Tables
- TABLE 1
Airway clearance studies in bronchiectasis
First author [ref.] Design Duration Subjects (n) Intervention Outcome measures Munoz [35] Randomised controlled trial 1 year 44 ELTGOL Sputum: volume, purulence, colour, microbiology
Respiratory function testing: FEV1
HRQoL: SGRQ
Cough-related QoL: LCQ
Dyspnoea: mMRC
Exercise capacity: 6MWT
Exacerbations: frequency, time to first exacerbation
Systemic inflammation: venous blood
Adherence: self-report diary
Adverse events: SpO2, Borg scale for dyspnoeaPlacebo (stretches) Arif [49] Randomised controlled trial 4 weeks 60 Antibiotics Sputum: quantity
Respiratory function testing: PEF
Dyspnoea: Modified Borg scale
Pulse oximetry: SpO2
Other: auscultationChest PT Antibiotics and chest PT Tsang [41] Randomised controlled trial <1 week 15
(acute exacerbation)PD + breathing + cough Sputum: wet weight
Respiratory function testing: FVC, FEV1, PEF
Patient perception: Likert scale (ease and effectiveness of ACT)Flutter + breathing + cough Breathing + cough Herala [50] Randomised controlled trial Unclear 15 Thoracic compression
Bubble PEPTranscutaneous partial pressure of carbon dioxide Nicolini [45] Randomised controlled trial 15 days 37 HFCWO Sputum: volume, cell count#
Respiratory function testing: FEV1, FVC, TLC, RV, MIP, MEP
HRQoL: CAT
Cough-related QoL: breathing, cough and sputum scale
Dyspnoea: mMRC
Gas exchange: PaO2, PaCO2
Systemic inflammation: C-reactive proteinConventional chest PT Control (medical therapy) De Souza [51] Randomised crossover 10 days 40 Flutter Sputum: wet and dry weight, adhesiveness, purulence
Respiratory function testing: impulse oscillometry
Dyspnoea: MRC
Patient perception: Likert scales (acceptability, tolerance, difficulty of expectorating sputum)
Pulse oximetry: SpO2, heart rateThoracic compression with deep breathing Control (tidal volume breathing) Silva [42] Randomised crossover <2 weeks 40 Flutter Sputum: wet and dry weight
Patient perception: Likert scale (acceptance, tolerability of ACT)Lung flute Tambascio [52] Randomised crossover 10 weeks 17 Flutter Sputum: adhesiveness, purulence, mucociliary transport, displacement in simulated cough machine, contact angle measurement, inflammatory analysis, microbiology Flutter (PEP only) Herrero-Cortina [43] Randomised crossover 5 weeks 31 AD Sputum: wet weight
Respiratory function testing: FEV1, FEV1% pred, FVC, FVC % pred, FEF25–75%
Cough-related QoL: LCQ
Pulse oximetry: SpO2, heart rate
Patient perception: Likert scale (preference for ACT)
Adverse events: pulse oximetry, heart rateELTGOL Temporary PEP (Uniko) Semwal [44] Randomised crossover 1 day 30 ADA Sputum: volume, wet weight
Respiratory function testing: PEF
Dyspnoea: Modified Borg
Pulse oximetry: SpO2
Other: Respiratory rate
Patient perception: VAS (comfort of ACT)Acapella Svenningsen [53] Randomised crossover 6 weeks 29 (15 COPD,
14 bronchiectasis)Aerobika Respiratory function testing: FEV1% pred, FVC % pred, FEV1/FVC
HRQoL: SGRQ
Exercise capacity: 6MWT
Patient perception: patient evaluation questionnaire (cough frequency, dyspnoea, ease in bringing up sputum)Usual care Figueiredo [33] Randomised crossover 9 days 8 Flutter Sputum: volume
Respiratory function testing: Impulse oscillometry (FOT)Flutter sham Guimarães [54] Randomised crossover 24 days 10 ELTGOL Sputum: dry weight
Respiratory function testing: FVC, FEV1, FEV1/FVC, FEF25–75%, IC, VC, TLC, RVFlutter Control (sitting) Tambascio [34] Randomised crossover 9 weeks 18 Flutter Sputum: mucociliary relative transport velocity, displacement in a simulated cough machine and contact angle measurement Flutter (PEP only) Murray [30] Randomised crossover 7 months 20 Acapella Choice Sputum: 24 h sputum volume, microbiology
Respiratory function testing: FEV1, FVC, FEF25–75%, MIP, MEP
HRQoL: SGRQ
Cough-related QoL: LCQ
Exercise capacity: incremental shuttle walk test
Adherence: diary
Adverse events: diary (haemoptysis, increased use of short-acting bronchodilator)No chest PT Syed [55] Randomised crossover <2 days 35 ACBT with PD
Conventional chest PT (percussion, vibrations,Sputum: wet weight
Respiratory function testing: FVC, FEV1, FEV1/FVC
Patient perception: VAS (comfort of ACT)PD, coughing, breathing) Patterson [56] Randomised crossover 10–12 days 20
(acute exacerbation)Acapella DM or DH with PD Sputum: volume/weight
Respiratory function testing FEV1, FEV1% pred, FVC, VC, PEF
Dyspnoea: Borg scale, 15-count breathlessness score
Pulse oximetry: SpO2
Patient symptoms:
Interview-Based Questionnaire
Patient adherence: diary and weekly phone calls
Patient perception: preferenceUsual ACT (ACBT, PEP, huffs, nil) Patterson [57] Randomised crossover 2 days 20 Acapella DH and DM with PD Sputum: weight
Respiratory function testing: FEV1, FEV1% pred, FVC, FVC % pred, PEF, PEF % pred
Dyspnoea: 15 count breathlessness score
Pulse oximetry: SpO2
Patient perception: questionnaire (preference)
Other: number of coughsACBT (including percssion, vibrations and PD) Thompson [58] Randomised crossover 4 weeks 17 ACBT Sputum: weight
Respiratory function testing: PEF
HRQoL: Chronic Respiratory Disease Questionnaire
Dyspnoea: Borg scale duration of airway clearance session
Patient perception: preferenceFlutter Antunes [59] Randomised crossover 8 weeks 13 Conventional chest PT (percussion with vibrations, PD)
FlutterSputum: wet and dry weight
Respiratory function testing: FVC, FEV1, PEF
Pulse oximetry: SpO2, heart rate
Other: respiratory rateSutton [60] Randomised crossover 4 days 8 PD + FET
Control (sitting)Sputum: wet weight
Respiratory function testing: FEV1, FVC
Other: radio aerosol clearancewith nebulised saline and nebulised terbutaline Uzmezoglu [61] Randomised comparative 4 weeks 40 Flutter
ACBT with PDSputum: change in sputum production
Respiratory function testing: FEV1 % pred, FVC % pred, FEV1/FVC, PEF % predicated
HRQoL: SF-36
Dyspnoea: Modified Borg, MRC
Patient symptoms: questionnaireAbdelHalim [46] Randomised comparative 2 weeks 30
(acute exacerbation)ACBT + PD
Conventional PT (PDSputum: wet volume, microbiology
Respiratory function testing: FEV1, FVC, MMEF, FEV1/FVC
QoL: LCQ
Dyspnoea: mMRC
Gas exchange: PaO2, PaCO2, PA–aO2
Adverse events: not defined+ diaphragmatic breathing + percussion) Ramos [62] Randomised comparative 4 days 22 PD + coughing
PD + percussion +Sputum: wet and dry weight, viscoelasticity coughing PD + huff Control (coughing) Eaton [63] Prospective randomised comparative 7 days 37 Flutter
ACBT
ACBT + PDSputum: wet weight, volume
Respiratory function testing: FEV1% pred, FVC % pred
Dyspnoea: Borg scale
Pulse oximetry: SpO2
Patient perception: Likert scales (acceptability and tolerability, preference)Svenningsen [64] Randomised comparative 3 weeks 30 Aerobika Respiratory function testing: FEV1, FVC, DLCOsb
Exercise capacity: 6MWT
HRQoL: SGRQ
Imaging: CT, MRI
Patient perceptions: patient evaluation questionnaireHealth control D’Abrosca [65] Retrospective cohort study Minimum 10 days of ACT
(4-year data collection period)162 (97 COPD, 65 bronchiectasis) Temporary PEP (Uniko) Respiratory function testing: FEV1, FEV PaO2% pred, FVC, FVC % pred, FEV1/FVC, FEF25–75%, FEF50%
Gas exchange: PaO2PEP (mask) during a pulmonary rehabilitation programme Grillo [66] Prospective
Cohort study∼2 weeks 90 (32 stable, 32 exacerbation, 26 control) Usual ACT (type of ACT not defined): stable
Usual ACT (type of ACT not defined): exacerbation
Healthy controlRespiratory function testing: LCI, FEV1, transfer factor for CO, CO transfer coefficient ELTGOL: slow expiration with the glottis open in lateral posture; FEV1: forced expiratory volume in 1 s; HRQoL: health-related quality of life; SGRQ: St George's Respiratory Questionnaire; QoL: quality of life; LCQ: Leicester Cough Questionnaire; mMRC: modified Medical Research Council Questionnaire; 6MWT: 6-min walk test; SpO2: oxygen saturation measured by pulse oximetry; PT: physiotherapy; PEF: peak expiratory flow; PD: postural drainage; FVC: forced vital capacity; ACT: airway clearance technique; PEP: positive expiratory pressure; HFWCO: high frequency chest wall oscillation; TLC: total lung capacity; RV: residual volume; MIP: maximal inspiratory pressure; MEP: maximal expiratory pressure; CAT: COPD assessment tool; PaO2: arterial oxygen tension; PaCO2: arterial carbon dioxide tension; MRC: Medical Research Council Scale; AD: autogenic drainage; FEF25–75%: forced expiratory flow at 25–75% of FVC; VAS: Visual Analogue Scale; FOT: forced oscillatory technique; IC: inspiratory capacity; VC: vital capacity; ACBT: active cycle of breathing technique; DM: <definition>; DH: <definition>; FET: forced expiratory technique; SF-36: Short Form 36; MMEF: maximal mid-expiratory flow; PA–aO2: alveolar–arterial oxygen tension difference; DLCOsb: single breath diffusing capacity of the lung for carbon monoxide; CT: computed tomography; MRI: magnetic resonance imaging; LCI: lung clearance index. #cell count (white blood cells, red blood cells, neutrophils and lymphocytes).