32 Journal of the Royal Society of Medicine Supplement No.
16 Volume 82 1989
Autogenic drainage: a modern approach to
physiotherapy in cystic fibrosis
M H Schoni MD Alpine Kinderklinik Pro Juventute, CH-7270 Davos Platz, Switzerland
Keywords: cystic fibrosis; physiotherapy; autogenic drainage; PEP mask; forced expiration technique
Introduction
The aim of chest physiotherapy is to prevent
respiratory complications and to improve pulmonary
function in cases of acute or chronic pulmonary
disease. The goals of physical intervention are
to maintain normal movement of the chest, to
strengthen auxiliary respiratory muscles, to mobilize
secretions, to prevent unproductive cough, to maintain
or improve exercise tolerance, to learn some breath
relieving body positions, and finally to improve self
esteem. To reach these goals, several techniques have
been developed which can be used according to
patients' needs. This paper reviews the approaches
to physiotherapy in cystic fibrosis (CF).
Historical reports
Since 1935 there have been several differing ideas
about physical therapy'. The most common breathing
exercises used to be pursed-lips breathing, controlled
deep breathing to open up poorly ventilated areas,
breathing with prolonged expiration and upper chest
pressure, and diaphragmatic breathing. Improvement
of lung function was reported by Miller2 after
3-month breathing training for patients with chronic
airway obstruction. This, however, was challenged by
Sinclair3, and later by Becklake et al.4. The mainstay
of pulmonary therapy in CF has long been postural
drainage with percussion and vibration. However,
since postural drainage with percussion represents
only one special aspect of a multimodal therapy, its
efficacy is unclear.
Postural drainage and percussion (clapping)
The goal of postural drainage and percussion of the
chest is to increase the rate of removal of secretion
from a particular segment or lobe of the lung by
gravitation. The results are frequently excellent in
patients with bronchiectasis. Immediate improvement
of maximal expiratory flows and specific airway
conductance have been described5'6. However, others
have not been able to reproduce these results7. The
comparison of chest clapping and postural drainage
and emptying a ketchup bottle8 has stimulated
researchers and physiotherapists to investigate, clinic-
ally and scientifically, the effects of the traditionally
applied physical therapy. The opinion that the volume
of secretions has to be large enough (> 30 ml/d) to be
jarred loose by percussion or vibration has been
challenged by Pryor et aL9 who combined a forced
expiration technique (FET/huffing) with conventional
assisted postural drainage and percussion. Despite the
fact that this new forced expiration technique resulted
in only a small measurable improvement of lung
function (increase of FEV1 of 6%) these authors
concluded that the efficiency of postural drainage is
improved by using forced expiration. Since postural
drainage is known to have some adverse effects on
oxygen saturation, and because stopping chest physio-
therapy for as little as 3 weeks6 results in a reversible
worsening of lung function, other therapies have been
evaluated.
Forced expiration technique (FET)
Apart from regular physical exercise or special
breathing exercises, the forced expiratory technique
was the first self-performed chest physiotherapy
reported to be useful for CF patients, and is based on
the concept of the equal pressure point (EPP) theory
of Mead et al.'0. It has also been shown that FET was
as effective as conventional physiotherapy in inducing
cough and mucus clearance9. Support of this tech-
nique has also been given by the observation that
transpulmonary pressure during FET was significantly
less than during coughing, and therefore less airway
compression occurred. The main advantage of this
technique is that it is easily performed alone by
the patient and thus avoids dependence on other
individuals for treatment. This technique has,
however, been questioned by Rossman" and others6
who found that (i) direct coughing was as effective as
any other techniques in the removal of secretions and
(ii) that any lung function test failed to show any relief
of airway obstruction despite elimination of various
amounts of sputum. Vigorous coughing (11 times over
10 min) was comparable to conventional physiotherapy
with postural drainage and clapping in terms of the
resulting sputum production and in influencing flows
at mid or low lung volume in another study'2. From
this, it would be reasonable to instruct a patient
that vigorous coughing can be used to replace chest
physiotherapy when it is impractical to perform the
latter.
Positive expiratory pressure breathing (PEP)
Some investigators have introduced helping devices
to support physiotherapy interventions, to improve
the loosening of sticky secretions, to increase the
volume of removable sputum, to provide self-
performed chest physiotherapy and to avoid high
pulmonary pressure swings as they occur during
coughing. A lightweight vibrator can be used to
support percussion and this form of therapy has been
shown to be as effective as therapist-administered
chest percussion and vibration'3. A randomized
study evaluated whether positive expiratory pressure
(PEP), applied with a face mask, improved the
ketchup bottle method'4. Despite the fact that only
minor improvements in sputum amount was observed
 Journal of the Royal Society of Medicine Supplement No. 16 Volume 82 1989
when the PEP method was compared to postural
drainage, FET, clapping and directed coughing, and
despite the absence of any short-term improvement
in lung function, the PEP mask was said to be the
most acceptable, subjectively. It has been argued that
PEP mask breathing affects the peripheral airways
and collateral air channels, whereas coughing and
FET were only effective in airways where dynamic
compression occurs. One month of PEP treatment,
however, was not superior to conventional clapping
physiotherapy15 whereas 18 months of forced
expiration through PEP, a slightly modified PEP
technique with high expiratory pressures, increased
sputum yield in the range of 20%, increased
expiratory flow rates, decreased hyperinflation and
lowered airway instability16. The results of compar-
able studies over short axid long periods are given in
Table 1.
Exercises
The need to have effective physiotherapy has been
demonstrated by the fact that continual physical
therapy improves well being and the life of the CF
patients. Besides active treatment it has been
recognized that sports at school and physical exercises
may substitute for chest physiotherapy in a minority
of patients. Although one study has shown that
7 weeks of supervised swimming training can improve
lung function'7, in another study, 3 months exercise
training at home did not improve lung function or
exercise tolerance and resulted in poor compliance18.
Favourable results of controlled sporting activities
compared to physiotherapy were, however, reported
by Blomquist'9, Edlund20 and Stanghelle2122. A
supplement of the International Journal of Sports
Medicine23 has highlighted the benefits and pitfalls
of exercise and training in CF patients. Other
reports24 suggest that active physical treatment -
such as PEP mask breathing - and exercise have
different immediate effects, with PEP mask breathing
being superior to submaximal exercise in terms of
sputum production. For. older patients, ergometer
exercise training at home improved the sense ofwell-
being and had a positive effect in clearing sputum in
an adjunct to routine chest physiotherapy25.
Autogenic drainage (AD)
In the search for an improved self-performed chest
physiotherapy to provide independence to the patient
and the most effective lung clearance of secretions,
Chevaillier introduced a novel technique which was
based mainly on precise observation of patients.
Mobilization of mucus was constantly observed in
children during sleep when one could hear the mucus
move. Furthermore daily observations of children
showed that during breathing exercises, during anti-
crisis techniques (positions which are taken during
acute asthmatic attacks), during playing and
laughing and during FEV, manoeuvres, mucus
moved better than most of the time during postural
drainage, pursed lip breathing, vibration and
clapping. Based on these observations, Chevaillier
introduced autogenic drainage (AD) which he
described as a series of principles. In his description26,
based on a paper by Alexander-7 and later again in
a paper by Kraemer et aL28, the principle of reaching
the highest possible airflow in different generations
of bronchi by controlled breathing was put into
practice by a three phase breathing exercise. The aim
33
was to (a) unstick the peripheral mucus by breathing
at low lung volumes, (b) collect the mucus in the
middle airways by breathing at tidal volume level and
finally (c) evacuate the secretions from the central
airways by breathing at higher lung volumes. At the
beginning of this breathing technique, inspiration
should be slowly through the nose to guarantee
optimal moistening and heating of the inspired air;
this partly prevents coughing. At the end of an
inspiration a short stop of breathing with an open
glottis is performed. Expiration is done without
pursed lips breathing through the open mouth and
open glottis; the latter has to be learned and practised.
Whether the glottis is kept open or closed can be
verified by gasping without making a sound. By this
breathing manoeuvre compression and bronchial
obstruction are probably avoided.
The first phase of unsticking secretions is then
started by a directed increased inspiration followed
by deep expiration. By concomitantly lowering mid
tidal volume below FRC level, the range of closing
volume is automatically reached and secretions from
peripheral lung regions are mobilized by compression
of peripheral alveolar ducts. Mid respiratory tidal
volume is lowered in the range of normal expiratory
reserve volume (ERV). The end of inhalation is
followed by a short breathing stop with open glottis
to ensure equal filling of all the lung segments,
including the obstructed ones, by collateral filling.
During the next exhalation the alveolar pressure
will be the same in most lung parts, with minor
paradoxical airflow. The second phase of collecting
mucus in the larger bronchi is achieved by deepening
inspiration and expiration. Tidal volume breathing
is then changed gradually from expiratory reserve
volume into the inspiratory reserve volume (IRV)
range to mobilize secretions from the apical parts of
the lungs as well. The velocity of flow must be
controlled to avoid high flow peaks which result in
spasm of the collapsible segments at the equal
pressure point (EPP). The longer the expiration
time, the greater the distance the secretions are
transported. In the third and last phase the patient
increases flow starting from a level at about the
middle of his inspiratory reserve capacity (IRC) and
by a small burst of coughing the mucus is finally
brought out. At the end of this phase self control
of flow is essential to avoid unproductive forced
coughing.
All the three phases are depicted in Figure 1 which
has been drawn according to the published data of
Kraemer28. Several points havelto be considered
when learning this technique: first, it can only be
learned by the help of a trained person; secondly, the
patient is in an upright sitting position, undergoes
relaxation and concentration, performs diaphragmatic
breathing and tries to avoid paradoxical movements
of the chest and coughing; thirdly, when learning this
technique the patient is guided by tactile and auditive
assistance of the teacher, which he gradually takes
over and adds his proprioceptive sensations for
detecting moving secretions; and finally, sessions of
30-45 min twice a day are necessary.
Based on the theory that, with autogenic drainage,
higher flows of a longer duration can be achieved
when performing partially forced expirations starting
from various volumes smaller than the total lung
capacity (TLC), we registered flow volume curves from
CF patients during autogenic drainage, from which
34 Journal of the Royal Society of Medicine Supplement No. 16 Volume 82 1989

Table 1. Summary ofpapers dealing with physiotherapy listed according to year as they appeared since 1979

Duration Durationi
Author n of session of trial Techniques Results

Pryor9 16 98-127 min 4 dayq A: PD, coughing, self On B treatment time

percussion, shaking by physio decreased, sputum weight
B- PD, FLT, coughing, self increased, FEVy increased
percuission 6%
C: B+percussion by physio B vs C not significant
Zach"7 10 lh 7 weeks Swimming After course lung function
improved; 10 weeks later
returned to preswimming level
Rossman" 6 40 min 5 days A: spontneous cough All better than A
B: PD; C: PD+percussion E was as good as B, C or D
D: PD, deep breathing No additional benefit from
. ~~ ~ ~ ~ ~ ~ ~ I.
percussion by physio PD or physio help compared
E: directed coughing to directed coughing
Cleariig 99 m Tc aerosol
DeCesarel 10 n.i. 1 day Krpton 81 m scan after Improvement of ventilation
PD pereussion and vibration seen only in patients with
by physiotherapist severe disease
Desmond6 10 n-i. 6 weeks 3w PD, percussion, vibration When off therapy significant
at home; 3w without physio
.~~~~~~~~~~~~~~~~~~~~~~~~~~~ decrease of FVC (3%),
FEF25-75 (20%), FEV1 (10%)
Significant long-term effect,
no immediate effect
Sutton33 10 30 min 4 days A: Resting in upright(control) During C, D more clearing
B: Directed coughing than during A, B. Wet sputum
C: FET morewith B, C, D than A,
D: FET+PD FET and FET+PD superior
99 m Tc clearance to direct coughing
Zapletal7 24 30 min 1 day Lung function at 30 min FEF 25 decreased, sGaw
and 2 h after physio increased of 10-20%. Direct
(PD, percusion, coughing) cinema demonstration of-
bronchial narrowing
De Boeck2 9 25 min 2 days Lung function at 1 h after Static lung volumes not
25 min physio session vs affected. FEF 50 and FEF 25
coughing alone increased 14% resp. 22% with
coughing alone 18%, 25%
resp. after physio
Falk24 14 20-35 min 4 days A:PD, FET, clapping, cough Sputum amodnt B, C> D, A
B: PD+PEP, FET, cough lung function: no effect
C: PEP, FET, cough after A FVC decreased 6.6%
D: Pursed lip, cough Saturation: decreased A>B,
PEP 15-30 cm H0 C, D; incr B, C, D
randomized, cross over C subjectively best accepted
Holzer'8 86 30 min 3 months exercise No effect on lung function
at home and on exercise tolerance,
compliance at home poor
Groth39 12 15 min 1 day PEP, lung function before During PEP FRC increased
immediate after and 15 min Decrease of washout volume
later lung clearance index and
trapped gas. No effect on
TLC, TV, RV
Webber34 16 n.i. 4 days A: PD without percussion Sputum weight A 57, B 52 g
B: PD, FET self percussion B: FEV1 -improved (no values)
randomized
Parker35 10 30 min 4 days 4 double coughs/3 min sitting Sputum production, amount
4 FET/3 min sitting radioaerosol clearance
4PET/3 min in PD
".
better after FET, FET+PD
than after cough alone
Rogers36 16 n.i. 4 days PET No effect on FVC, FEV1
- PET+percussion PEFR on the 5% significance
FET+PD level
Van der 74 n.i. 2 years FET Decrease of lung function in
Laag37 the range of the natural
course of lung function
deterioration
VerboonM 8 1.5 h 4 days FET No differences in FEV, FVC,
FET+PD PEFR; more sputum on
PET+PI)

continued
 Journal of the Royal Society of Medicine Supplement No. 16 Volume 82 1989 35

Table 1 continued

Duration Duration
Author n of session of trial Techniques Results

Tyrrell"5 15 30 min 1 month Conventional physio No differences in

vs PEP lung function after
one month
Webber40 12 n.i. 3 days FET vs FET+PEP Significant improvement
with FET+PD in FEV1,
FVC, PEFR, FEF50, no
change in TLC, RV,
DLCO
Webber4" 18 n.i. 3 days A: FET+PD Sputum in A, B > C
B: FET+PEP+PD A vs B not significant
C: FET+PEP sitting PEP has no additional
positive effect
Oberwaldner16 20 20-90 min 18 months Forced expiration through Increased yield of sputum
PEP (20%). Increased
expiration flow rates,
decreased hyperinflation,
decreased airway
instability
Blomquist19 11 30 min 12 months 6 months physical Improvement of Po2, small
exercises changes in lung function
6 months physical during physical exercise
exercises+FET
Hardy3l 7 20 min 1 day Infants mean age 3.1 months After physio decreased
PD, percussion vibration compliance, decreased work of
breathing and power of
breathing
Edlund20 10 50 min 12 weeks Swimming Improved clinical
status, improved exercise
tolerance, lung function not
changed
Stanghelle2" 8 3-9 h 5 years 4 on training, regular Those who trained improved
per week physical exercise, 4 did lung function and peak 02
no training uptake
Stanghelle22 8 100 min 8 weeks Daily trampoline exercise No changes in lung function
per week
Schlemper29 8 30 min 2 days Autogenic drainage (AD) More sputum on AD 16.3 g
vs PEP than on PEP 5.8 g (means)
Falk24 12 15 min 2 days PEP vs bicycle exercise Sputum weight during
PEP higher than
during exercise,
no differences in
lung function
Salh25 16 15 min 2 months Bicycle ergometry at 12 had peak work capacity
5 times/week home peak minute ventilation and
minute oxygen consumption
improved. Sputum yield
improved in 6
McIlwaine30 18 n.i. 2 months 1: PD+percussion No changes in lung function
2: PEP+huffing 12 produced more sputum
3: AD on AD. Clinical scores the
cross over randomized same in each group

Abbreviations: PD, postural drainage;

AD, autogenic drainage;
PEP, positive expiratory pressure;
FET, forced expiration technique;
n.i., not indicated;
FVC, forced vital capacity;
FEV1, forced expiratory volume in one second;
FEF 25,50,75, forced expiratory flow at 25%, 50%, 75% of vital capacity;
FEF 25-75, forced expiratory flow between FEF 25% and 75%;
PEFR, peak expiratory flow rate;
TLC, total lung capacity;
TGV, thoracic gas volume;
RV, residual volume;
sGaw, specific airway conductance
36 Journal of the Royal Society of Medicine Supplement No. 16 Volume 82 1989
NOMAU PHASE: 1 2 3
RV
kl F I_ _ _ I . , v
Figure 1. Phases of autogenic drainage shown on a spirogram
of a normal person Phase 1: unstick, phase 2: collect, phase
3: evacuate. (Vt=tidal volume, ERV=expiratory reserve
volume, RV=reserve volume, FRC= functional residual
capacity, IRV= inspiratory reserve voume;IRV+ Vt+ERV=
vital capacity)
Fl ow (V)
l/sec
Volius (V)
Figure 2. Forced flow-volume curve (fat line) and partial flow-
volume curves (small lines as they are produced in AD) from
a patient doing autogenic drainage; explanation see text
a representative experiment is shown in Figure 2.
During forced expiration, (thick line) compression
occurs at low lung volumes, whereas, during AD,
higher flow transients with the same low lung
volumes are achieved without bronchial collapse.
Thus, it seems that moving secretions is made easier
in the peripheral parts of the lung.
However, parts of this technique have been
challenged by German physiotherapists and clinicans
who stated that breathing in the ERV range was
seldom observed in their patients due to difficulties to
lower mid tidal volume level. Therefore, they simplified
the procedure so that the patient begins by moving his
mid tidal volume up and down by deepening breaths
and comfortably adapts the process to his individual
need without undue force or effort. After a breath
arrest of about 2-3 s at the end of every inspiration, a
passive, relaxed but rather fast expiration to normal
expiratory level follows, succeeded by an actively
performed expiration supported by expiratory inter-
costal muscles and thus driving down exhalation to
low ERV. Therefore, this 'German' technique uses a
combination of diaphragmatic and rib-cage breathing.
In patients with easily collapsible airways, a
proximal expiratory stenosis such as pursed lips or
nose breathing is recommended. Using this modified
technique preliminary results have been presented29,
showing that the mean sputum amount with AD was
16.3±4 g and with PEP mask breathing it was
5.8±2.6 g, (n=8 CFI's, age 4-17 years, immediate
effect after one session with AD or PEP). In this same
report it is claimed that trapped gas was significantly
reduced. However, these data have never been
published in a peer reviewed journal, and results are,
therefore, to be interpreted with caution. Autogenic
drainage has also been compared with PEP, PD and
conventional physiotherapy by a cross-over design by
the Vancouver Children's Hospital group30. These
authors reported that after a two month period of
therapy several advantages ofAD or PEP over conven-
tional therapy occurred in patients with hyperreactive
airways with more sputum produced with AD. These
results agree with our own experiences. In a two
week's controlled inpatient study no statistically
significant improvement of lung function occurred,
but sputum production decreased and transcutaneous
oxygen saturation improved.
Conclusions
Several techni-ques are available today for effective
physiotherapy in CF patients. No single technique is
better than the others, so an individual adjustment
of a specific technique has to be determined for every
patient. General rules cannot be given but guidelines
can be suggested to adjust the techniques to the needs
of the patient. Age, severity of the disease, concomitant
pathology, familiarity with the technique, family back-
ground, social situation, intelligence, self esteem and
acceptance have to be considered when the physio-
therapy regimen is considered for a patient. A multi-
disciplinary approach is needed, with the views of
physicians, nurses, physiotherapists, sport therapists,
parents and friends being taken into account when
devising the physical therapy for each patient. The
best technique' for any patient is the one which he
feels most comfortable with and is able to continue,
which produces the largest amount of sputum, and
which maintains acceptable health according to the
stage of disease. It is also known that the enthusiasm
of the physiotherapist, physician or teacher affects the
level of benefit received from the treatment. In this
way, every effort we direct towards the individual needs
of the patient is rewarded by his or her well being.
Acknowledgment: The author thanks Mrs Rita Kieselmann,
Munich, for assistance in teaching autogenic drainage in our
clinic.
References
1 Livingstone JL, Gillespie M. The value of breathing
exercises in asthma. Lancet 1935;i:705-6
2 Miller WF. A physiologic evaluation of the effects of
diaphragmatic breathing training in patients with
chronic pulmonary emphysema. Am JMed 1954;17:471-9
3 Sinclair JD. The effects of breathing exercises in
pulmonary emphysema. Thorax 1955;10:246-52
4 Becklake MR, McGregor M, Goldman HL, Brando JL. A
study of the effects of physiotherapy in chronic hyper-
trophic emphysema using lung function tests. Dis Chest
1954;26:180-90
5 Feldman J, Traver GA, Taussig LM. Maximal expiratery
flows after postural drainage. Am Rev Respir Die 1979;
119:239-43
6 Desmond KJ, Schwenk WF, Eli Thomas PT, Beaudry PH,
Coates AL. Immediate and long term effects of chest
physiotherapy in patients with cystic fibrosis. J Pediatr
1983;103:538-42
 Journal of the Royal Society of Medicine Supplement No. 16 Volume 82 1989
7 Zapletal A, Stefanova J, Horak J, Vavrova V, Samanek
M. Chest physiotherapy and airway obstruction in
patients with cystic fibrosis - a negative report. Eur J
Respir Dis 1983;64:426-33
8 Murray JF. The ketchup-bottle method. N Engl J Med
1979;300:1155-7
9 Pryor JA, Webber BA, Hodson ME, Batten JC. Evalu-
ation of the forced expiration technique as an adjunct
to postural drainage in treatment of cystic fibrosis. Br
Med J 1979;2:417-8
10 Mead J, Turner J, Macklem PY, Little JB. Significance
of the relationship between lung recoil and maximal
expiratory flow. J Appi Physiol 1967;22:95-108
11 Rossman CM, Waldes R, Sampson D, Newhouse MT.
Effect of chest physiotherapy on the removal of mucus
in patients with cystic fibrosis. Am Rev Respir Dis
1982;126:131-5
12 De Boeck Ch, Zinman R. Cough versus chest physio-
therapy. Am Rev Respir Dis 1984;129:182-4
13 Hartsell M. The effect of postural drainage, manual
percussion and vibration vs. postural drainage and and
mechanical vibration on maximal expiratory flows. Am
Rev Respir Dis 1978;117:204
14 Falk M, Kelstrup M, Andersen JB, Kinoshita T, Falk
P, Stovring S, Gothgen I. Improving the ketchup bottle
method with positive expiratory pressure,PEP, in cystic
fibrosis. Eur J Respir Dis 1984;65:423-32
15 Tyrrell JC, Martin J, Hiller EJ. PEP mask
physiotherapy in cystic fibrosis. 13th Annual Meeting
of the European Working Group for Cystic Fibrosis.
Book of Abstracts, Jerusalem. 1985:23
16 Oberwaldner B, Evans JC, Zach MS. Forced expiration
against a variable resistance: A new chest physiotherapy
method in cystic fibrosis. Pediatr Pulmonol 1986;2:
358-67
17 Zach MS, Purrer B, Oberwaldner B. Effect of swimming
on forced expiration and sputum clearance in cystic
fibrosis. Lancet 1981;ii:1201-3
18 Holzer FJ, Schnall R, Landau LI. The effect of home
exercise programme in children with cystic fibrosis and
asthma. Aust Paediatr 1984;20:297-302
19 Blomquist M, Freyschuss U, Wiman L-G, Strandvik B.
Physical activity and self treatment in cystic fibrosis.
Arch Dis Child 1986;61:362-7
20 Edlund LD, French FW, Herbst JJ, Ruttenbuerg HD,
Ruhlung RO, Adams TD. Effects of a swimming program
on children with cystic fibrosis. Am J Dis Child
1986;140:80-83
21 Stanghelle JK, Michalsen H, Skyberg D. Five-year
follow-up of pulmonary function and peak oxygen uptake
in 16 year old boys with cystic fibrosis, with special
regard to the influence of regular physical exercise. Int
J Sports Med 1988;Supplement 9:19-25
22 Stanghelle JK, Hjeltnes N, Bangstad HJ, Michalsen H.
Effect of daily short bouts of trampoline exercise during
8 weeks on pulmonary function and the maximal oxygen
uptake of children with cystic fibrosis. Int J Sports Med
1988;Supplement 9:32-7
23 Supplement 1, Vol 9, International Journal of Sports
Medicine 1988
24 Falk M, Kelstrup M, Andersen JB, Pedersen SS, Rossing
I, Dirksen H. PEP treatment or physical exercise- Effects
on secretions expectorated and indices of central and
peripheral airway function. Congress Abstracts, Exerpta
Medica, Asia Pacific Congress Series, 10th International
Cystic Fibrosis Congress, Sydney, Australia, 1988;35
25 Salh B, Dodds M, Webb AK. Influence of ergometer
training on sputum output and physical fitness in
adult cystic fibrosis patients. Congress Abstracts,
Excerpta Medica, Asia Pacific Congress Series, 10th
International Cystic Fibrosis Congress, Sydney,
Australia, 1988;36
37
26 Chevaillier J. Autogenic Drainage (A.D.) In: Lawson D,
ed. Cystic fibrosis: horizons. Chichester: John Wiley,
1984:235
27 Alexander FA. Physikalische Therapie beim kindlichen
Asthma bronchiale. Mschr Kinderheilk 1976;124:222-4
28 Kraemer R, Zumbuihl C, Rudeberg A, Lentze, MJ,
Chevaillier J. 'Autogene Drainage' bei Patienten mit
zystischer Fibrose. Pddiatr Prax 1986;33:223-32
29 Schlemper B, Lindemann H, Bittner P. Ergebnisse einer
Vergleichsstudie zwischen autogener Drainage und
PEP-Maskenatmung. 7. Ambulanzleitertagung der
Deutschen Gesellschaft zur Bekampfung der Muco-
viscidose. Schumacher H. ed. 1986.
30 Mcllwaine M, Davison AGF, Wong LTK, Pirie GE,
Nakielna EM. Comparison of positive expiratory
pressure and autogenic drainage with conventional
percussion and drainage therapy in the treatment of CF.
Congress Abstracts, Exerpta Medica, Asia Pacific
Congress Series, 10th International Cystic Fibrosis
Congress, Sydney, Australia, 1988
31 Hardy KA, Wolfson MR, Titinsky M, Motley R, Shaffer
H, Schidlow DV. The effect of combined therapy of
aerolized bronchodilators and chest physiotherapy on
newly diagnosed infants with cystic fibrosis. CF Club
Abstracts 1986;27:33
32 DeCesare, JA, Babchyck BM, Colten HR, Treves S.
Radionuclide assessment of the effects of chest physical
therapy on ventilation in cystic fibrosis. Phys Ther
1982;62:820-5
33 Sutton PP, Parker RA, Webber BA, Newman SP,
Garland N, Lopez-Vidriero MT, Pavia D, Clarke SW.
Assessment of the forced expiration technique, postural
drainage and directed coughing in chest physiotherapy.
Eur J Respir Dis 1983;64:62-8
34 Webber BA, Parker RA, Hofmeyr JL, Hodson ME. Evalu-
ation of self-percussion during postural drainage using
the forced expiration technique (FET). In: Lawson D, ed.
Cystic fibrosis: horizons. Chichester: John Wiley, 1984:229
35 Parker RA, Webber BA, Sutton PP, Newman SP.
Garland N, Lopez-Vidriero, Pavia D, Clarke SW.
Evaluation of three individual components of postural
drainage treatment. In: Lawson D, ed. Cystic fibrosis:
horizons. Chichester: John Wiley, 1984:230
36 Rogers D, Tottle J, Pickering DM, Plews E, Davies V,
Newcombe RG, Goodchild MC, Dodge JA. Comparison
of physiotherapy techniques employed in cystic fibrosis.
In: Lawson D, ed Cystic fibrosis: horizons. Chichester:
John Wiley, 1984:232
37 Van der LaagJ, Steenbergen H,Helders PJM. Prolonged
use of forced expiration technique in cystic fibrosis. In:
Lawson D, ed Cystic fibrosis: horizons. Chichester: John
Wiley, 1984:233
38 Verboon JML, Bakker W, Dukman JH. Effect of the
forced expiration technique and postural drainage in
adults with cystic fibrosis. In: Lawson D, ed Cystic
fibrosis: horizons. Chichester: John Wiley, 1984:234
39 Groth S, Stafanger G, Dirksen H, Andersen JB, Falk
M, Kelstrup M. Positive expiratory pressure (PEP-mask)
physiotherapy improves ventilation and reduces volume
of trapped gas incystic fibrosis. Bull Eur Physiopathol
Respir 1985;21:339-43
40 Webber BA, Hofmeyr JL, Hodson ME, Batten JC. The
effects of postural drainage incorporating the forced
Expiration technique on pulmonary function in cystic
fibrosis. 13th Annual Meeting ofthe European Working
Group for Cystic Fibrosis. Book of Abstracts, Jerusalem
1985:24
41 Webber BA, Hofmeyr Jn, Hodson ME, Baten JC.
Evaluation of positive expiratory pressure as an adjunct
to postural drainage. 13th Annual Meeting of the
European Working Group for Cystic Fibrosis. Book of
Abstracts, Jerusalem. 1985:95