Chest physiotherapy
Chest physiotherapy was carried out using the oscillatory
PEP device Acapella Choice (Smiths Medical ASD Inc.,
Weston, MA, USA). Patients were individually trained
by senior chest physiotherapist (J.L. Pentland). The
frequency/resistance dial (range 1e5) was set at three for
all participants. This setting was the maximum tolerated
by all participants. Patients performed three sets of the
following cycle at each session (20e30 min), twice a day.
(1). A tight seal was maintained around the mouthpiece.
(2). For 10 breaths, patients inhaled to three quarters of
the maximum inspiratory capacity then a 3-s breath hold
followed by exhalation to functional residual capacity.
(3). Then followed by two to three forceful expiratory
huffs.
Once the physiotherapist was satisfied with the patients’
technique, chest physiotherapy was done at home but was
checked at each study visit.
Technique, compliance and occurrence of any adverse
effects (specifically, any haemoptysis or increased use of
short-acting bronchodilator therapy) were assessed using
a diary card, which was reviewed at each visit. Sessions
ended with an education session (described below).