Management of bronchial secretions with Free Aspire in children with cerebral palsy: impact on clinical outcomes and healthcare resources

Giancarlo Garuti, Elisa Verucchi, Isabella Fanelli, Michele Giovannini, Joao Carlos Winck, Mirco Lusuardi

Management of secretions in children with cerebral palsy is often problematic due to severe deformation of the rib cage, impaired cough, and patients'inability to collaborate with chest physiotherapy. Assessing the effectiveness of different methods and techniques of secretion clearance is hampered by the lack of direct outcome measures and by limited patient cooperation. This observational study was planned to evaluate the efficacy of Free Aspire, a device that utilizes a special method to remove secretions from the bronchial tree in hypersecretive patients. Cerebral palsy patients were selected who had experienced more than 3 episodes of respiratory exacerbations in the latest year despite therapeutic optimization (including bronchial clearance techniques) and who had received at least one antibiotic course or underwent at least one access to the Emergency Room (ER) or admission to hospital in the 6 months prior to the study. Patients with congestive heart failure or contraindications for Free Aspire were excluded. We prospectively enrolled 8 patients (mean age 8.25 ± 6.11 years) who had been using in the past techniques for clearance secretions different from Free Aspire. The treatment with Free Aspire consisted of at least two 20-min sessions per day. The observational study period was 18 months. In the 6 months prior to start the treatment (T0), patients had a mean number of 4.0 ± 2.23 visits from the primary care pediatrician (PCP), spent 14 ± 20 days in hospital, and received antibiotics for 35 ± 17 days. After the first 6 months of treatment (T1), they had 1.7 ± 0.73 PCP visits, no days spent in hospital, and 9.75 ± 10.4 days of antibiotic therapy. At 12 months of treatment (T2), PCP visits were 1.7 ± 0.70, days in hospital 1.12 ± 0.3, and days of antibiotics 10.25 ± 10. At 18 months of treatment (T3) no hospitalizations had occurred, PCP visits were 0.25 ± 0.70, and days of antibiotic therapy 4.8 ± 12.62. The technique proved to be safe and well tolerated. Our findings show that Free Aspire for bronchial secretion clearance in cerebral palsy patients with limited capacity to collaborate is safe and effective in reducing the impact of respiratory exacerbations in terms of number of PCP visits, days spent in hospital, and days of antibiotic therapy; its regular use maintains this effect in time.