IPV group (intrapulmonary percussive ventilation): pharmacological treatment along with the IPV device(¹⁸18 Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:617-25. http://doi.org/10.2147/COPD.S145440 http://doi.org/10.2147/COPD.S145440... ). HFCWO (high-frequency chest wall oscillation) group: pharmacological treatment along with the HFCWO device(¹⁸18 Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:617-25. http://doi.org/10.2147/COPD.S145440 http://doi.org/10.2147/COPD.S145440... ). Control group: pharmacological treatment(¹⁸18 Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:617-25. http://doi.org/10.2147/COPD.S145440 http://doi.org/10.2147/COPD.S145440... ).	- Significant improvement in the IPV and HFCWO groups in relation to dyspnea and performance of ADL and pulmonary function (arterial blood gas values); - Significant improvement in maximal inspiratory and expiratory pressure in the IPV group, as well as greater efficiency in airway clearance and pulmonary muscle strengthening; - Similar results in cytological alterations of sputum with a decrease in inflammatory cells(¹⁸18 Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:617-25. http://doi.org/10.2147/COPD.S145440 http://doi.org/10.2147/COPD.S145440... ).
T6: Marques et al., 2020(¹⁹19 Marques A, Pinho C, Francesco S, Martins P, Neves J, Oliveira A. A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections. Respir Med. 2020;162:105861. https://doi.org/10.1016/j.rmed.2019.105861 https://doi.org/10.1016/j.rmed.2019.1058... ) Randomized controlled trial	To verify the effects of FRR, compared to traditional pharmacological care of the symptoms and functionality of people with lower respiratory tract infection (LRTI)(¹⁹19 Marques A, Pinho C, Francesco S, Martins P, Neves J, Oliveira A. A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections. Respir Med. 2020;162:105861. https://doi.org/10.1016/j.rmed.2019.105861 https://doi.org/10.1016/j.rmed.2019.1058... ). n = 115. EG: n = 55; age: 56.02±18.5 years. CG: n=60; age: 54.1±17.3 years old(¹⁹19 Marques A, Pinho C, Francesco S, Martins P, Neves J, Oliveira A. A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections. Respir Med. 2020;162:105861. https://doi.org/10.1016/j.rmed.2019.105861 https://doi.org/10.1016/j.rmed.2019.1058... ).	Experimental group: conventional pharmacological treatment combined with FRR, which includes: breath control (breathing with semi-closed lips, rest and relaxation positions, and diaphragmatic breathing); CIFE and ELTGOL; ACBT technique, exercise training (mobilization of the trunk and upper and lower limbs, muscle strengthening, and stretching exercises) and health education sessions(¹⁹19 Marques A, Pinho C, Francesco S, Martins P, Neves J, Oliveira A. A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections. Respir Med. 2020;162:105861. https://doi.org/10.1016/j.rmed.2019.105861 https://doi.org/10.1016/j.rmed.2019.1058... ). Control group: conventional pharmacological treatment(¹⁹19 Marques A, Pinho C, Francesco S, Martins P, Neves J, Oliveira A. A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections. Respir Med. 2020;162:105861. https://doi.org/10.1016/j.rmed.2019.105861 https://doi.org/10.1016/j.rmed.2019.1058... ).	- Both groups improved in all studied variables except for the values obtained in the modified Borg scale; - Improvement in terms of pulmonary crackle, oxygen saturation values, mMRC scale, and 6-minute walk test in the EG(¹⁹19 Marques A, Pinho C, Francesco S, Martins P, Neves J, Oliveira A. A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections. Respir Med. 2020;162:105861. https://doi.org/10.1016/j.rmed.2019.105861 https://doi.org/10.1016/j.rmed.2019.1058... ).
T7: Nicolini et al., 2017(²⁰20 Nicolini A, Mascardi V, Grecchi B, Ferrari-Bravo M, Banfi P, Barlascini C. Comparison of effectiveness of temporary positive expirayory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Clin Respir J. 2017;12(3):1274-82. https://doi.org/10.1111/crj.12661 https://doi.org/10.1111/crj.12661... ) Randomized controlled trial	To compare the effectiveness of two devices that use PEP in reducing exacerbations and improving respiratory function(²⁰20 Nicolini A, Mascardi V, Grecchi B, Ferrari-Bravo M, Banfi P, Barlascini C. Comparison of effectiveness of temporary positive expirayory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Clin Respir J. 2017;12(3):1274-82. https://doi.org/10.1111/crj.12661 https://doi.org/10.1111/crj.12661... ). n = 120. T-PEP group: n = 40; age: 72.15±1.2 years. O-PEP group: n=40; age: 70.67±2.1 years. CG: n=40; age: 71.13±1.9(²⁰20 Nicolini A, Mascardi V, Grecchi B, Ferrari-Bravo M, Banfi P, Barlascini C. Comparison of effectiveness of temporary positive expirayory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Clin Respir J. 2017;12(3):1274-82. https://doi.org/10.1111/crj.12661 https://doi.org/10.1111/crj.12661... ).	O-PEP group: pharmacological therapy along with an oscillatory positive expiratory pressure (O-PEP) generator device(²⁰20 Nicolini A, Mascardi V, Grecchi B, Ferrari-Bravo M, Banfi P, Barlascini C. Comparison of effectiveness of temporary positive expirayory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Clin Respir J. 2017;12(3):1274-82. https://doi.org/10.1111/crj.12661 https://doi.org/10.1111/crj.12661... ). T-PEP group: pharmacological therapy along with a device that generates temporary positive expiratory pressure (T-PEP)(²⁰20 Nicolini A, Mascardi V, Grecchi B, Ferrari-Bravo M, Banfi P, Barlascini C. Comparison of effectiveness of temporary positive expirayory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Clin Respir J. 2017;12(3):1274-82. https://doi.org/10.1111/crj.12661 https://doi.org/10.1111/crj.12661... ). Control group: pharmacological therapy(²⁰20 Nicolini A, Mascardi V, Grecchi B, Ferrari-Bravo M, Banfi P, Barlascini C. Comparison of effectiveness of temporary positive expirayory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Clin Respir J. 2017;12(3):1274-82. https://doi.org/10.1111/crj.12661 https://doi.org/10.1111/crj.12661... ).	- Only the T-PEP group statistically reduced exacerbations; - The use of the two devices resulted in improvements in the dyspnea scale, in pulmonary function, and in the COPD assessment test; - Both interventions were well tolerated(²⁰20 Nicolini A, Mascardi V, Grecchi B, Ferrari-Bravo M, Banfi P, Barlascini C. Comparison of effectiveness of temporary positive expirayory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Clin Respir J. 2017;12(3):1274-82. https://doi.org/10.1111/crj.12661 https://doi.org/10.1111/crj.12661... ).
T8: Dwyer et al., 2019(²¹21 Dwyer TJ, Daviskas E, Zainuldin R, Verschuer J, Eberl S, Bye PTP, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53(4):1801793. https://doi.org/10.1183/13993003.01793-2018 https://doi.org/10.1183/13993003.01793-2... ) Randomized controlled crossover trial	To compare the effect of exercise on a treadmill with the use of PEP in cleaning the airways at rest(²¹21 Dwyer TJ, Daviskas E, Zainuldin R, Verschuer J, Eberl S, Bye PTP, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53(4):1801793. https://doi.org/10.1183/13993003.01793-2018 https://doi.org/10.1183/13993003.01793-2... ). n = 15. Age: 27 years (18%-48%)(²¹21 Dwyer TJ, Daviskas E, Zainuldin R, Verschuer J, Eberl S, Bye PTP, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53(4):1801793. https://doi.org/10.1183/13993003.01793-2018 https://doi.org/10.1183/13993003.01793-2... ).	Treadmill intervention: 20 minutes of constant exercise(²¹21 Dwyer TJ, Daviskas E, Zainuldin R, Verschuer J, Eberl S, Bye PTP, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53(4):1801793. https://doi.org/10.1183/13993003.01793-2018 https://doi.org/10.1183/13993003.01793-2... ). Intervention with PEP: breathing 15 times through the device, followed by deep breathing, coughing, and huffing. Cycle repeated 6 times for 20 minutes(²¹21 Dwyer TJ, Daviskas E, Zainuldin R, Verschuer J, Eberl S, Bye PTP, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53(4):1801793. https://doi.org/10.1183/13993003.01793-2018 https://doi.org/10.1183/13993003.01793-2... ). Control intervention: breath control sitting calmly for 20 minutes(²¹21 Dwyer TJ, Daviskas E, Zainuldin R, Verschuer J, Eberl S, Bye PTP, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53(4):1801793. https://doi.org/10.1183/13993003.01793-2018 https://doi.org/10.1183/13993003.01793-2... ). Participants were randomly assigned to the three interventions for participation(²¹21 Dwyer TJ, Daviskas E, Zainuldin R, Verschuer J, Eberl S, Bye PTP, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53(4):1801793. https://doi.org/10.1183/13993003.01793-2018 https://doi.org/10.1183/13993003.01793-2... ).	- Exercise on a treadmill increased the clearance of secretions but was significantly less effective than intervention with PEP; - After the treadmill intervention, less sputum was eliminated from the central region of the lung compared to the PEP intervention; - PEP enabled more coughing spells than intervention on the treadmill(²¹21 Dwyer TJ, Daviskas E, Zainuldin R, Verschuer J, Eberl S, Bye PTP, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised cross-over trial. Eur Respir J. 2019;53(4):1801793. https://doi.org/10.1183/13993003.01793-2018 https://doi.org/10.1183/13993003.01793-2... ).
T9: Simoni et al., 2019(²²22 Simoni LHS, Santos DO, Souza HCD, Baddini-Martinez JA, Santos MK, Gastaldi AC. Acute effects of oscillatory PEP and thoracic compression on secretion removal and impedance of the respiratory system in non-cystic fibrosis bronchiectasis. Respir Care. 2019;64(7):818-27. https://doi.org/10.4187/respcare.06025 https://doi.org/10.4187/respcare.06025... ) Randomized controlled crossover trial	Evaluate the short-term effect of O-PEP and chest compressions on airway clearance(²²22 Simoni LHS, Santos DO, Souza HCD, Baddini-Martinez JA, Santos MK, Gastaldi AC. Acute effects of oscillatory PEP and thoracic compression on secretion removal and impedance of the respiratory system in non-cystic fibrosis bronchiectasis. Respir Care. 2019;64(7):818-27. https://doi.org/10.4187/respcare.06025 https://doi.org/10.4187/respcare.06025... ). n = 40. EG: n = 20; age: 57±14 years old. CG: n=20; age: 56±10 years old(²²22 Simoni LHS, Santos DO, Souza HCD, Baddini-Martinez JA, Santos MK, Gastaldi AC. Acute effects of oscillatory PEP and thoracic compression on secretion removal and impedance of the respiratory system in non-cystic fibrosis bronchiectasis. Respir Care. 2019;64(7):818-27. https://doi.org/10.4187/respcare.06025 https://doi.org/10.4187/respcare.06025... ).	Two groups were created: people with bronchiectasis (bronchiectasis group / EG) and healthy people (control group). Each group performed three sessions randomly, that is, three types of intervention: O-PEP (Flutter^®) intervention; lower back reeducation intervention; control intervention (sitting quietly)(²²22 Simoni LHS, Santos DO, Souza HCD, Baddini-Martinez JA, Santos MK, Gastaldi AC. Acute effects of oscillatory PEP and thoracic compression on secretion removal and impedance of the respiratory system in non-cystic fibrosis bronchiectasis. Respir Care. 2019;64(7):818-27. https://doi.org/10.4187/respcare.06025 https://doi.org/10.4187/respcare.06025... ).	- The lower back reeducation intervention increased the amount of sputum eliminated, but O-PEP was more effective in the EG; - In the EG, there was a decrease in resistance to air passage through the airways; - There were no significant differences in acceptance, tolerance, dyspnea, and oxygen saturation(²²22 Simoni LHS, Santos DO, Souza HCD, Baddini-Martinez JA, Santos MK, Gastaldi AC. Acute effects of oscillatory PEP and thoracic compression on secretion removal and impedance of the respiratory system in non-cystic fibrosis bronchiectasis. Respir Care. 2019;64(7):818-27. https://doi.org/10.4187/respcare.06025 https://doi.org/10.4187/respcare.06025... ).

[1] Corresponding author: Pedro Miguel Martins Dias E-mail: pedrodias_vrsa@hotmail.com

Brasil

Brasil

Functional respiratory re-education interventions in people with respiratory disease: a systematic literature review

Intervenciones de reeducación funcional respiratoria en la persona con enfermedad respiratoria: revisión sistemática de la literatura

ABSTRACT

Objectives:

Methods:

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