Airway-Clearance Techniques in Children and Adolescents with Chronic Suppurative Lung Disease and Bronchiectasis

Abstract

Common symptoms of chronic suppurative lung disease or bronchiectasis in children and adolescents are chronic cough with sputum production, retention of excess secretions in dilated airways, and a history of recurrent infections. Clinical management includes the prescription of airway-clearance techniques (ACTs) to facilitate mucociliary clearance, optimize sputum expectoration, relieve symptoms, and improve well-being. A wide range of ACTs are available for selection, and these strategies may be applied in isolation or in combination. The choice of technique will depend in part on the age of the child, their clinical state, and factors which may influence treatment adherence. While the evidence base for ACTs in children and adolescent with these conditions is not robust, the current available evidence in addition to clinical expertise provides guidance for technique prescription and clinical effect. An overview of the most commonly applied ACTs, including their physiological rationale and discussion of factors influencing prescription in children and adolescents is outlined in this review.

Airway clearance, mucoactive therapies and pulmonary rehabilitation in bronchiectasis

“…All of these programmes included lower and upper limb exercises and strengthening exercises and were tailored to the individual patient's capabilities. In children, exercise (especially endurance exercise) is helpful and some experts have also suggested that singing may have a salutatory effect in children …”

“…For children with bronchiectasis, the principles of ACT in current practice follow what has been described in adults, given the paucity of research which exists. 36 Questions remain around how airway clearance relates to key clinical outcomes in bronchiectasis in both adults and children. 6,36 Crucially, there is no strong evidence to inform choice, frequency or duration of ACT in bronchiectasis.…”

“…36 Questions remain around how airway clearance relates to key clinical outcomes in bronchiectasis in both adults and children. 6,36 Crucially, there is no strong evidence to inform choice, frequency or duration of ACT in bronchiectasis. Tailoring of ACT to the individual patient is recommended across the age range 19,37 and physiotherapists must consider how to optimally personalize ACT.…”

“…In children, exercise (especially endurance exercise) is helpful and some experts have also suggested that singing may have a salutatory effect in children. 36,37 Although the evidence base and anecdotal experience suggest that PR or ET is beneficial for patients with bronchiectasis, there are residual unanswered questions. Indeed, exercise as an ACT is an unanswered question in this patient group.…”

The Saudi Thoracic Society guidelines for diagnosis and management of noncystic fibrosis bronchiectasis

“…There is limited evidence that the active breathing cycles and flutter are superior in the gravity-assisted position compared with the sitting position. [ 206 207 208 ]…”