Long-term benefits of airway clearance in bronchiectasis: a randomised placebo-controlled trial

Abstract

Keeping airways clear of mucus by airway clearance techniques seems essential in bronchiectasis treatment, although no placebo-controlled trials or any studies lasting longer than 3 months have been conducted. We evaluate the efficacy of the ELTGOL (slow expiration with the glottis opened in the lateral posture) technique over a 1-year period in bronchiectasis patients with chronic expectoration in a randomised placebo-controlled trial.Patients were randomised to perform the ELTGOL technique (n=22) or placebo exercises (n=22) twice-daily (ClinicalTrials.gov, NCT01578681). The primary outcome was sputum volume during the first intervention and 24 h later. Secondary outcomes included sputum volume during the intervention and 24 h later at month 12, exacerbations, quality of life, sputum analyses, pulmonary function, exercise capacity, systemic inflammation, treatment adherence, and side effects.Sputum volume during intervention and 24 h later was higher in the ELTGOL group than in the placebo group both at the beginning and end of the study. Patients in the ELTGOL group had fewer exacerbations (p=0.042) and a clinically significant improvement in the St George's Respiratory Questionnaire score (p<0.001) and the Leicester Cough Questionnaire score compared with the placebo group (p<0.001).Twice-daily ELTGOL technique over 1 year in bronchiectasis patients facilitated secretion removal and was associated with fewer exacerbations, improved quality of life, and reduced cough impact.

Airway clearance, mucoactive therapies and pulmonary rehabilitation in bronchiectasis

“…compared the ELTGOL technique to placebo exercises twice daily (b.d.) in 44 patients over a 1‐year period and reported fewer exacerbations, reduced cough impact and improved HRQoL in the ELTGOL group …”

“…E fficacité de l ’expiration lente t otale g lotte o uverte en décubitus l atéral/slow expiration with the glottis opened in the lateral posture …”

“…13 In 17 patients, Thompson et al reported that there was no significant difference between ACBT and the Flutter (oscillating PEP device) after a 4-week treatment period, in any of the outcomes used (HRQoL, lung function and sputum). 14 16 In terms of the supporting evidence for oscillating PEP, Murray et al compared Acapella to no treatment in 20 stable adult bronchiectasis patients over a 3-month period. 17 There was no change in pulmonary exacerbation frequency or pulmonary function.…”

Non Cystic Fibrosis Bronchiectasis-new clinical approach, management of treatment and pulmonary rehabilitation

“…In a study performed by Herrero Cortina et al, both AD and ELTGOL resulted in significantly greater sputum compared to the control group (51). Anther study, involving ELTGOL, made by Munoz et al which compared the ELTGOL technique to placebo exercises twice daily in 44 patients over a 1-year period, reported fewer exacerbations, reduced cough impact and improvement in the quality of life in the therapy group (52). Another technique is gravity-assisted positioning (GAP) which is passive and relies solely on the effects of gravity and changes in regional ventilation with positioning, so it cannot be used alone as an ACT.…”

Bronchiectasis Exacerbations: Clinical Relevance and Management

“…The 2017 ERS bronchiectasis guidelines strongly advocate airway clearance techniques (ACTs). Recently, the largest randomized control trial (RCT) in this field, that included 44 patients randomised to perform twice daily ELTGOL (slow expiration with the glottis opened in the lateral posture) technique (n = 22) or placebo exercises (n = 22) over 1 year, showed that patients in the ELTGOL group had significantly reduced bronchiectasis exacerbations and improved QoL 68 . A previous Cochrane review concluded that ACTs appear to be safe and may account for improvements in sputum expectoration, symptoms, lung function and QoL 69 .…”