Comparative Effectiveness of PEP, Oscillatory PEP, and Device-Assisted Autogenic Drainage (Simeox) During Pulmonary Exacerbations in Cystic Fibrosis: A Retrospective Observational Study

Background: Respiratory physiotherapy is a crucial component of treatment for patients with cystic fibrosis (CF), particularly during exacerbations of bronchopulmonary disease.Objectives: This study aimed to check how physiotherapy methods influence changes in spirometric parameters in patients with cystic fibrosis during hospitalization for CF exacerbation.Material and methods: We analyzed data of patients with CF exacerbation, hospitalized between 2019 and 2022, when using Simeox device was available and who had spirometry measured at the beginning and the end of stay. The control group was created from CF patients hospitalized in the same period and using other rehabilitation methods. Results from previous hospitalizations of both groups up to 5 years age were included.Results: Thirty-seven patients (mean age 22,5 years) used Simeox and had spirometry measured twice. At the beginning, there were no differences between groups using different physiotherapy methods. Improvement was achieved in all exacerbations, without significant differences between groups in final results and changes in spirometry. A trend towards greater improvement in FVC in the Simeox group was observed: 11,5 vs. 6,0% of predicted, p = 0,053 and 21,3 vs. 15,5% of baseline, p = 0,074. Subjective rehabilitation assessment in 20 patients using Simeox showed that mucus was easier to move (85%), detach (80%) and loosen (85%), compared to the standard techniques.Conclusion: In patients using Simeox spirometry improved at least as in standard physiotherapy and the impact of the device was positively assessed by most patients. Prospective studies are needed to assess the device's place in the modulators era.