Airway clearance, mucoactive therapies and pulmonary rehabilitation in bronchiectasis

Abstract

This paper aims to provide physiological rationale for airway clearance, mucoactive therapy and pulmonary rehabilitation (PR) (or exercise interventions) in bronchiectasis. There is increasing emphasis on the role of airway clearance techniques (ACT) in the management of bronchiectasis. No single ACT has currently shown superior effect over another. Given the large range of different techniques available, consideration of the physiological effects underpinning a technique including expiratory flow, ventilation and oscillation, is essential to effectively personalize ACT. Key clinical trials of mucoactives in bronchiectasis are underway and will provide clarity on the role of these agents in the management of patients with bronchiectasis. Prescription of mucoactive therapies should be done in conjunction with ACT and therefore the mechanism of action of mucoactive drugs and their timing with ACT should be taken into consideration. PR and/or exercise training are recommended in all current bronchiectasis guidelines. There is a clear physiological rationale that muscle weakness and physical inactivity may play a role in disease progression as well as impacting health‐related quality of life, frequency of pulmonary exacerbations and ability to mobilize sputum. However, there are residual unanswered questions surrounding the delivery and accessibility to PR. This review summarizes the physiological principles and supporting evidence for airway clearance, mucoactive medication and PR, which are key components in the management of bronchiectasis.

Application and effectiveness of respiratory physiotherapy in the prevention and treatment of patients with Covid-19

“…To improve the effectiveness of coughing, it should be intense. Exercises for effective coughing are repeated with the same frequency as breathing exercises [13,14].…”

“…Effective coughing techniques include: -double coughing, -reinforced coughing, -controlled coughing, -intensive exhalation, -coughing combined with intensive breathing [9,14].…”

“…With this technique, it is crucial to remember to avoid the kidneys and spine. The duration of the procedure is selected individually to the patient's needs [13,14].…”

ERS International Congress 2020: highlights from the Respiratory Infections assembly

“…Airway clearance therapy addresses to the airway structural dysfunction with the aim to overcome the failure of mucus clearance. Active interventions include physical exercise (pulmonary rehabilitation), mucus drainage techniques, the use of mechanical devices and pharmacological therapies [29,30]. Hypertonic saline 7% improved lung function and quality of life in non-cystic fibrosis bronchiectasis patients [31], bronchodilators and N acetyl cysteine have an unknown efficacy, while mannitol and rhDNase proved to be ineffective [32,33].…”

Moving forward: Bronchiectasis and chronic suppurative lung disease in children and adults in the 21st century

“…O'Neill et al . described the importance of individualized, age‐appropriate chest clearance techniques taught by a respiratory physiotherapist.…”