Airway Clearance Strategies in Cystic Fibrosis and Non-Cystic Fibrosis Bronchiectasis

Abstract

Many patients with cystic fibrosis (CF) and non-CF bronchiectasis present with common symptoms in clinical domains that appear to benefit from airway clearance strategies. These symptoms include chronic productive cough, retention of excessive, purulent mucus in dilated airways, impairment of normal mucociliary clearance (MCC), atelectasis, breathlessness, fatigue, respiratory inflammation, fever, infection, and airflow obstruction. Airway clearance strategies may involve singular and focused interventions for the purpose of removing secretions and improving lung recruitment and gas exchange in patients with atelectasis. Strategies may also involve indirect or adjunctive interventions that facilitate or enhance effective airway clearance at different ages or stages of the disease process, for example, inhalation therapy, exercise, oxygen therapy, or noninvasive ventilation. The aim is to optimize care by selecting any one or combination of these in responding intelligently and sensitively to individual and changing patient requirements during their lifetime. Currently, a solid evidence base does not exist for airway clearance strategies in CF and non-CF bronchiectasis, and much of airway clearance clinical practice remains in the domain of clinical expertise. The paucity of evidence is partly explained by the relatively immature research machinery in allied health care internationally but is also partly to do with inadequate or inappropriate research designs. This article aims to provide an overview of the nature of, and physiological basis for, the direct and indirect airway clearance strategies in CF and non-CF bronchiectasis with reference to the best available evidence.

The Likelihood of Preventing Respiratory Exacerbations in Children and Adolescents with either Chronic Suppurative Lung Disease or Bronchiectasis

“…Non-pharmacological airway clearance techniques are strategies that aim to clear the airway of secretions, improve gas exchange, and hence reduce the risk of infection in the lower airways (95). The core components involve postural drainage, percussion, vibration of the chest wall, and coughing (96), and specific techniques include active cycle of breathing techniques, forced expiration techniques, autogenic drainage, postural drainage, oscillating positive expiratory pressure, high frequency chest wall oscillation, and exercise and/or pulmonary rehabilitation (96).…”

Airway Clearance Therapy in Cystic Fibrosis Patients Insights from a Clinician Providing Cystic Fibrosis Care

“…Clinical trials for ACT techniques without devices (eg, vibratory vests) are difficult due to significant variability of primary outcomes due often to patients employing more than one technique for airway clearance. 3 Use of “breathing techniques” with associated devices is extremely important for airway secretion clearance in treatment of CF. Use of active breathing exercises to enhance airway mucus clearance strengthens lung capacity lung over time.…”

“…than one technique for airway clearance. 3 Use of "breathing techniques" with associated devices is extremely important for airway secretion clearance in treatment of CF. Use of active breathing exercises to enhance airway mucus clearance strengthens lung capacity lung over time.…”

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

“…The main goals of airway clearance techniques (ACTs) are to enhance mucus mobilization, reduce airway resistance, improve ventilation and gas exchange and to reduce work of breathing. Although ACTs are an important part of the treatment of our pediatric respiratory population, a sound evidence base is lacking and airway clearance strategies are largely based on clinical expertise [ 4 ]. One of the barriers is the lack of adequate outcome measures specifically related to respiratory physiotherapy.…”