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Airway clearance techniques for bronchiectasis.

Annemarie L Lee1, Angela T Burge, Anne E Holland

  • 1West Park Healthcare Centre, 82 Buttonwood Ave, Toronto, ON, Canada, M6M 2J5.

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Airway clearance techniques (ACTs) are safe for stable bronchiectasis patients, improving sputum expectoration, lung function, and quality of life. Their effectiveness during acute exacerbations remains unknown, requiring further research.

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Area of Science:

  • Pulmonary Medicine
  • Respiratory Therapy
  • Clinical Trials

Background:

  • Non-cystic fibrosis bronchiectasis is characterized by chronic cough and sputum production, potentially leading to clinical decline.
  • Airway clearance techniques (ACTs) aim to improve sputum expectoration, but their efficacy in stable and acute bronchiectasis is not well-established.

Purpose of the Study:

  • To assess the effects of ACTs on acute exacerbations, hospitalizations, and health-related quality of life (HRQoL) in bronchiectasis patients.
  • To evaluate the safety and physiological/symptomatic benefits of ACTs in stable and acute bronchiectasis.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) comparing ACTs with no treatment, sham ACTs, or directed coughing.
  • Searched Cochrane Airways Group Specialised Register and PEDro database; handsearched journals.
  • Included parallel and cross-over trials in adults and children with bronchiectasis.

Main Results:

  • Seven studies (105 participants) met criteria; most were cross-over design with variable methodological quality.
  • ACTs showed no significant difference in exacerbation rates but improved HRQoL, sputum expectoration, and reduced breathlessness/cough in stable bronchiectasis (low-quality evidence).
  • High-frequency chest wall oscillation (HFCWO) improved lung function (FEV1, FVC); some ACTs reduced pulmonary hyperinflation. No adverse events reported for airway oscillating devices.

Conclusions:

  • ACTs appear safe for stable bronchiectasis patients, potentially improving sputum clearance, lung function, symptoms, and HRQoL.
  • The efficacy of ACTs during acute bronchiectasis exacerbations is currently unknown.
  • Further research is needed to determine the long-term clinical value of ACTs for patient-important outcomes and disease progression in stable bronchiectasis.