***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: To compare the short-term effects of postural drainage with clapping ( PD ) and autogenic drainage ( AD ) on oxygen saturation , pulmonary function , and sputum recovery , we studied ten patients with cystic fibrosis ( CF ) r and omly treated with PD or AD on separate days .  Pulse oximetry was monitored and sputum was collected during and for 1 h following each treatment . Pulmonary function was measured before and then 1 , 15 , and 60 min after each treatment . There was no significant difference in the amount of sputum recovered with AD ( 14.0 + /- 3.5 g ) vs PD ( 10.4 + /- 3.0 g ) and no significant differences in pulmonary function occurred . Oxygen saturation during PD fell from 93.3 + /- 0.7 % to 91.2 + /- 0.8 % ( p < 0.01 ) and required 15 min following treatment to return to baseline . Oxygen saturation did not fall during AD and increased to 94.5 + /- 0.7 % by 1 h following treatment ( baseline , 93.3 + /- 0.8 % ; p < 0.01 ) . We conclude that AD is less likely to produce oxygen desaturation and may be better tolerated by patients with CF , while producing similar benefits in sputum clearance Background High frequency chest wall oscillation ( HFCWO ) is st and ard treatment for airway clearance in the USA and has recently been introduced in the UK and Europe . There is little published research comparing HFCWO with airway clearance techniques ( ACTs ) frequently used in the UK and Europe . The aim of this study was to compare the short-term effects of HFCWO with usual ACTs in patients with cystic fibrosis hospitalised with an infective pulmonary exacerbation . Methods A 4-day r and omised crossover design was used . Patients received either HFCWO on days 1 and 3 and usual ACTs on days 2 and 4 or vice versa . Wet weight of sputum , spirometry and oxygen saturation were measured . Perceived efficacy , comfort , incidence of urinary leakage and preference were assessed . Data were analysed by mixed model analysis . Results 29 patients ( 72 % male ) of mean ( SD ) age 29.4 ( 8.4 ) years and mean ( SD ) forced expiratory volume in 1 s ( FEV1 ) percentage predicted ( FEV1 % ) 38 ( 16.7 ) completed the study . Significantly more sputum was expectorated during a single treatment session and over a 24 h period ( mean difference 4.4 g and 6.9 g , respectively ) with usual ACTs than with HFCWO ( p<0.001 ) . No statistically significant change in FEV1 % or oxygen saturation was observed after either HFCWO or usual ACTs compared with baseline . 17 patients ( 55 % ) expressed a preference for their usual ACT . Conclusions During both a finite treatment period and over 24 h , less sputum was cleared using HFCWO than usual ACT . HFCWO does not appear to cause any adverse physiological effects and may influence adherence 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 QUESTION : Can a session of exercise with incorporated expiratory manoeuvres substitute for a session of breathing techniques for airway clearance in children with cystic fibrosis ? Are children with cystic fibrosis as co-operative and satisfied with the exercise regimen as with the breathing techniques ? . DESIGN R and omised , cross-over trial with concealed allocation and intention-to-treat analysis . PARTICIPANTS 34 children with cystic fibrosis in a stable clinical state . INTERVENTIONS Participants underwent two 20-min airway clearance interventions on two scheduled clinic days : one involving three bouts of various whole-body exercise modalities each followed by independent expiratory manoeuvres , and the other involving breathing control , thoracic expansions with manual expiratory compressions , and the forced expiratory technique . OUTCOME MEASURES Wet weight of expectorated sputum , change in lung function , co-operation with treatment , perceived treatment quality , and satisfaction with treatment were all assessed after each intervention . RESULTS The wet weight of sputum after exercise was 0.6 g higher after the exercise intervention , which was not statistically or clinical ly significant ( 95 % CI -0.2 to 1.4 ) . However , lung function and participant satisfaction with the treatment were both significantly better after the exercise intervention .  Co-operation with treatment and perceived treatment quality were equally high for each intervention . CONCLUSION A session of various whole-body exercises interspersed with independent expiratory manoeuvres could be an acceptable substitute for a session of breathing control , thoracic expansions with manual expiratory compressions , and the forced expiratory technique in children with mild cystic fibrosis lung disease ABSTRACT Purpose : To determine the effects of short- and long-term use of autogenic drainage ( AD ) on pulmonary function and sputum recovery in people with cystic fibrosis ( CF ) . Methods : The authors conducted a systematic review of r and omized and quasi-r and omized clinical trials in which participants were people with CF who use AD as their sole airway clearance technique . Results : Search es in 4 data bases and secondary sources using 5 key terms yielded 735 articles , of which 58 contained the terms autogenic drainage and cystic fibrosis . Ultimately , 4 studies , 2 of which were long term , were included . All measured forced expiratory volume in 1 second ( FEV1 ) and found no change . The long-term studies were underpowered to detect change in FEV1 ; however , the short-term studies found a clinical ly significant sputum yield ( ≥4 g ) . Conclusion : AD has been shown to produce clinical ly significant sputum yields in a limited number of investigations . The effect of AD on the function of the pulmonary system remains uncertain , and questions have emerged regarding the appropriateness of FEV1 as a valid measure of airway clearance from peripheral lung regions . Further consideration should be given to the use of FEV1 as a primary measure of the effect of AD Background : Chest physiotherapy has been used for many years to assist in the removal of abnormal viscid bronchial secretions in cystic fibrosis ( CF ) patients . Objectives : This study compared the short-term effects of two physiotherapy regimens in patients with CF :  autogenic drainage ( AD ) preceded by either saline inhalation ( ‘ salineNEB + AD ’ ) or by intrapulmonary percussive ventilation ( IPV ) with saline ( ‘ salineIPV + AD ’ ) . Methods : In a r and omized crossover design , 20 clinical ly stable CF patients with similar pulmonary function at baseline received either ‘ salineNEB + AD ’ or ‘ salineIPV + AD ’ on 2 consecutive days . Transcutaneous oxygen saturation , heart rate , Borg dyspnea score and mucus wet weight were evaluated after 15 min of either salineNEB or salineIPV , and after a subsequent 30 min of AD . Results : There were no significant changes in oxygen saturation , heart rate or Borg score at any point of either physiotherapy intervention . There was no significant difference in sputum wet weight recovered with either salineNEB ( 2.2 ± 1.8 g , mean ± SD ) or salineIPV ( 1.7 ± 1.9 g ) alone . Subsequent AD did produce significantly greater amounts of sputum wet weight ( p < 0.0001 for both ) than in the initial saline delivery period , yet the amount of wet weight was similar irrespective of whether AD was preceded by salineNEB ( 9.7 ± 6.5 g ) or salineIPV ( 11.6 ± 7.3 g ) . Conclusions : Recovered sputum weight is similar whether AD is preceded by salineNEB or salineIPV . The much greater amount of mucus obtained during the AD period than during the saline delivery period warrants further investigation Impaired mucociliary clearance due to defective ion and water transport and the effects of chronic airway infections lead to stasis of secretions and progressive pulmonary damage in patients with cystic fibrosis ( CF ) . Methods to improve removal of tenacious lung secretions in CF patients contribute to slowing the decline in respiratory function . We have evaluated an intrapulmonary percussive ventilator ( IPV ) , which is a device design ed to enhance airway clearance and preserve lung function . A previous pilot study by us had determined that the device was acceptable to patients and is safe . We undertook a 6 month parallel comparative trial of the IPV versus st and ard , manual chest physiotherapy in 16 CF children and adults . No significant differences in spirometric measures , numbers of hospitalizations , use of oral or IV antibiotics , or anthropometric measurements were detected between the st and ard aerosol/chest physiotherapy group and the IPV group over the duration of the trial . Patient acceptance , as determined by participant survey , was good . The device appeared to be safe and durable . It was concluded that the IPV is as effective as st and ard aerosol and chest physiotherapy in preserving lung function and anthropometric measures , and there was no difference in the use of antibiotics and hospitalizations UNLABELLED Preliminary examinations with an innovative device for physiotherapy , VRP 1-Desitin ( " Flutter " ) , in patients suffering from chronic mucus retention and bronchial collapse gave encouraging results . Therefore , we tried to confirm these findings and to evaluate the use of this new physiotherapy . It is based on oscillations of air in the respiratory tract during expiration ( rate about 2 to 32 Hertz ) diminishing adhesiveness of bronchial mucus and bronchial collapse . Pressure and flow changing depend on the position of mouth-piece and effort of breathing . In order to establish the efficiency of the VRP 1 a comparing investigation was initiated . 20 patients with cystic fibrosis , aged 7 to 28 years , performed physiotherapy with VRP 1 and autogenic drainage ( AD ) , respectively , in a r and omized order one after another , each physiotherapy taking twenty minutes . The expectorated sputum was weighed by means of a precision balance . Mean values during VRP 1 treatment were 5.0 g ( range 0 to 12.0 g ) , during AD 4.8 g ( range 0 to 11.7 g 
    Output:
    
From the studies assessed , autogenic drainage was not found to be superior to any other form of airway clearance technique .