4-week daily airway clearance using oscillating positive-end expiratory pressure<i>versus</i>autogenic drainage in bronchiectasis patients: a randomised controlled trial

Livnat, Galit; Yaari, Naama; Stein, Nili; Bentur, Lea; Hanna, Moneera; Harel, Maya; Adir, Yochai; Shteinberg, Michal

doi:10.1183/23120541.00426-2021

Cited by 3 publications

(1 citation statement)

References 42 publications

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“…Upon study completion, regular airway clearance revealed significant improvements in the Leicester Cough Questionnaire (LCQ) (median 1.3 improvement, P=0.002) and St George's Respiratory Questionnaire (SQRQ) total score (median 7.8 improvement, P=0.004), increased sputum volume and improved exercise capacity [39]. In addition, several small RCTs compared usual airway clearance, including the active cycle of the breathing technique and autogenic drainage, with PEP devices, including Acapella (Smiths Medical, London, UK), Flutter (Scandipharm Inc., Birmingham, Alabama, USA) and bubble-PEP [40][41][42][43][44]. Regular airway clearance resulted in increased sputum expectoration and improved health-related quality of life (HRQoL) in patients with bronchiectasis regardless of the clearance method.…”

Section: Airway Clearancementioning

confidence: 99%

Bronchiectasis management in adults: state of the art and future directions

Choi,

McShane,

Aliberti

et al. 2024

Eur Respir J

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Formerly regarded as a rare disease, bronchiectasis is increasingly recognised. A renewed interest in this disease has led to significant progress in bronchiectasis research. Randomised clinical trials have demonstrated the benefits of airway clearance techniques, inhaled antibiotics and long-term macrolide therapy in bronchiectasis patients. However, the heterogeneity of bronchiectasis remains one of the most challenging aspects of management. Phenotypes and endotypes of bronchiectasis have been identified to help find “treatable traits” and partially overcome disease complexity. The goals of therapy for bronchiectasis are to reduce the symptom burden, improve quality of life, reduce exacerbations and prevent disease progression. We review the pharmacological and non-pharmacological treatments that can improve mucociliary clearance, reduce airway inflammation and tackle airway infection, the key pathophysiological features of bronchiectasis. There are also promising treatments in development for the management of bronchiectasis, including novel anti-inflammatory therapies. This review provides a critical update on the management of bronchiectasis focusing on treatable traits and recent randomised clinical trials.

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Section: Airway Clearancementioning

confidence: 99%

Bronchiectasis management in adults: state of the art and future directions

Choi,

McShane,

Aliberti

et al. 2024

Eur Respir J

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European Respiratory Society statement on airway clearance techniques in adults with bronchiectasis

et al. 2023

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Airway clearance techniques (ACTs) are part of the main management strategy for patients with bronchiectasis. Despite being a priority for patients, accessibility, implementation, and reporting of ACTs are variable in clinical settings and research studies. This European Respiratory Society statement summarises current knowledge about the ACTs in adults with bronchiectasis and makes recommendations to improve future evidence base. A task force of 14 experts and two patient representatives (10 countries) determined the scope of this statement through consensus and defined six questions. The questions were answered based on systematic searches of the literature.The statement provides a comprehensive review of the physiological rationale for ACTs in adults with bronchiectasis, and the mechanisms of action along with the advantages and disadvantages of each ACT. Evidence on the ACTs in clinical practice indicates that active cycle of breathing techniques, positive expiratory pressure devices and gravity assisted drainage technique are the most frequently used techniques, although there is limited evidence on the type of ACTs used in specific countries. A review of 30 randomised trials for the effectiveness of the ACTs shows that these interventions increase sputum clearance during or after treatment, reduce the impact of cough and the risk of exacerbations, and improve health-related quality of life. Furthermore, strategies for reducing the risk of bias in future studies are proposed. Finally, an exploration of patientś perceptions, barriers and enablers related to this treatment is also included to facilitate implementation and adherence to ACTs.

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Evaluation of outcome reporting in clinical trials of physiotherapy in bronchiectasis: The first stage of core outcome set development

et al. 2023

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Introduction The aim of this study is to explore outcomes currently reported in physiotherapy trials for bronchiectasis and investigate the level of consistency in outcome reporting. This mapping of outcomes will be used to inform the development of a core outcome set (COS) for physiotherapy research in bronchiectasis. Outcomes reported in randomised clinical trials (RCTs) and RCT protocols were reviewed and evaluated. We included trials with physiotherapy as the main intervention, including pulmonary rehabilitation, exercise prescription, airway clearance, positive expiratory pressure devices, breathing training, self-management plans, and home exercise program. Medline, CINAHL, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and the physiotherapy evidence database (PEDro) were searched from inception using a prespecified search strategy. Records including adult patients with bronchiectasis were included. Outcomes were listed verbatim and categorised into domains based on a pre-specified system, frequency of reporting and sources of variation were inspected. Results Of 2158 abstracts screened, 37 trials (1202 participants) and 17 trial protocols were identified. Eighteen different physiotherapy techniques were investigated. A total of 331 outcomes were reported. No single outcome was reported by all trials. The most reported outcomes were lung function (27 trials, 50%), health related quality of life (26 trials, 48.1%), and dyspnoea (18 trials, 33.3%). A list of 104 unique outcomes covering 23 domains was created. Trials focus on physiological outcomes, mainly those related to respiratory system functions. Outcomes related to functioning and life impact are often neglected. Conclusion Outcome reporting in physiotherapy research for bronchiectasis was found to be inconsistent in terms of choosing and defining outcomes. Developing a core outcome set in this area of research is needed to facilitate aggregation of future trial results in systematic reviews that will in turn inform the strength of evidence for the effectiveness of physiotherapy. Outcome choice should include all stakeholders, including patients. Trial registration This study is registered in the PROSPERO registry under the number CRD42021266247.

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4-week daily airway clearance using oscillating positive-end expiratory pressureversusautogenic drainage in bronchiectasis patients: a randomised controlled trial

Cited by 3 publications

References 42 publications

Bronchiectasis management in adults: state of the art and future directions

Bronchiectasis management in adults: state of the art and future directions

European Respiratory Society statement on airway clearance techniques in adults with bronchiectasis

Evaluation of outcome reporting in clinical trials of physiotherapy in bronchiectasis: The first stage of core outcome set development

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