Airway Clearance Methods Used in Bronchiectasis Appear Safe, Effective

Airway Clearance Methods Used in Bronchiectasis Appear Safe, Effective

Scientists in Canada and Australia have reviewed research describing methods used to relieve symptoms of bronchiectasis (BE). Their comprehensive report, titled Airway clearance techniques for bronchiectasis, appeared on Nov. 23, 2015, in the Cochrane Library.

Bronchiectasis is a medical condition in which the airways become abnormally wide (dilated), causing excess mucus to build and putting patients at an increased risk of chest infection. Some researchers and industry experts alike believe that bronchiectasis is underdiagnosed among patients with pulmonary disease, with many BE patients being misdiagnosed with a generic form of COPD instead, and that the overall size of the population may be in excess of one million patients. However, it is believed that a better understanding of bronchiectasis among physicians and patients can lead to more accurate diagnoses, effective treatment strategies, and improved patient outcomes.

Several different airway clearance techniques are available to help bronchiectasis patients clear such mucus, and include positioning, directed coughing, positive expiratory pressure, airway oscillating devices, gravity-assisted drainage, and various breathing methods. The effectiveness of these different techniques is, however, not clearly established.

The investigators, led by Dr. Annemarie L. Lee of West Park Healthcare Centre, Toronto, wanted to comprehensively assess the literature supporting the use of airway clearance techniques for bronchiectasis. Based on their search, the review included a total of 7 studies with 105 participants. Six of the studies examined the lung condition in adults and one in children.

Overall, the airway clearance methods appeared to be safe and effective. Two studies indicated improvement in quality of life and in disease-specific and cough-related measures. There was some evidence of improved breathlessness and cough, but no change in oxygenation. Only two of the studies were conducted for as long as six months, making it difficult to predict long-term effects based on the evidence. The methods used in the trials were not described in great detail, so the investigators noted that the data are not strong and still preliminary.

In their study report, the authors concluded that “[airway clearance techniques] appear to be safe for individuals (adults and children) with stable bronchiectasis and may account for improvements in sputum expectoration, selected measures of lung function, symptoms and [quality of life].”

It was not clear whether these techniques impacted acute exacerbations, or a sudden worsening of symptoms, which can include shortness of breath and an increased quantity and a changed color of phlegm.

The scientists noted, “The role of these techniques in acute exacerbation of bronchiectasis is unknown. In view of the chronic nature of bronchiectasis, additional data are needed to establish the short-term and long-term clinical value of ACTs [airway clearance techniques] for patient-important outcomes and for long-term clinical parameters that impact disease progression in individuals with stable bronchiectasis, allowing further guidance on prescription of specific ACTs for people with bronchiectasis.”

Notably, AffloVest is one recent method that could potentially improve breathing in bronchiectasis. The device is a chest wall oscillation system designed to assist breathing in people with respiratory problems. AffloVest has been studied in adolescents with cystic fibrosis and shown to improve lung function. According to the National Heart, Lung and Blood Institute (NHLBI), cystic fibrosis is responsible for approximately half of the U.S. bronchiectasis cases.

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