***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY OBJECTIVE To compare the intrapulmonary percussive ventilator ( IPV ) to chest physiotherapy ( P&PD ) with respect to acute changes in ( 1 ) pulmonary function and ( 2 ) sputum physical properties in patients with cystic fibrosis ( CF ) . DESIGN R and omized crossover . SETTING Community-based CF referral center . PARTICIPANTS Nine nonhospitalized person ( range , 7 to 40 years ; median , 12.4 years ) with moderate to excellent Shwachman scores . INTERVENTIONS Three treatment regimens : ( 1 ) 2.5 mg albuterol delivered via IPV ( internal percussive component activated ) ; ( 2 ) 2.5 mg . albuterol delivered via IPV ( internal percussive component inactivated ) , followed by P&PD ; and ( 3 ) 2.5 mg albuterol delivered via updraft nebulizer , followed by P&PD . MEASUREMENTS AND RESULTS Outcome measures included pulmonary function testing ( PFTs ) and quantitative and qualitative sputum analysis . Among the three treatment groups , there were no significant differences in the change in predicted PFTs 1 h or 4 h after treatment , nor in the volume of sputum expectorated in the first 4 or in the subsequent 20 h. Among patients receiving IPV , more serious disease was associated with greater improvement in FEF25 - 75 1 h after treatment , but these differences disappeared by 4 h. There were no meaningful differences in viscoelastic characteristics of sputum expectorated after each treatments . Participants reported general satisfaction with no adverse effects while using IPV . CONCLUSIONS This initial pilot study suggests ( 1 ) stable patients with CF tolerated one treatment of IPV without adverse sequelae , and ( 2 ) IPV was as effective as st and ard aerosol and P&PD in improving short-term PFT results and enhancing sputum expectoration We studied the acute effects of 4 different chest physical therapy regimens using a r and omised cross-over design in 14 patients with cystic fibrosis . Treatment A consisted of postural drainage , percussion and vibration ; treatment B of postural drainage and periodic application of a face mask with positive expiratory pressure ( PEP ) ; treatment C of PEP in the sitting position ; treatment D of the forced expiration technique in the sitting position . In terms of sputum expectorated , treatments B and C were superior to treatment D and especially to treatment A ( p less than 0.05 ) . Skin oxygen tension , PSO2 was monitored continuously during and for 35 min after treatment . A substantial and prolonged decay in PSO2 was observed during treatment A , quite different from other patterns seen . During and even following treatment C , an increase in PSO2 was noted . PEP was well accepted by the patients , who preferred treatment C , and we suggest it is incorporated in chest physical therapy regimens if the therapeutic objective is to increase expectoration Long-term treatment of chronic bronchitis with chest physiotherapy with or without positive expiratory pressure ( PEP ) by mask was studied in 43 patients r and omly allocated to PEP treatment ( PEP group , 20 patients ) and conventional chest physiotherapy ( control group , 23 patients ) . After instruction , the treatments were self-administered twice daily for 12 months ( 34 patients ) and 5 months ( 9 patients ) . Twice weekly , patients filled in a diary concerning symptoms . The PEP group had significantly less cough and less mucus production . The number of acute exacerbations were calculated from the diaries and were lower in the PEP group compared to the control group , and 85 percent of the patients in the PEP group were free from acute exacerbations versus 48 percent in the control group . The PEP group also used less antibiotics and mucolytics . The PEP group had a small increase in FEV1 of mean 62 ml compared to a small decrease of 43 ml for the control group . Treatment with a simple PEP device can reduce morbidity in patients with chronic bronchitis and may preserve lung function from a more rapid decline The use of a positive expiratory pressure ( PEP ) mask was compared with postural drainage in the treatment of 10 patients with cystic fibrosis . The patients were allocated r and omly in a crossover fashion to the two regimens and evaluated initially by a physiotherapist and over a 4 week treatment period by use of a diary card . There was no significant difference in sputum production or change in lung function between each technique as assessed by the physiotherapist . Diary card evaluation also failed to demonstrate a difference in sputum production , symptom score or peak expiratory flow rate between the 4 week treatment periods . It was concluded that PEP mask therapy is an acceptable and effective alternative to postural drainage in interval therapy of patients with cystic fibrosis , although the patients have tended to revert to postural drainage during acute exacerbations BACKGROUND --In vitro studies have suggested that both the viscoelastic properties of lung secretions and the peak flow attained during simulated cough influence clearance . This study examines the possible association of the viscoelastic properties of sputum and maximum expiratory flow with measured effectiveness of mucus clearance induced by instructed cough and by forced expiration technique ( FET ) in patients with airways obstruction . METHODS --Nineteen patients ( 11 men and eight women ) of mean ( SE ) age , % predicted FEV1 , and daily sputum wet weight of 64 ( 2 ) years , 52 (6)% , and 37.5 ( 7.9 ) g respectively participated in the study . Mucus movement from proximal and peripheral lung regions was measured by an objective non-invasive radioaerosol technique . Each patient underwent three assessment s : control , cough , and FET . During cough and FET , maximum expiratory flow was measured at the mouth level . Apparent viscosity and elasticity of the expectorated sputum sample s were measured with a viscometer . RESULTS --Compared with the control run ( mean ( SE ) clearance : 16 (3)% ) there was an increase in clearance from the whole lung during cough ( 44 (5)% ) and FET ( 42 (5)% ) , and also an enhanced clearance of inhaled , deposited radioaerosol from the trachea , inner and intermediate regions of the lungs , but not from the outer region . There were , however , no differences in regional clearance between cough and FET . Neither regional nor total clearance correlated with maximum expiratory flow , apparent viscosity , elasticity , or daily sputum wet weight . CONCLUSIONS --These results confirm that cough and FET both promote effective clearance but suggest that , unlike in vitro studies , sputum production and viscoelasticity , as well as maximum expiratory flow , provide no guide to clearance efficacy in humans We studied the effectiveness of some of the components of a physiotherapy regimen on the removal of mucus from the lungs of 6 subjects with cystic fibrosis . On 5 r and omized study days , after inhalation of a 99mTc-human serum albumin aerosol to label primarily the large airways , the removal of lung radioactivity was measured during 40 min of ( a ) spontaneous cough while at rest ( control ) , ( b ) postural drainage , ( c ) postural drainage plus mechanical percussion , ( d ) combined maneuvers ( postural drainage , deep breathing with vibrations , and percussion ) administered by a physiotherapist , ( e ) directed vigorous cough . Measurements continued for an additional 2 h of quiet rest . Compared with the control day , all forms of intervention significantly improved the removal of mucus : cough ( p less than 0.005 ) ,  physiotherapy maneuvers ( 0.005 less than or equal to p less than 0.01 ) ,  postural drainage  ( p less than 0.05 ) , and  postural drainage plus percussion  ( p less than 0.01 ) . However , there was no significant difference between regimented cough alone and therapist-administered combined maneuvers , nor between  postural drainage  alone and with  mechanical percussion . We conclude that in cystic fibrosis , vigorous , regimented cough sessions may be as effective as therapist-administered physiotherapy in removing pulmonary secretions .  Postural drainage , although better than the control maneuver , was not as effective as cough and was not enhanced by mechanical percussion . Frequent , vigorous self-directed cough sessions are potentially as useful as more complex measures for effective bronchial toilet Fourteen patients with cystic fibrosis were trained in 2 self-administered chest physiotherapy ( PT ) techniques : high-pressure PEP-mask physiotherapy ( PEP ) , and autogenic drainage ( AD ) . They then visited the clinic on 5 consecutive days , and , in a r and om order , performed 1 of the following : PEP , AD , PEP followed by AD ( PEP-AD ) , AD followed by PEP ( AD-PEP ) , and , no PT except for spontaneous coughing . Lung function was measured repeatedly before , during , and after PT ;  time needed for and sputum produced by each form of PT was recorded . PEP produced the highest amount of sputum , followed by PEP-AD , AD-PEP , and AD ; all 4 forms of PT produced significantly more sputum than coughing . Lung function improved significantly after PEP , AD , and PEP-AD , but PEP-induced changes did not exceed those after AD . Within the investigated group , the PEP-induced lung function improvement per milliliter of sputum produced was significantly lower for those patients with airway hyperreactivity . The fact that the highest sputum yield with PEP was not reflected in higher PEP-effected lung function changes might thus be explained by PEP-induced bronchospasm in patients with airway hyperreactivity .  PEP  clears more sputum than AD or combined techniques ; patients with airway hyperreactivity , however , should either prefer AD or should take a bronchodilator premedication before PEP OBJECTIVE The aim of the present study was to investigate the efficacy of two frequently used physiotherapies ( PTs ) for the removal of bronchial secretions in cystic fibrosis ( CF ) lung disease :  autogenic drainage ( AD ) and the Flutter ( Desitin in Germany ) . AD is believed to improve mucus clearance from peripheral to central airways due to airway caliber changes in combination with a special breathing technique . The Flutter is an easy-to-use physiotherapy device based on oscillations of a steel ball during expiration through a pipe-type device . MATERIAL S AND METHODS To evaluate the acute and chronic physiotherapy effects of these two techniques , 14 CF patients underwent either twice daily AD or Flutter treatment for 4 consecutive weeks in a r and omized crossover design . Prior to each therapy interval , for a 1-week wash-out period , no PT was administered , but patients continued regular medication . At the beginning and end of each 4-week interval , pulmonary function was measured before and after an acute 30-min therapy . At the end of the PT session , sputum was collected , weighed , and deep frozen until analyzed . The viscoelasticity of the sputum was evaluated using a magnetic microrheometer . RESULTS No significant changes were noted for FVC , FEV1 , or sputum volume throughout the study . Sputum viscoelasticity ( rigidity index ) , however , was significantly lower ( p<0.01 ) after therapy with the Flutter in comparison with AD , predicting improvements in mucociliary and cough clearability of the secretions . In a companion in vitro experiment , oscillations generated by passing humidified air over CF sputum lining an acrylic tube connected to a Flutter de-ice were found to decrease sputum elasticity , as measured by a filancemeter . These findings suggest that applied oscillations are capable of decreasing mucus viscoelasticity within the airways at frequencies and amplitudes achievable with the Flutter device , and provide direct evidence that PT can reduce the viscoelasticity of sputum Recently , the flutter was introduced as a new device to improve sputum expectoration . Preliminary data suggested a significant improvement in expectoration and lung function during flutter treatment in patients with cystic fibrosis ( CF ) . The aim of the present study was to compare the effects of the flutter and the positive expiratory pressure ( PEP ) mask on symptoms and lung function in children with CF . In a crossover r and omized study 22 patients with CF ( mean age 12 yrs , range 7 - 17 yrs ) performed physiotherapy using either the flutter or the PEP mask twice a day during two treatment periods of 2 weeks , separated by a one week wash-out period , in a r and om sequence . Lung function parameters ( peak expiratory flow , forced vital capacity ( FVC ) , forced expiratory volume in one second , maximal midexpiratory flow , maximal expiratory flow at 25 % of FVC , thoracic gas volume , total lung capacity , residual volume/total lung capacity , airway resistance and specific airway conductance ) and changes in transcutaneous oxygen haemoglobin saturation were assessed before and after the first supervised session and at the end of each treatment period . Throughout the study peak flow was measured and symptoms were scored daily . No significant changes in any lung function parameter occurred after a single session or after 2 weeks of physiotherapy with either method . There was no difference in acceptability and subjective efficacy . In conclusion , any superiority of the flutter over the positive expiratory pressure mask technique for expectoration could not be confirmed during 2 weeks of daily treatment in children with cystic fibrosis . Both methods are well accepted by children and do not change lung function . Long-term comparison of both methods , including expectoration measurements , seems to be required for further evaluation of the potential success of physiotherapy in cystic fibrosis AUTHOR : e-mail address please Background : Airway clearance techniques are an important part of the routine care of patients with bronchiectasis . The use of the Flutter , 
    Output:
    
Chest physiotherapy , including postural drainage , chest wall percussion and vibration , and a forced expiration technique ( called huffing ) , increase airway clearance as assessed by sputum characteristics ( ie , volume , weight , and viscosity ) and clearance of the radioaerosol from the lung , but the long-term efficacy of these techniques compared with unassisted cough alone is unknown .
Other devices that allow patients to achieve the same benefits derived from chest physiotherapy without the assistance of a caregiver appear to be as effective as chest physiotherapy in increasing sputum production .
CONCLUSIONS Some nonpharmacologic therapies are effective in increasing sputum production , but their long-term efficacy in improving outcomes compared with unassisted cough alone is unknown