Physiotherapists’ use of airway clearance techniques during an acute exacerbation of bronchiectasis: a survey study

Abstract

Background Airway clearance techniques are recommended for individuals with bronchiectasis both in stable state and during an acute exacerbation, however the current use of airway clearance techniques in the management of individuals during an acute exacerbation is unclear. The aims of this study were to establish what current physiotherapy clinical practice comprises for adults and paediatrics during an acute exacerbation of bronchiectasis; identify physiotherapist’s perceptions of the effectiveness of airway clearance techniques and identify what factors influence their treatment decisions in this population. Methods An anonymous online survey was distributed to the members of the Australian Physiotherapy Association and Physiotherapy New Zealand between August 2016 and April 2017. Results The survey was accessed by 130 physiotherapists and 121 of those deemed themselves eligible and consented to participate. Most participants (89%) reported prescribing airway clearance techniques for 81–100% of individuals during an acute exacerbation of bronchiectasis. The most commonly used airway clearance techniques with adults were huffing (92%), exercise (89%) and the active cycle of breathing technique (89%). The techniques perceived most effective for adults were physical exercise (100%), oscillating positive expiratory pressure devices (97%), directed huffing (95%) the active cycle of breathing technique (90%) and positive expiratory pressure (90%). The most commonly used airway clearance techniques for paediatric patients were: newborn-3 years - percussion (85%) and modified postural drainage (85%); 4–10 years - huffing (100%) and exercise (85%); 11–18 years - huffing (92%) and exercise (77%), active cycle of breathing technique (77%) and positive expiratory pressure therapy (77%). The techniques perceived most effective for paediatric patients were directed huffing (100%), percussion (100%) and positive expiratory pressure via a mask or mouthpiece (93%). The most commonly reported factors influencing choice of technique were patient clinical presentation (72%) and the presence/absence of contra-indications (72%). Conclusion This survey demonstrates that airway clearance techniques are routinely used as part of physiotherapy management of individuals experiencing an acute exacerbation of bronchiectasis, and that choice of technique and perceived effectiveness varies depending on the age of the patient.

Airway clearance treatments in bronchiectasis: feasibility of linking survey results to registry data and a survey of patients’ and physiotherapists’ practices

“…Most patients reported using ACBT, huffing and exercise and/or physical activity; previous studies in bronchiectasis have reported similar findings. 7,8,15,17 PEP and OPEP were used less frequently than ACBT in the UK and also used less than in other countries e.g. Australia and New Zealand.…”

“…The Bronchiectasis Observational Cohort and Biobank UK (Bronch-UK); and EMBARC (the European Multicentre Bronchiectasis Audit and Research Collaboration)) registries collect baseline and follow up data (including some basic ACT data) on patients with bronchiectasis throughout UK and Europe. At time of our study initiation, there were limited surveys on ACT practices 7,8 and UK ACT practices have not been explored for 20 years. 8 The aims of the current study were (i) to assess the feasibility of collecting online survey data relating to ACTs from patients and physiotherapists and linking the patient survey data to their outcome data in the Bronch-UK/EMBARC Registry; (ii) to assess the association between the patients" reported ACT practices and their outcome data and (iii) to ascertain the factors affecting physiotherapists" decision making, related to their patients" ACT practices.…”

Goal-oriented rehabilitation in a 15-year-old case of cystic bronchiectasis secondary to Pierre-robin sequence- Case report

“…Another study was done by Phillips et al, (2021) on the utilisation of airway clearing procedures by physiotherapists during an acute exacerbation of bronchiectasis and found that individuals having an acute exacerbation of bronchiectasis are frequently treated with airway clearing procedures as part of their physiotherapy treatment, and the technique employed and perceived success differs depending on the patient's age.…”

Airway inflammation in patients with bronchiectasis

“…Usled oštećenja cilijarnog aparata, dolazi do zastoja viskoznog sekreta u disajnim putevima, koji dodatno ometa funkciju cilija, i olakšava infekciju odnosno kolonizaciju bakterijama. Kolonizovane bakterije luče citokine, medijatore inflamacije, proteolitičke enzime koji dovode do destrukcije plućnog tkiva odnosno hronične inflamacije [38,39]. Produkti bakterija i oštećenih epitelnih ćelija, luče hemotaksične faktore, koji uzrokuju nakupljanje neutrofila.…”