![]() ![]() Many studies had a risk of bias as they did not report how the randomisation sequence was either generated or concealed. In PEP versus HFCWO, from one long‐term high‐quality study (107 participants) there was little or no difference in terms of number of adverse events however, those in the PEP group had fewer adverse events related to the lower airways when compared to HFCWO (high‐certainty evidence). In PEP versus oscillating PEP, adverse events were only reported in the flutter group (five participants complained of dizziness, which improved after further instructions on device use was provided) (22 participants, low‐quality evidence). In a study where infants performing either PEP or PDPV experienced some gastro‐oesophageal reflux, this was more severe in the PDPV group (26 infants, low‐quality evidence). There was limited evidence reported on adverse events these were measured in five studies, two of which found no events. The results for the remaining outcome measures (including our third primary outcome of mucus clearance) were not examined or reported in sufficient detail to provide any high‐quality evidence only very low‐ to moderate‐quality evidence was available for other outcomes. Participant preference was reported in 10 studies and in all studies with an intervention period of at least one month, this was in favour of PEP. In one of the included studies which used PEP with a mouthpiece, it was reported (personal communication) that there was no difference in the number of respiratory exacerbations (66 participants, low‐quality evidence). There was a lower exacerbation rate in participants using PEP compared to other techniques when used with a mask for at least one year (five studies, 232 participants moderate‐ to high‐quality evidence). However, long‐term studies had equivocal or conflicting results regarding the effect on this outcome (low‐ to moderate‐quality evidence).Ī second primary outcome was the number of respiratory exacerbations. Single interventions or series of treatments that continued for up to three months demonstrated little or no difference in effect between PEP and other methods of airway clearance on this outcome (low‐ to moderate‐quality evidence). These studies compared PEP to ACBT, autogenic drainage (AD), oral oscillating PEP devices, high‐frequency chest wall oscillation (HFCWO) and BiPaP and exercise.įorced expiratory volume in one second was the review's primary outcome and the most frequently reported outcome in the studies (24 studies, 716 participants). ![]() In 22 of the 28 studies the PEP technique was performed using a mask, in three of the studies a mouthpiece was used with nose clips and in three studies it was unclear whether a mask or mouthpiece was used. ![]() Data were not published in sufficient detail in most of these studies to perform any meta‐analysis. A total of 28 studies (involving 788 children and adults) were included in the review 18 studies involving 296 participants were cross‐over in design. ![]()
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