The benefits of mechanical insufflator-exsufflator compared to autogenic drainage in adults with cystic fibrosis

Background: Autogenic drainage (AD) is used for airway clearance in individuals with cystic fibrosis (CF). The mechanical insufflator-exsufflator (MI-E) device is commonly used in patients with neuromuscular diseases for airway clearance by increasing inspiratory volume and expiratory flow. MI-E use has not been studied extensively in CF patients. Objectives: To examine whether there are advantages to using the MI-E device in patients with CF. Subjects: Fourteen males and eight females from the national center for CF, with an average FEV₁ of 54% were recruited. Design: Prospective cross-over trial (IRB 3009-16-SMC). Intervention: Subjects received either AD or MI-E in a random order. Sputum was collected and weighed immediately after treatment. Subjects performed lung function tests at baseline, 20 minutes after and 1 hour after treatment; additionally, a 2-minute walk test was performed at the end of all lung function tests. Saturation, dyspnea scores while resting and after a 2-minute walk and subjective fatigue were recorded. Results: Thirty-six percent more sputum was collected following MI-E than AD treatment (P <.0001). A significant difference in saturation in response to the 2MWT was noted in both treatments significantly less desaturation was recorded after the 2MWT in the MI-E treatment (P <.01). Conclusions: Treatment with the MI-E was more effective for clearing sputum in CF subjects, initial evidence suggests that the MI-E may be successfully incorporated into treatment protocols. Further studies are needed to assess the long-term benefits of MI-E in patients with CF.