PEP-mask and cystic fibrosis: what's new

Chest physiotherapy is a crucial part of therapeutic strategies in patients with cystic fibrosis (CF). The so-called PEP-mask is a two-way valve applied to different interfaces that provides positive end-expiratory pressure, improving alveolar recruitment and ventilation and promoting the mobilization of secretions. This should counteract the obstruction of the lower airways typical of the disease.

The change in ventilation inhomogeneity represents one of the endpoints used in the evaluation of short-term efficacy of PEP-mask in cystic fibrosis.

In this crossover, randomized and controlled study, the change in alveolar ventilation was evaluated using the nitrogen multiple-breath washout (N2MBW) test, before and after use of the PEP mask in children with CF.

This test showed controversial results.

The modification of alveolar ventilation due to PEP-mask occur over a time that differs from subject to subject, based on clinical history and the severity of lung damage already established. The exhaled nitrogen washout test may not be sensitive enough in identifying such changes.

BIBIOGRAPHY
Gambazza S, Mariani A, Guarise R, Ferrari B, Carta F, Brivio A, Bizzarri S, Castellani C, Colombo C, Laquintana D. Short-term effects of positive expiratory pressure mask on ventilation inhomogeneity in children with cystic fibrosis: A randomized, sham-controlled crossover study. Pediatr Pulmonol. 2024 Feb 16. doi: 10.1002/ppul.26915. Epub ahead of print. PMID: 38362833