Airway clearance techniques for patients with acute exacerbations of COPD – physiotherapy practice in Sweden

Abstract

Introduction: There is considerable global variability in clinical practice regarding the prescription of airway clearance techniques (ACTs) for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Little is known about the physiotherapy practice and opinion of ACTs in Sweden. Aims: To identify current practice regarding ACT prescription for patients with AECOPD among physiotherapists in Sweden. Methods: A cross-sectional, descriptive study was conducted via a web-based questionnaire (38 questions), sent to all (n=54) hospitals in Sweden. 120 physiotherapists treating patients with AECOPD responded. The main survey themes included frequency of ACT prescription, perception of ACT effectiveness and importance, and factors underpinning clinical reasoning. Categorical responses were compared between two groups (those with 5 years cardiorespiratory experience) via Chi2 tests. Results: 90% (n=104) of physiotherapists prescribe ACTs for >60% of patients with AECOPD (p=0.796 between groups). The most frequently used (‘very often’ and ‘often’) ACTs were positive expiratory pressure (PEP) devices (90%; n=105), ‘huff’ (88%; n=103), cough (73%; n=83) and deep breathing exercises (66%; n=77). 89% (n=104) of physiotherapists felt ACTs were ‘somewhat important’ or ‘very important’ in the overall management of AECOPDs (p=0.842 between groups). 64% (n=75) of physiotherapists were unsure of the scientific evidence regarding ACTs for patients with AECOPD. Conclusions: Physiotherapists in Sweden consider ACTs to be highly important in the management of patients with AECOPD. PEP devices are the most commonly prescribed ACT for this patient group.