***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 BACKGROUND : Conventional chest physical therapy ( CCPT ) , applied by therapists using cupped h and s to perform percussion , is commonly used in hospitalized adults . However , increased work load dem and s and occupational health concerns ( eg , carpal tunnel syndrome ) limit the overall utilization of this therapy . Therefore , we conducted a study to compare the overall effectiveness of CCPT to high-frequency chest wall compressions ( HFCWC ) applied via a vibratory vest . METHODS : A single-center , r and omized trial among hospitalized intubated and non-intubated adult patients requiring chest physical therapy comparing CCPT and HFCWC .  The primary outcome measure was hospital stay . RESULTS : A total of 280 per- protocol patients ( out of an a priori estimated 320 patients required to demonstrate a 20 % relative reduction in hospital stay ) were r and omly assigned to receive CCPT ( no. = 146 , 52.1 % ) or HFCWC ( no. = 134 , 47.9 % ) . The hospital stay was 12.5 ± 8.8 days for patients r and omized to CCPT and 13.0 ± 8.9 days for patients r and omized to HFCWC ( P = .62 ) . Patient comfort was assessed using a visual analog scale ( increasing score reflects greater discomfort ) and was statistically greater for patients r and omized to CCPT compared to HFCWC ( 2.2 ± 0.8 vs 1.9 ± 0.8 , P = .009 ) . The duration of time until radiographic resolution of lobar atelectasis trended less for CCPT compared to HFCWC ( 5.2 ± 4.3 d vs 6.5 ± 5.2 d , P = .051 ) . All other secondary outcomes , including hospital mortality and nosocomial pneumonia , were similar for both treatment groups . CONCLUSIONS : This study was inadequately powered for the primary outcome of interest and hence we can not make recommendations on the preferential use of HFCWC or CCPT for intubated and non-intubated adult patients . HFCWC was associated with statistically better comfort scores . ( Clinical Trials.gov registration NCT00717873 . 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 The Flutter VRP1 ( Flutter ) is cl aim ed to increase the clearance of excess bronchial secretions and to improve lung function and oxygenation , but these cl aims were based on computer models , laboratory assisted experiments and uncontrolled clinical trials . A prospect i ve r and omized clinical trial was undertaken , in subjects with cystic fibrosis , using the active cycle of breathing techniques as the ' gold st and ard ' . The cl aims could not be substantiated and the possibility of sputum retention was of concern when the Flutter was used as significantly more sputum ( P < 0.001 ) was cleared with the active cycle of breathing techniques alone . There were no significant changes in lung function or oxygenation OBJECTIVE To assess and compare immediate effects of chest physiotherapy with positive expiratory pressure ( PEP ) versus oscillating PEP on transcutaneously measured blood-gas tensions in patients with cystic fibrosis . METHODS Fifteen patients ( mean age 12.5 y , range 6.9 - 21.5 y ) participated . The treatments were r and omized and performed on 2 separate occasions , 8 weeks apart . Spirometry was conducted before and after each treatment . We transcutaneously measured  oxygen tension ( P(tO2 ) . RESULTS There were no changes in spirometry values . During PEP , different trends in blood-gas tension were seen , and there were no consistent changes . During oscillating PEP  , P(tO2 ) increased and P(tCO2 ) decreased . During oscillating PEP  , P(tCO2 ) was lower and the intra-individual change in P(tCO2 ) was more pronounced than during PEP . The results obtained immediately after oscillating PEP showed a higher P(tO2 ) and a lower P(tCO2 ) than with PEP . CONCLUSION PEP and oscillating PEP can both cause transitory effects on blood gases in patients with cystic fibrosis . However , oscillating PEP alters blood-gas tensions more than does PEP , and hyperventilation during oscillating PEP may reduce treatment time Background Streamlining the timing of treatments in cystic fibrosis ( CF ) is important to optimise adherence while ensuring efficacy . The optimal timing of treatment with hypertonic saline ( HTS ) and airway clearance techniques ( ACT ) is unknown . Objectives This study hypothesised that HTS before ACT would be more effective than HTS during ACT as measured by Lung Clearance Index ( LCI ) . Methods Adults with CF providing written informed consent were r and omised to a crossover trial of HTS before ACT or HTS during ACT on consecutive days . ACT treatment consisted of Acapella Duet . Patients completed LCI and spirometry at baseline and 90 min post treatment . Mean difference ( MD ) and 95 % CIs were reported . Results 13 subjects completed the study ( mean ( SD ) age 33 ( 12 ) years , forced expiratory volume in 1second % ( FEV1 % ) predicted 51 % ( 22 ) , LCI ( no. turnovers ) 14 ( 4 ) ) . Comparing the two treatments ( HTS before ACT vs HTS during ACT ) , the change from baseline to 90 min post treatment in LCI ( MD ( 95 % CI ) −0.02 ( −0.63 to 0.59 ) ) and FEV1 % predicted ( MD ( 95 % CI ) −0.25 ( −2.50 to 1.99 ) ) was not significant . There was no difference in sputum weight ( MD ( 95 % CI ) −3.0 ( −14.9 to 8.9 ) ) , patient perceived ease of clearance ( MD ( 95 % CI ) 0.4 ( −0.6 to 1.3 ) or satisfaction ( MD ( 95 % CI ) 0.4 ( −0.6 to 1.5 ) ) . The time taken for HTS during ACT was significantly shorter ( MD ( 95 % CI ) 14.7 ( 9.8 to 19.6 ) ) . Conclusions In this pilot study , HTS before ACT was no more effective than HTS during ACT as measured by LCI . Trial registration number NCT01753869 ; Pre- results Background Cystic fibrosis patients require daily airway clearance therapies . The primary objective of this study was to compare the short-term efficacy of high-frequency chest compression and positive expiratory pressure mask on expectorated sputum , pulmonary function , and oxygen saturation in patients with CF hospitalized for an acute pulmonary exacerbation . Methods A controlled r and omized cross-over trial with 24 hours between treatments was used . Thirty-four CF patients ( 26 ± 6.5 years ) were included in the study . Before and 30 minutes after each treatment were recorded : pulmonary function testing , oxygen saturation , and perceived dyspnea . Preference for the two devices was assessed . Results No statistically significant difference between high-frequency chest compression and positive expiratory pressure mask was found in sputum production and in lung function testing . A reduction in SpO2 was found after positive expiratory pressure mask ( 98 ± 1.0 % versus 97 ± 1.2 % ; P < 0.001 ) . Both treatments induced a statistically significant increase in Borg scale for dyspnea without differences between them . Patients reported greater satisfaction with positive expiratory pressure mask than with high-frequency chest compression ( P < 0.001 ) . Conclusion High-frequency chest compression and positive expiratory pressure mask have comparable short-term effects on expectorated sputum and lung function . Although positive expiratory pressure mask was associated with a lower SpO2 , it was better tolerated than high-frequency chest compression . Keywords Airway clearance therapies ; High-frequency chest compression ; Sputum ; Cystic High levels of shear stress can prevent and disrupt Pseudomonas aeruginosa biofilm formation in vitro . Intrapulmonary percussive ventilation ( IPV ) could be used to introduce shear stress into the lungs of cystic fibrosis ( CF ) patients to disrupt biofilms in vivo . We performed a first-of-its-kind pilot clinical study to evaluate short-term IPV therapy at medium ( 200 bursts per minute , bpm ) and high frequency ( 400 bpm ) as compared to autogenic drainage ( AD ) on lung function and the behavior of P. aeruginosa in the CF lung in four patients who are chronically colonized by P. aeruginosa . A significant difference between the three treatment groups was observed for both the forced expiratory volume in 1 s ( FEV1 ) and the forced vital capacity ( FVC ) ( p < 0.05 ) . More specifically , IPV at high frequency significantly increased FEV1 and FVC compared to AD ( p < 0.05 ) and IPV at medium frequency ( p < 0.001 ) . IPV at high frequency enhanced the expression levels of P. aeruginosa planktonic marker genes , which was less pronounced with IPV at medium frequency or AD . In conclusion , IPV at high frequency could potentially alter the behavior of P. aeruginosa in the CF lung and improve lung function . Trial registration : The trail was retrospectively registered at the IS RCT N registry on 6 June 2013 , under trial registration number IS RCT N75391385 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 
    Output:
    
There was no clear evidence that oscillation was a more or less effective intervention overall than other forms of physiotherapy ; furthermore there was no evidence that one device is superior to another .
Increased adherence to therapy may then lead to improvements in other parameters , such as exercise tolerance and respiratory function .