Feasibility of computerized adventitious respiratory sounds to assess the effects of airway clearance techniques in patients with bronchiectasis

Abstract

Objective To examine the feasibility of adventitious respiratory sound (ARS) as an outcome measure to assess the effects of airway clearance techniques (ACTs) in outpatients with bronchiectasis. Methods ARS were registered pre/post four ACTs sessions. Clinical outcomes included: number of crackles (coarse and fine), number of wheezes (monophonic and polyphonic), wheezes occupation rate (%) and sputum quantity. Feasibility outcomes of ARS included: reasons for exclusion, suitability, safety, equipment and time required, magnitude of change after intervention and sample size estimation. Results Seven patients (49.7±20.5yrs; FEV 1 69.3±15.8% predicted) were included. Recordings from four patients were excluded due to excessive environment noise. All ARS measurements were completed without any adverse events. An electronic stethoscope was acquired and the time spent to complete each assessment was 6±3.5min. The largest changes were observed for number of expiratory coarse crackles [effect size(95%CI) ES=0.40(0.01-0.79)], which correlated moderately with sputum quantity (r=0.56), and inspiratory monophonic wheezes [ES=0.61(0.22-1.00)]. The estimated sample size for a full crossover trial was 46.

Reliability and Validity of Computerized Adventitious Respiratory Sounds in People with Bronchiectasis

“…Chronic sputum production is a common clinical feature of people with bronchiectasis, and it is known that crackles and wheezes may be related to the presence of excess of mucus in the airways [7]. In fact, a positive moderate correlation was observed between the number of crackles during the expiratory phase and the ratio of sputum expectorated during an airway clearance session in bronchiectasis [15]. Our data suggest that ARS may not be related to disease severity (BSI, FEV 1 %, number of lobes affected) and patient-reported outcomes (LCQ and QoL-B) and, therefore, the use of ARS to monitor people with bronchiectasis or assess the effects of treatments (e.g., airway clearance techniques, pulmonary rehabilitation) should be encouraged in combination with other measurements.…”

“…Both crackles and wheezes have been proposed as coadjutant measures to diagnose and monitor exacerbations [12,13] and a sensitive outcome to detect changes after a pulmonary rehabilitation program in COPD [14]. In people with bronchiectasis, ARS are feasible outcomes for assessing the effects of a crucial component of pulmonary rehabilitation in this population, the airway clearance techniques [15], but their measurement properties are not fully known.…”

Functional respiratory re-education interventions in people with respiratory disease: a systematic literature review

“…In this sense, the auscultation of adventitious noises is a viable method to assess the effects of airway clearing techniques (28) .…”

Outcome measures for airway clearance techniques in children with chronic obstructive lung diseases: a systematic review

“…Computer Aided Lung Sound Analysis (CALSA) has earlier been proposed to be a convenient outcome measure for respiratory physiotherapy [ 5 ]. Since previous studies including adult patients indicated that CALSA shows potential to be a sensitive measure for the detection of local changes in the airways after airway clearance [ 91 – 94 ]. Future research is required to assess the abilities of CALSA to quantify treatment effects of ACTs in the pediatric population.…”