Airway clearance physiotherapy improves quality of life in people with bronchiectasis

Question

Does regular airway clearance using an oscillating positive expiratory pressure (PEP) device improve quality of life, sputum volume, respiratory function, and exercise capacity in people with bronchiectasis?

Design

Randomised, crossover, controlled trial with 3-month intervention periods separated by a 1-month washout period.

Setting

Acute teaching hospital in Scotland.

Participants

20 adults with radiologically diagnosed bronchiectasis and chronic sputum expectoration, who were not performing regular physiotherapy for airway clearance. Smoking, asthma, emphysema, and cystic fibrosis were exclusion criteria.

Interventions

While in the intervention arm, participants performed 20–30 minutes of airway clearance twice daily. Each session consisted of three cycles of 10 breaths through an oscillating positive expiratory pressure (PEP) device called the Acapella, followed by the forced expiratory technique and coughing. Each participant's technique was reviewed by a physiotherapist monthly during the intervention arm. During the control arm, the device was retained by the investigators and participants performed no physiotherapy for airway clearance. Throughout the study, both groups received all other standard management including antibiotics when exacerbation criteria were met. Any changes to the participants’ usual medication regimen were noted.

Outcome measures

The primary outcome was the Leicester Cough Questionnaire (LCQ) – a 19-point, patient-reported measure of the impact of cough severity on quality of life with three domains (physical, psychological, and social). Secondary outcomes included the St George's Respiratory Questionnaire (SGRQ), 24-hour sputum volume, lung function, maximum respiratory pressures, and the incremental shuttle walk test, measured at the end of each intervention arm.

Results

All participants completed the study with no adverse events during airway clearance. During the 3-month intervention period, the total LCQ score showed significantly greater improvement than during the control period: difference in medians for total LCQ score 1.3 points, p = 0.002. Each of the three domains within the LCQ also showed significant benefits. Other outcomes that showed significantly greater improvements due to the airway clearance intervention were the SGRQ (difference in medians 8.5 points, p = 0.005), 24-hr sputum volume (difference in medians 3 ml, p = 0.02), and the incremental shuttle walk distance (difference in medians 40 m, p = 0.001). The groups did not differ significantly on the remaining secondary outcomes.

Conclusion

Regular airway clearance with oscillating PEP improves diseaserelated quality of life and exercise capacity in people with bronchiectasis.