Active cycle of breathing technique for cystic fibrosis

Abstract

People with cystic fibrosis (CF) experience chronic airway infections as a result of mucus build up within the lungs. Repeated infections often cause lung damage and disease. Airway clearance therapies aim to improve mucus clearance, increase sputum production, and improve airway function. The active cycle of breathing technique (ACBT) is an airway clearance method that uses a cycle of techniques to loosen airway secretions including breathing control, thoracic expansion exercises, and the forced expiration technique. To compare the clinical effectiveness of ACBT with other airway clearance therapies in CF. We searched the Cochrane CF Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Last search: 05 August 2010. Randomised or quasi-randomised controlled clinical studies, including crossover studies, comparing ACBT with other airway clearance therapies in CF. Two review authors independently screened each article, abstracted data and assessed the risk of bias of each study. Fifty-eight studies were identified of which 17 (346 participants) met the inclusion criteria. Four randomised controlled studies (98 participants) were included in the meta-analysis; three were of crossover design. The 13 remaining studies were crossover studies with inadequate reports for complete assessment.Included studies compared ACBT to autogenic drainage, airway oscillating devices, high frequency chest compression devices, and conventional chest physiotherapy. Patient preference varied: more patients preferred autogenic drainage over ACBT, more preferred ACBT over airway oscillating devices, and more were comfortable with ACBT versus high frequency chest compression. No significant difference was seen in sputum weight between ACBT and autogenic drainage or between ACBT and airway oscillating devices. There was no significant difference in lung function and the number of pulmonary exacerbations between ACBT and ACBT plus conventional chest physiotherapy. All other outcomes were either not measured or had insufficient data for analysis. There is insufficient evidence to support or reject the use of ACBT over any other airway clearance therapy. Four studies, with four different comparators, found that ACBT was comparable to other therapies in outcomes such as patient preference, lung function, sputum weight, oxygen saturation, and number of pulmonary exacerbations. Longer-term studies are needed to more adequately assess the effects of ACBT on outcomes important for patients such as quality of life and patient preference.