The effectiveness of a bronchial drainage technique (ELTGOL) in COPD exacerbations. Respirology. 2009 Jan 23
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Gelezen door Thierry Troosters
The ‘Expiration with Glottis Open in the Lateral Posture’ (ELTGOL) is a widely used technique for mucous clearance, also in Belgium. This Italian group applied the technique in patients hospitalized with COPD exacerbations. Fifty nine patients were randomly allocated to a group receiving standard care or standard care and respiratory physiotherapy (ELTGOL) for the first 7 days of the hospital admission. Thereafter they also received usual care only. Respiratory physiotherapy was applied for 30 minutes each day following the administration of inhaled medication. A limited number of patients (11 controls and 11 ELTGOL patients were followed up for six months). When the whole group was considered, however, no differences were observed and by the end of the hospital admission the control group (8.2ml) and ELTGOL group (6.8ml) produced a similar and low amount of sputum. No differences were seen in lung function recovery, quality of life, MRC scores and hospitalization time. Patients in ELTGOL reported somewhat lower Borg scores (although it is not clear how this was assessed). There was a trend for a larger reduction in the 24h sputum volume produced in ELTGOL compared to controls (p=0.07) when the analysis was restricted to patients with mucous hypersecretion (>25ml/day). The authors –in my opinion correctly- conclude that there is only limited role for ELTGOL in the treatment of COPD exacerbations. Obviously remarks can be placed by the outcome measure (sputum volume, lung function) and the application, only in the first week of the hospital admission. Nevertheless it seems as if indeed the technique has no clear benefits when applied to unselected patients, admitted to hospital with exacerbations. Whether other techniques are more helpful was not studied.
