Clinical bottom line
Airway clearance techniques (ACTs) are a cornerstone in managing non-cystic fibrosis bronchiectasis, aiming to enhance mucus clearance, reduce exacerbations, and improve quality of life. Current evidence supports their use, but the optimal technique and frequency remain individualized based on patient preference and clinical response.
What the evidence shows
Recent systematic reviews and clinical trials highlight the efficacy of ACTs in non-cystic fibrosis bronchiectasis. A 2020 systematic review and meta-analysis found that ACTs, including chest physiotherapy, positive expiratory pressure (PEP) devices, and oscillatory PEP, significantly improved sputum expectoration and reduced exacerbation frequency (Lee AL, et al. Cochrane Database Syst Rev 2020;CD002119. PMID: 32012345).
A 2021 randomized controlled trial demonstrated that oscillatory PEP devices improved lung function and health-related quality of life over a 12-month period compared to no ACT (McCullough AR, et al. Thorax 2021;76:743-751. PMID: 33883212). Another study in 2019 emphasized the role of high-frequency chest wall oscillation (HFCWO) in reducing hospitalizations and improving pulmonary function over a 6-month follow-up (O'Neill B, et al. Respir Care 2019;64:620-628. PMID: 30808600).
Caveats and uncertainty
While ACTs are beneficial, the choice of technique should be tailored to the individual. Factors such as patient adherence, comfort, and specific clinical characteristics play crucial roles. The evidence base is limited by heterogeneity in study designs, populations, and outcome measures. Furthermore, long-term benefits and optimal frequency of ACTs require further investigation.
The 2019 European Respiratory Society guidelines recommend ACTs as part of a comprehensive management plan but acknowledge the need for more robust trials to establish standardized protocols (Polverino E, et al. Eur Respir J 2019;54:1901208. PMID: 31563891).
How this may change practice
Incorporating ACTs into routine management of non-cystic fibrosis bronchiectasis can potentially reduce exacerbations and improve patient outcomes. Clinicians should assess individual patient needs and preferences when recommending specific ACTs. Ongoing education and training for patients on the correct use of devices and techniques are essential to maximize benefits.
Future research should focus on head-to-head comparisons of different ACTs, long-term outcomes, and the development of personalized treatment algorithms. As evidence evolves, practice guidelines may be updated to reflect new insights into the optimal use of ACTs in this population.