***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 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 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 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 Bronchial hygiene therapy is a st and ard part of the treatment of patients with cystic fibrosis ( CF ) . Coughing alone promotes sputum expectoration and is probably the primary effective component of st and ard bronchial hygiene therapy . The purpose of this study was to determine whether substituting regular exercise , which also promotes coughing , for two of three daily bronchial hygiene treatments would affect the expected improvements in pulmonary function and exercise response in hospitalized patients with CF . Seventeen patients with CF hospitalized ( means length of stay = 13.0 + /- 2.6 days ) for an acute exacerbation of their pulmonary disease participated in the study . The patients were r and omly assigned to either a group that participated in two cycle ergometer exercise sessions and one bronchial hygiene treatment session per day ( EX Group [ n = 9 ] ) or a group that participated in three bronchial hygiene treatment sessions per day ( PD Group [ n = 8 ] ) . Pulmonary functions and responses to a progressive , incremental cycle ergometer exercise test were measured on admission and before discharge . Bronchial hygiene therapy consisted of postural drainage , in six positions , with chest percussion and vibration . Therapeutic exercise was of moderate intensity and was individually adjusted based on the patient 's heart rate and arterial oxygen saturation response to the admission exercise test . Coughing was encouraged during and after all treatments . Pulmonary function and exercise response were significantly improved over the period of hospitalization in both groups ; the improvements were the same in the two groups . These results indicate that , in some hospitalized patients with CF , exercise therapy may be substituted for at least part of the st and ard protocol of bronchial hygiene therapy 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 Promotion of sputum expectoration by chest physiotherapy is an essential part of cystic fibrosis management . The role of exercise in improving sputum expectoration and lung function in these patients is more contentious . We therefore investigated the effect of adding an exercise programme to conventional chest physiotherapy in eight adult subjects ( four male ) with cystic fibrosis . Subjects were treated on two non-consecutive days of the second week of a course of in-patient antibiotic therapy in a cross-over fashion . On the exercise and physiotherapy day , subjects exercised 60 min before physiotherapy . On the physiotherapy alone day , subjects rested for 60 min instead of exercising . Physiotherapy was administered on both study days ( postural drainage , percussion , deep breathing , vibrations , forced expiratory technique and coughing ) . Lung function tests were performed at baseline , after exercise or rest and again immediately and 30 min after physiotherapy .  Sputum weights were measured in the 60 min of exercise or rest ( period A ) and for the 60 min physiotherapy period and 30 min after physiotherapy ( period B ) . Mean total sputum expectoration ( period A and B ) was 14 g on physiotherapy alone and 21.5 g ( 4.8 ) on exercise and physiotherapy ( mean difference 7.5 g , 95 % CI 1.4 - 13.6 g , P = 0.02 ) . Mean sputum weights during period A ( i.e. rest vs. exercise ) on physiotherapy alone and exercise and physiotherapy were 2.6 and 7 g respectively ( mean difference 4.4 g , 95 % CI-0.07 - 8.8 g , P = 0.053 ) . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE We report the results of a long-term comparative trial of physiotherapy by the positive expiratory pressure ( PEP ) technique with a PEP mask ( Astra Meditec ) versus conventional postural drainage and percussion ( PD&P ) .  Forty patients , ages 6 to 17 years , with Shwachman scores between 52 and 93 , attending the cystic fibrosis clinic were enrolled in the study and r and omly assigned to one of two groups . Group A ( control ) continued to perform physiotherapy by using PD&P for a 1-year period , whereas patients assigned to group B performed physiotherapy with the PEP technique for the same period . Compliance with physiotherapy was closely monitored for both groups throughout the study . Clinical status and pulmonary function ( forced vital capacity [ FVC ] , FEV1 , and FEF25 - 75 ) were measured at 3-month intervals . Group B ( PEP ) demonstrated improved pulmonary function in all parameters as measured by change in percent predicted value for age , gender , and height . The changes in pulmonary function over the study period were : FVC , + 6.57 ; FEV1 , + 5.98 ; and FEF25 - 75 , + 3.32 . This improvement was significantly different from that of group A ( PD&P ) whose pulmonary function declined in all parameters ( FVC , -2.17 ; FEV1 , -2.28 ; FEF25 - 75 , -0.24 ) . The differences between treatment groups were statistically significant for the changes in FVC ( p = 0.02 ) and FEV(1 ) ( p = 0.04 ) . Our results indicate that for our patients with cystic fibrosis , pulmonary physiotherapy with the PEP technique was superior to conventional physiotherapy with the PD&P technique In Pol and the st and ard treatment of pulmonary manifestation of cystic fibrosis consists of physiotherapy techniques of postural drainage with clapping . However many studies demonstrated that various alternative airway clearance techniques performed in Europe the last few years have been more effective than postural drainage . The aim of the study was a comparative analysis of the efficiency of selected chest physiotherapy methods used in the treatment of children with cystic fibrosis . We studied 21 patients , aged 5 - 18 ( x 10.57 ) , who were 
    Output:
    
There was no difference between CCPT and other airway clearance techniques in terms of respiratory function measured by st and ard lung function tests .
Studies undertaken during acute exacerbations demonstrated relatively large gains in respiratory function irrespective of airway clearance technique .
Longer-term studies demonstrated smaller improvements or deterioration over time .
This review demonstrated no advantage of CCPT over other airway clearance techniques in terms of respiratory function .
There was a trend for participants to prefer self-administered airway clearance techniques .