Postural Drainage or Flutter® Device in Conjunction with Breathing and Coughing Compared to Breathing and Coughing Alone in Improving Secretion Removal and Lung Function in Patients with Acute Exacerbation of Bronchiectasis: A Pilot Study

Abstract

Maximizing normal coughing, the single best means for clearing pulmonary secretions and protecting the lung, is a primary focus of physiotherapy in patients with impaired mucociliary clearance. In busy Hong Kong hospitals, patients are often encouraged to use breathing and coughing (BC) manoeuvres, in conjunction with other techniques such as postural drainage (PD) and the use of the Flutter(r) device (FL), as self-treatment to mobilize secretions. This pilot study examined whether the effects of PD and FL on secretion clearance and lung function indices in patients with acute exacerbations of bronchiectasis were greater than that of BC alone. Fifteen patients admitted with bronchiectasis were randomly allocated to three groups: PD+BC, FL+BC and BC alone. Treatment was applied for 15 minutes daily in all groups, until the day of discharge. Variables measured included wet weight sputum production (during the 15-minute treatment time, during the subsequent 15-minute post-treatment period, and over 24 hours), forced vital capacity, forced expiratory volume in 1 second, and peak expiratory flow rate. Variables were recorded on Days 2 and 4 after admission and on the day of discharge. Patients were asked to allocate subjective ease and effectiveness scores for their treatment method. There was no difference in sputum production or lung function parameters among the three groups at any of the measurement points. Patients reported that all techniques were equally easy to use, but FL was perceived as being the most effective in clearing secretions. PD and FL do not appear to facilitate secretion removal beyond that achieved by BC alone.