Evaluation of a novel technique in airway clearance therapy – Specific Cough Technique (SCT) in cystic fibrosis: A pilot study of a series of N-of-1 randomised controlled trials

Gursli, Sandra; Sandvik, Leiv; Bakkeheim, Egil; Skrede, B.; Stuge, Britt

doi:10.1177/2050312117697505

Cited by 11 publications

(19 citation statements)

References 23 publications

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“…Participants rinsed their mouth with water, before careful instructions were given on how to produce sputum from a deep cough, using the huff cough method [29]. Participants took three deep maximal breaths, before coughing as hard and as deeply as possible in a standing position.…”

Section: Methodsmentioning

confidence: 99%

Airway microbiome composition correlates with lung function and arterial stiffness in an age-dependent manner

et al. 2019

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ObjectiveTo investigate age-associated changes in airway microbiome composition and their relationships with lung function and arterial stiffness among genetically matched young and elderly pairs.MethodsTwenty-four genetically linked family pairs comprised of younger (≤40 years) and older (≥60 years) healthy participants were recruited (Total n = 48). Lung function and arterial stiffness (carotid-femoral pulse wave velocity (PWV) and augmentation index (AIx)) were assessed. Sputum samples were collected for targeted 16S rRNA gene amplicon sequencing and correlations between microbiome composition, lung function and arterial stiffness were investigated.ResultsElderly participants exhibited reductions in lung function (FEV1 (p<0.001), FVC (p<0.001) and percentage FEV1/FVC (p = 0.003)) and a 1.3–3.9-fold increase in arterial stiffness (p<0.001) relative to genetically related younger adults. Elderly adults had a higher relative abundance of Firmicutes (p = 0.035) and lower relative abundance of Proteobacteria (p = 0.014), including specific genera Haemophilus (p = 0.024) and Lautropia (p = 0.020) which were enriched in the younger adults. Alpha diversity was comparable between young and elderly pairs (p>0.05) but was inversely associated with lung function (FEV1%Predicted and FVC %Predicted) in the young (p = 0.006 and p = 0.003) though not the elderly (p = 0.481 and p = 0.696). Conversely, alpha diversity was negatively associated with PWV in the elderly (p = 0.01) but not the young (p = 0.569). Specifically, phylum Firmicutes including the genus Gemella were correlated with lung function (FVC %Predicted) in the young group (p = 0.047 and p = 0.040), while Fusobacteria and Leptotrichia were associated with arterial stiffness (PWV) in the elderly (both p = 0.004).ConclusionAgeing is associated with increased Firmicutes and decreased Proteobacteria representation in the airway microbiome among a healthy Asian cohort. The diversity and composition of the airway microbiome is independently associated with lung function and arterial stiffness in the young and elderly groups respectively. This suggests differential microbial associations with these phenotypes at specific stages of life with potential prognostic implications.

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Section: Methodsmentioning

confidence: 99%

Airway microbiome composition correlates with lung function and arterial stiffness in an age-dependent manner

et al. 2019

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“…It is therefore important that clinicians prescribing these devices base their judgement on the published clinical evidence of efficacy. Further, patient selection along with proper instruction of how to use the device optimally, including performing effective huffcoughs [123][124][125] is important to optimize therapeutic effect. Finally, this review has highlighted that clinical investigations have thus far been focused on patients with COPD/ chronic bronchitis.…”

Section: Discussionmentioning

confidence: 99%

Non-Pharmaceutical Techniques for Obstructive Airway Clearance Focusing on the Role of Oscillating Positive Expiratory Pressure (OPEP): A Narrative Review

Coppolo¹,

Schloss²,

Suggett

et al. 2021

Pulm Ther

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Mucus secretion in the lungs is a natural process that protects the airways from inhaled insoluble particle accumulation by capture and removal via the mucociliary escalator. Diseases such as cystic fibrosis (CF) and associated bronchiectasis, as well as chronic obstructive pulmonary disease (COPD), result in mucus layer thickening, associated with high viscosity in CF, which can eventually lead to complete airway obstruction. These processes severely impair the delivery of inhaled medications to obstructed regions of the lungs, resulting in poorly controlled disease with associated increased mor-

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“…In a previous study we performed a series of N-of-1 randomized, controlled trials and have reported on the individual efficacy, safety and participants’ perceptions of a novel ACT–Specific Cough Technique (SCT) compared to Forced Expiration Technique (FET) [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…The objective of the present secondary analysis of the prior study [ 8 ] was to assess the effectiveness of the intervention, by evaluating whether participation in the trial led to changes in HRQoL and in particular, clinical meaningful changes in CFQ-R-Respiratory Symptoms Scores (CFQ-R-RSS). A second aim was to examine potential associations between HRQoL and other clinical outcomes, such as sputum production and pulmonary function.…”

Section: Introductionmentioning

confidence: 99%

Airway clearance physiotherapy and health-related quality of life in cystic fibrosis

et al. 2022

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Objective Airway clearance physiotherapy is recommended in cystic fibrosis, but limited evidence exists to suggest how much treatment is enough. As a secondary analysis of a prior study investigating the safety, efficacy, and participants’ perceptions of a novel airway clearance technique, specific cough technique (SCT) compared to forced expiration technique (FET), we aimed to evaluate whether the intervention was associated with changes in health-related quality of life (HRQoL). Methods We conducted randomised, controlled individual trials with six adults (N-of-1 RCTs). Each trial included eight weeks of treatment, twice a week, using saline inhalation in horizontal positions, one with SCT and one with FET, in random order. Efficacy was measured by sputum wet weight (g) after each session. Perceived usefulness and preference were self-reported at the end of the study. Lung function was assessed at baseline and at the end of study. HRQoL was measured using the Cystic Fibrosis Questionnaire-Revised (CFQ-R) at baseline (week 1) and at completion of the study (week 8). Individual HRQoL scores (0–100) were coded and analysed using CFQ-R Software Program, version 2.0. Results Patient-reported outcomes were completed by all subjects. Individual CFQ-R-Respiratory Symptoms Scores (CFQ-R-RSS) showed a positive change, meeting the minimal important difference (MID) ≥ 4 points in five participants and a negative change in one individual. A strong correlation (r = 0.94 (p<0.01) was found between total sputum weight (g) and the positive changes in CFQ-R-RSS, and between changes in lung function and CFQ-R-RSS (r = 0.84 (p = 0.04). Conclusion The airway clearance intervention was associated with clinically meaningful changes in patient-reported symptoms on the CFQ-R in the majority of the participants. This finding warrants further investigation regarding treatment, duration and frequency. A long-term study may reveal beneficial effects on other clinically meaningful endpoints, such as pulmonary exacerbations, high-resolution computed tomography scores and HRQoL. Trial registration The study was registered in ClinicalTrials.gov, under the number NCT0 1266473.

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Evaluation of a novel technique in airway clearance therapy – Specific Cough Technique (SCT) in cystic fibrosis: A pilot study of a series of N-of-1 randomised controlled trials

Cited by 11 publications

References 23 publications

Airway microbiome composition correlates with lung function and arterial stiffness in an age-dependent manner

Airway microbiome composition correlates with lung function and arterial stiffness in an age-dependent manner

Non-Pharmaceutical Techniques for Obstructive Airway Clearance Focusing on the Role of Oscillating Positive Expiratory Pressure (OPEP): A Narrative Review

Airway clearance physiotherapy and health-related quality of life in cystic fibrosis

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