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The well-executed study by Sisson et al. [1] demonstrates the potential of vest chest physiotherapy (VCPT) in improving airway clearance in cystic fibrosis (CF) patients. The authors point out that they observed a nonsignificant tendency towards higher exhaled nitric oxide (NOx) levels in CF compared to healthy control subjects which is at odds with previous findings of lower NOx in CF [2, 3]. Contrary to Sisson et al.’s hypothesis, VCPT in CF patients reduced rather than increased NOx. The authors discuss this unexpected finding with regard to increased cellular NO utilisation and distal airway mucous barriers to NO diffusion.

Oscillatory Shear Stress-Induced Arginase Activity May Explain Reduced Exhaled Nitric Oxide Levels after Vest Chest Physiotherapy in Cystic Fibrosis