Autogenic drainage and assisted autogenic drainage in children with cystic fibrosis: A systematic review

Chest physiotherapy is considered an essential part of symptomatic, multidisciplinary management in cystic fibrosis (CF), as it facilitates clearance of viscous pulmonary secretions.

Objectives

To determine the effect of autogenic drainage (AD) and assisted autogenic drainage (AAD) compared to no; sham; or other types of chest physiotherapy in children with CF.

Methods

Six databases, clinicaltrials.gov and pactr.org were searched. We included randomized controlled trials, quasi-randomized controlled trials and randomized cross-over trials on AD and AAD in children younger than 18 years, diagnosed with CF. One author conducted the database search. Titles, abstracts and data were evaluated by two independent reviewers with agreement by discussion and consensus.

Results

A total of 126 titles were screened, of which seven were eligible. However, only two studies made a clear distinction between pediatric (ntotal = 47; n₁ = 36 & n₂ = 9) and adult data, and were therefore analyzed. We were unable to perform a meta-analysis, as only one study clearly indicated separate results for the different periods of the cross-over. Based on the pediatric data of this one study, participants who received AD had a significant improvement in Huang scores; a tendency to have fewer hospital admissions during one year when compared to postural drainage; and a clear preference for AD by participants. One other study reported pediatric data, however no significance levels were provided.

Conclusion

Due to the lack of pediatric-specific randomized controlled trials, small sample sizes and unclear risk of bias of most studies, we were unable to determine the efficacy and/or safety of AD and AAD in children with CF.