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Respir Care. 2015 Mar;60(3):406-11. doi: 10.4187/respcare.03384. Epub 2014 Dec 9.

Expiratory Reserve Volume During Slow Expiration With Glottis Opened in Infralateral Decubitus Position (ELTGOL) in Chronic Pulmonary Disease: Technique Description and Reproducibility.

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Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil.
School of Physiotherapy, Health Department, UNINOVE, São Paulo, Brazil.
Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil.



There has not been a detailed description of expiratory reserve volume (ERV) during slow expiration with glottis open in infralateral decubitus position (ELTGOL, for Expiration Lente Totale Glotte Ouverte en infraLatéral) and its reproducibility. The aim of this study was to determine ERV during ELTGOL and to evaluate ERV intra-observer and inter-observer reliability.


In this prospective study, subjects were 30-70 y of age with chronic lung disease. ELTGOL (an active-passive or active physiotherapy technique) was applied in random order by 3 observers: 2 trained physiotherapists (PT 1 and PT 2) and the subject him/herself. Two ELTGOL compressions (A and B) were applied by PT 1, PT 2, and the subject.


Thirty-two subjects were evaluated with moderate lung obstruction, FEV1: 47.7 ± 15.4, and ERV: 61.7 ± 29.4. The mean value of ERV for PT 1 was 51.4 ± 24.8%; for PT 2, it was 54.3 ± 31.8%; and for the subject, it was 53.5 ± 26.2% (P = .49). Considering the mean value of ERV, the ELTGOL mobilized more than 80% of ERV. There was good reliability intra-PT: PT 1, intraclass correlation coefficient (ICC) 0.85 (0.70-0.93), P < .0001; PT 2, ICC 0.90 (0.80-0.95), P < .0001, and inter-PT (ICC 0.86 [95% CI 0.71-0.93], P < .001). The Bland-Altman plot with mean bias and limits of agreement for ERV of PT 1 and PT 2 was -3.3 (-42.7 to 35.9).


ELTGOL mobilized more than 80% of ERV in subjects with moderate airway obstruction; there is no difference in ERV exhaled during the technique applied by a physiotherapist or by the subject. ELTGOL is a reproducible technique, determined by inter- and intra-observer testing.


chronic obstructive; physiotherapy (techniques); pulmonary disease; reproducibility of results; respiratory therapy

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