European Respiratory Society statement on airway clearance techniques in adults with bronchiectasis

Airway clearance techniques (ACTs) are part of the main management strategy for patients with bronchiectasis. Despite being a priority for patients, accessibility, implementation and reporting of ACTs are variable in clinical settings and research studies. This European Respiratory Society statement summarises current knowledge about ACTs in adults with bronchiectasis and makes recommendations to improve the future evidence base. A task force of 14 experts and two patient representatives (10 countries) determined the scope of this statement through consensus and defined six questions. The questions were answered based on systematic searches of the literature. The statement provides a comprehensive review of the physiological rationale for ACTs in adults with bronchiectasis, and the mechanisms of action along with the advantages and disadvantages of each ACT. Evidence on ACTs in clinical practice indicates that the most frequently used techniques are active cycle of breathing techniques, positive expiratory pressure devices and gravity-assisted drainage, although there is limited evidence on the type of ACTs used in specific countries. A review of 30 randomised trials for the effectiveness of ACTs shows that these interventions increase sputum clearance during or after treatment, reduce the impact of cough and the risk of exacerbations, and improve health-related quality of life. Furthermore, strategies for reducing the risk of bias in future studies are proposed. Finally, an exploration of patients' perceptions, barriers and enablers related to this treatment is also included to facilitate implementation and adherence to ACTs.</p

Functional Capacity In Severe Chronic Obstructive Pulmonary Disease

Objective: To investigate the functional capacity in patients with severe chronic obstructive pulmonary disease (COPD) and healthy subjects. Methods: The present study was conducted in the School of Physical Therapy and Rehabilitation, Department of Chest Medicine, Medical School, Hacettepe University, Ankara, Turkey, from June 2002 to July 2003. Forty-five male patients with severe (23 moderately severe, 22 very severe) COPD and 45 healthy controls participated in the study. Pulmonary function tests and 6-minute walk test (6MWT) were performed. The Borg score and heart rate were measured before and after the test. External work of walking was calculated as the product of body weight and walked distance. Functional dyspnea was measured using the modified Medical Research Council (MRC) dyspnea scale. Results: Both distance and external work of 6MWT were significantly lower in severe COPD patients than healthy subjects (p 0.05). Patients with very severe impairment had a significantly lower percentage of predicted 6MWT distance (p < 0.05). In these patients, 6MWT distance was correlated significantly with forced expiratory flow in one second (FEV1), MRC score, and Borg score whereas external work of walking correlated with age, FEV1, forced expiratory flow from 25-75%, MRC, and resting Borg score (p < 0.05). Conclusion: Severe COPD patients had a significantly impaired functional capacity as compared to their healthy counterparts. Patients with FEV1 < 35% have a lower percentage of functional capacity. Both distance and external work of 6MWT are influenced by large and small airway function, level of breathlessness reported during daily activity or scored during an exercise test in patients with FEV1 < 35%.Wo

Factors Determining Self-Efficacy In Chronic Obstructive Pulmonary Disease

Objective: We investigated the factors determining self-efficacy in patients with chronic obstructive pulmonary disease (COPD). Methods: Thirty male patients with COPD and 30 healthy controls participated in the study. Pulmonary function tests, 6-minute walk test (6MWT), modified Borg scale, modified Medical Research Council (MRC) dyspnea scale, Hospital Anxiety and Depression Scale (HADS), Activities of Daily Living Questionnaire (ADL-Q), and COPD Self-Efficacy Scale (CSES) were used for the evaluation. The study was performed between September 2003 and May 2004 at the Department of Chest Medicine, School of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey. Results: The COPD patients expressed higher depression and dyspnea level and impaired activities of daily living than healthy controls (p < 0.05). Duration of disease and the ADL-Q score was significantly correlated with all subscales of CSES (p < 0.05). Borg score and anxiety score were significantly related with negative affect, weather/environment, and behavioral risk factors subscales of CSES (p < 0.05). Lung function was significantly related with physical exertion and behavioral risk factors, and 6MWT distance was significantly correlated with weather/environment and behavioral risk factors subscales (p < 0.05). The MRC score was correlated with weather/environment score (p < 0.05). The ADL-Q score and disease duration accounted for 76% of the variance in self-efficacy (p < 0.05). Conclusion: Level of impaired activities of daily living due to respiratory limitation and the number of years since diagnosis are independent variables that predict self-efficacy, or level of confidence in engaging specific behaviors that lead to specific desired outcomes in COPD.Wo

Active Cycle Of Breathing Techniques In Non-Invasive Ventilation For Acute Hypercapnic Respiratory Failure

We hypothesised that applying the active cycle of breathing techniques (ACBT) in patients with acute hypercapnic respiratory failure undergoing non-invasive ventilation would improve patient outcome. Thirty-four patients were randomised so that 17 patients with acute hypercapnic respiratory failure received the ACBT and non-invasive ventilation (ACBT group), and 17 patients received non-invasive ventilation alone (control group). The primary outcome measure was length of time requiring non-invasive ventilation, and secondary outcome measures were change in acute physiology score, change in arterial blood gas values, total duration of non-invasive ventilation, and length of stay in the intensive care unit. Although not significant, there was a greater decrease in arterial carbon dioxide pressure in the ACBT group compared to the control group (-21.41 mmHg vs -17.45 mmHg, p = 0.27). Total duration of ventilation tended to be shorter in the ACBT group than in the control group (64.9 hours vs 84.1 hours, p = 0.15). Length of time in need of non-invasive ventilation was significantly lower in the ACBT group than in the control group (5.0 days vs 6.7 days, p = 0.03). There was no significant difference in length of stay in the intensive care unit between the two groups (8.0 vs 9.4 days, p = 0.31). The use of ACBT may have positive effects in the treatment of patients with acute hypercapnic respiratory failure, resulting in a shorter length of time requiring non-invasive ventilation.WoSScopu