The patients were instructed to shake the aerosol and actuate twice into the spacer. Afterwards the Nebuhaler-PEP-mask was placed tightly over mouth and nose and the patients inhaled slowly from FRC followed immediately by 10 inspirations and expirations through the device. When treated with PEP, the patients were taught to adjust their expiratory flow to create a pressure of 10 to 15 cm HaO measured by a manometer. The actual pressure level was individually determined according to the capability of the patient to breathe quietly 10 times without use of the auxiliary respiratory muscles. Buy Advair Diskus Online
This was clinically assessed by watching the abdomen moving outwards and the thorax elevating during inspiration without paradoxic movements. The instructions were given by a specialized physiotherapist. All treatments were given three times daily, in the morning when rising (around 7 am), in the afternoon (around 4 pm), and before going to bed (around 10 pm). The study was double-blind concerning the inhaled medication, but open concerning PEP, because the resistance could be felt by the patients. The patients were told that the treatments were terbutaline or placebo with or without PEP.