Autogenic drainage for airway clearance in cystic fibrosis

Burnham, Paul; Stanford, Gemma; Stewart, Ruth

doi:10.1002/14651858.cd009595.pub3

Cited by 12 publications

(8 citation statements)

References 81 publications

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“…AD was performed by four experienced chest physiotherapists devoted only to children with CF. AD is an airway clearance technique developed by Chevallier that is based on non-forced expiration during controlled breathing at different levels of vital capacity [ 9 , 10 ]. Briefly, while sitting, the patient first performs diaphragmatic breathing at low lung volume following a cycle of slow inspiration through the nose to total pulmonary capacity, followed by a pause of three seconds, then non-forced exhalation through the nose or mouth to residual volume.…”

Section: Methodsmentioning

confidence: 99%

Beneficial short-term effect of autogenic drainage on peripheral resistance in childhood cystic fibrosis disease

et al. 2022

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Background Airway clearance techniques are supposed to be a necessary adjunct for the enhancement of impaired peripheral clearance in cystic fibrosis (CF). The objective was to assess the effect of one physiotherapy session (autogenic drainage: AD) on mucus clearance (sputum wet weight) and impulse oscillometry system (IOS) indices, including those obtained from extended Resistance-Inertance-Compliance (eRIC) modelling, considering the degree of bronchial congestion. Methods Thirty children with CF (median age: 12.7 years) in a stable condition prospectively underwent IOS measurements at baseline and after AD. They were divided in two groups: with (visual analog scale of bronchial congestion by the physiotherapist ≥ 5/10) and without (scale < 5/10) bronchial congestion. Paired-comparison of the effects of AD on airway resistance measurements was done with Wilcoxon test. Results The congestion scale correlated with the wet weight of sputum production during the session (Pearson test: p < 0.0001, R = 0.66). Ten children had bronchial congestion and 20 were without congestion. In the whole group, R5–20 Hz significantly decreased after AD (P = 0.049), which was related to a decrease in the children with congestion (P = 0.025), whereas it was not significantly modified in the children without congestion (P = 0.327). The eRIC model allowed the calculation of the peripheral resistance of the respiratory system, which also decreased in the children with congestion (P = 0.037), however, not modified in the children without congestion (P = 0.390). Conclusion One session of autogenic drainage has the ability to decrease peripheral resistance obtained from IOS measurements, more specifically in children with CF with moderate to severe bronchial congestion. Trial registration ClinicalTrials.gov Identifier: NCT04094441.

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Section: Methodsmentioning

confidence: 99%

Beneficial short-term effect of autogenic drainage on peripheral resistance in childhood cystic fibrosis disease

et al. 2022

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“…Numerous systematic reviews have examined the literature on the effectiveness of various ACTs. [72][73][74][75][76][77] The current evidence suggests that the effects on respiratory function, HRQOL, and respiratory exacerbations are similar between ACTs and as such there is no one superior form of ACT for pwCF. [72][73][74][75][76][77] The one notable exception is the evidence suggesting that pwCF using HFCWO may experience a relatively higher rate of respiratory exacerbation compared with those using PEP.…”

Section: Types Of Airway Clearance Techniquesmentioning

confidence: 96%

“…[72][73][74][75][76][77] The current evidence suggests that the effects on respiratory function, HRQOL, and respiratory exacerbations are similar between ACTs and as such there is no one superior form of ACT for pwCF. [72][73][74][75][76][77] The one notable exception is the evidence suggesting that pwCF using HFCWO may experience a relatively higher rate of respiratory exacerbation compared with those using PEP. 74,78 Individual response and preference for a specific ACT is, therefore, likely to be a key consideration when selecting an ACT for each individual with CF.…”

Section: Types Of Airway Clearance Techniquesmentioning

confidence: 96%

Exercise and Airway Clearance Techniques in Cystic Fibrosis

Ward

Stiller

Holland

2022

Semin Respir Crit Care Med

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Exercise and airway clearance techniques (ACTs) have been a cornerstone of treatment for people with cystic fibrosis (pwCF) for many decades. Exercise may confer both respiratory and nonrespiratory benefits for pwCF, with greater exercise capacity associated with improved survival. A wide variety of exercise interventions for pwCF have been investigated. ACTs may assist in reducing respiratory symptoms for pwCF and are currently recommended to be performed daily, with the types of ACTs used varying globally. While recommended components of care, both exercise and ACTs are time-intensive and maintaining adherence to the recommendations over the longer term can be challenging. It has been proposed that with advances in the therapeutic options for pwCF, a rationalization of the therapeutic regimen may be possible. We summarize the current evidence for the use of exercise and ACTs by pwCF, discuss the implications of the introduction of cystic fibrosis transmembrane conductance regulator modulators on both exercise and ACTs, and highlight areas for further research.

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“…Cochrane Reviews have reported short-term effects (specifically, increased mucus transport) of tACT, but no evidence supporting long-term benefit 12 . Moreover, non-superiority between tACTs using various techniques and devices [13][14][15][16] and tACT without any adjuncts (conventional chest physiotherapy by percussion and drainage) 12 mean there remains no globally agreed definitive treatment strategy for tACT prescription in CF.…”

Section: Background and Rationalementioning

confidence: 99%

Exercise as an Airway Clearance Technique in people with Cystic Fibrosis (ExACT-CF): rationale and study protocol for a randomised pilot trial

et al. 2022

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Background: Chest physiotherapy is an established cornerstone of care for people with cystic fibrosis (pwCF), but is often burdensome. Guidelines recommend at least one chest physiotherapy session daily, using various airway clearance techniques (ACTs). Exercise (with huffs and coughs) may offer an alternative ACT, however the willingness of pwCF to be randomised into a trial needs testing. The ‘ExACT-CF: Exercise as an Airway Clearance Technique in people with Cystic Fibrosis’ trial will test the feasibility of recruiting pwCF to be randomised to continue usual care (chest physiotherapy) or replace it with exercise ACT (ExACT) for 28-days. Secondary aims include determining the short-term clinical impact (and safety) of stopping routine chest physiotherapy and replacing it with ExACT, and effects on physical activity, sleep, mood, quality of life and treatment burden, alongside preliminary health economic measures and acceptability. Methods: Multi-centre, two-arm, randomised (1:1 allocation using minimisation), pilot trial at two sites. Fifty pwCF (≥10 years, FEV1 >40% predicted, stable on Elexacaftor/Tezacaftor/Ivacaftor (ETI)) will be randomised to an individually-customised ExACT programme (≥once daily aerobic exercise of ≥20-minutes duration at an intensity that elicits deep breathing, with huffs and coughs), or usual care. After baseline assessments, secondary outcomes will be assessed after 28-days, with additional home lung function and exacerbation questionnaires at 7, 14 and 21-days, physical activity and sleep monitoring throughout, and embedded qualitative and health-economic components. Feasibility measures include recruitment, retention, measurement completion, adverse events, interviews exploring the acceptability of trial procedures, and a trial satisfaction questionnaire. Discussion: Co-designed with the UK CF community, the ExACT-CF pilot trial is the first multi-centre RCT to test the feasibility of recruiting pwCF stable on ETI into a trial investigating ExACT. This pilot trial will inform the feasibility, design, management, likely external validity for progression to a main phase randomised controlled trial. Registration: Clinicaltrials.gov (NCT05482048).

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Autogenic drainage for airway clearance in cystic fibrosis

Cited by 12 publications

References 81 publications

Beneficial short-term effect of autogenic drainage on peripheral resistance in childhood cystic fibrosis disease

Beneficial short-term effect of autogenic drainage on peripheral resistance in childhood cystic fibrosis disease

Exercise and Airway Clearance Techniques in Cystic Fibrosis

Exercise as an Airway Clearance Technique in people with Cystic Fibrosis (ExACT-CF): rationale and study protocol for a randomised pilot trial

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