Should lung transplant recipients routinely perform airway clearance techniques? A randomized trial

Despite the widespread use of airway clearance (AC) techniques to clear excessive secretions and improve lung function, little is known about their efficacy following lung transplantation (LTx). This study compared the effects of two AC strategies (proactive vs reactive) on a range of clinical outcomes following LTx.

A prospective randomized trial was conducted. Uncomplicated patients were recruited 1 month postoperatively. Patients performed AC using positive expiratory pressure either twice daily (proactive strategy) or only in the presence chest infection (reactive strategy). Lung function (FEV(1) and FVC), CXR (Brasfield score) and bronchoscopic airway characteristics (anastomotic healing, patency and secretions) were assessed at 1, 2 and 3 months postoperatively. Adherence was measured.

Of 60 consecutive patients, 36 (18 proactive, 18 reactive) were recruited and completed the study. Both groups improved lung function (FEV(1) 72 +/- 4% to 81 +/- 4%, P < 0.0001; FVC 69 +/- 3% to 81 +/- 3%, P < 0.0001) and Brasfield scores (17.8 +/- 0.5 to 19.8 +/- 0.5, P < 0.002) over the study period. No significant differences for any outcome were found between the two groups. The vast majority of patients had fully healed, 100% patent anastomoses without secretions at 3 months. There were no significant differences between the two groups in airway characteristics and the incidence of chest infection. Adherence to both strategies was high (84% proactive, 100% reactive).

Proactive AC following lung transplantation was not associated with a reduced incidence of respiratory infection, alteration of CXR findings or improvement in airway characteristics.