Active Cycle Of Breathing Technique Research Articles

Ensayo clínico aleatorizado de técnicas de aclaramiento mucociliar en niños con bronquiectasias sin fibrosis quística

ObjectiveTo evaluate effectiveness of manual expiratory pressure and expiratory flow increase (EFI) combined with mechanical insufflation-exsufflation (MI-E) and assisted coughing (AC) versus active cycle of breathing techniques (ACBT) in stable bronchiectasis children without cystic fibrosis (CF). Material and methodsRandomized clinical trial with 2 groups of 6 children (age 8.1±1.3) who received of respiratory physiotherapy (RP) sessions twice a month. The main endpoints studied are: weight of sputum collected after each session of RP and lung function measurements at baseline and 12 months, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow between 25%-75% of FVC (FEF25-75%). We also evaluated the number of visits to emergency department, infective exacerbations and the impact of cough on quality of life with the Leicester Cough Questionnaire (LCQ), at the beginning and the end of study. ResultsThe weight of sputum and FEF25-75% increase significantly with manual expiratory pressure, EFI combined with MI-E and AC versus ACBT in our sample. There are no significant differences in FEV1 and FVC. Number of exacerbations decreased in both groups compared to the previous year (without CP treatment), and total score of the LCQ. ConclusionSlow manual expiratory pressure, EFI combined with MI-E and AC for airway permeabilization in children with non-CF bronchiectasis produce significant benefits compared to ACBT.

189 Airway clearance techniques currently used in a cystic fibrosis center in Argentina

Introduction: Nowadays modern physiotherapy has proven to be an effective approach to Cystic Fibrosis treatment although many patients still had a tendency to continue with conventional therapies. Objective: To describe which method of the Airway Clearance Techniques (ACT) patients perform and to know if they had incorporated exercise as a part of their treatment. Methods: Cross sectional, observational study. Data of physiotherapy techniques (ACT, exercise and Inhaled Therapy) were collected. Results: There were 110 patients attended in our clinic. From these, 101 patients (92%) perform some kind of ACT. 30 (27.2%) perform MPD /C (Modified Postural Drainage and Chest Compression), 29 (26.3%) prefer PD/Pc (postural drainage and percussion), 36 (32.7%) ACBT (active cycle of breathing technique) and 12 (10.9%) PEP (Positive Expiratory Pressure) and Osc. PEP (Oscillating Positive Expiratory Pressure) with other techniques. Only 39 patients (35.4%) were daily assisted by a physiotherapist. 88 patients were able to perform exercise according to their age, although 70 (79.5%) usually do. Related to inhaled therapy, 84 of 110 patients (76.3%) use DNase and 42 (38.1%) Hypertonic Saline. Conclusions: Although many patients still prefer PD/ Pc, a considerable number of them had incorporated modern physiotherapy. A great number of patients had understood the importance of an active life and they perform some type of sport or exercise according to the child’s age and abilities.

190 Patient perceptions of physiotherapy and the role of airway clearance techniques within an adult cystic fibrosis clinic

Introduction: Nowadays modern physiotherapy has proven to be an effective approach to Cystic Fibrosis treatment although many patients still had a tendency to continue with conventional therapies. Objective: To describe which method of the Airway Clearance Techniques (ACT) patients perform and to know if they had incorporated exercise as a part of their treatment. Methods: Cross sectional, observational study. Data of physiotherapy techniques (ACT, exercise and Inhaled Therapy) were collected. Results: There were 110 patients attended in our clinic. From these, 101 patients (92%) perform some kind of ACT. 30 (27.2%) perform MPD /C (Modified Postural Drainage and Chest Compression), 29 (26.3%) prefer PD/Pc (postural drainage and percussion), 36 (32.7%) ACBT (active cycle of breathing technique) and 12 (10.9%) PEP (Positive Expiratory Pressure) and Osc. PEP (Oscillating Positive Expiratory Pressure) with other techniques. Only 39 patients (35.4%) were daily assisted by a physiotherapist. 88 patients were able to perform exercise according to their age, although 70 (79.5%) usually do. Related to inhaled therapy, 84 of 110 patients (76.3%) use DNase and 42 (38.1%) Hypertonic Saline. Conclusions: Although many patients still prefer PD/ Pc, a considerable number of them had incorporated modern physiotherapy. A great number of patients had understood the importance of an active life and they perform some type of sport or exercise according to the child’s age and abilities.

Chest physiotherapy during an acute exacerbation of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a slowly progressive, irreversible constriction of the airways causing breathlessness, cough and respiratory distress. The primary cause is repeated exposure to cigarette smoke, although occupational exposures may contribute towards its development. The prevalence of COPD is estimated between 2% and 4%, representing approximately one to two million people in England. Acute exacerbations occur when there is rapid and prolonged worsening of symptoms, which may include increased secretions and cough, and one in eight unplanned hospital stays concern COPD, making it the second largest cause of emergency admissions in the United Kingdom. Across Europe, admission rates vary in Nordic countries; rates have been estimated to be between 360 and 460 per 100,000 per year, and in 1994, COPD admissions are numbered 125,508 in Germany, 45,624 in Spain and 40,190 in Italy. This places a considerable financial burden on health care services, representing a condition for which economic evaluation of therapeutic interventions is particularly relevant. The National Institute for Health and Clinical Excellence (NICE) estimates the direct cost of COPD to the National Health Services (NHS), which exceeds £491m per year (expenditure based on 2001–2002 activity). More than half of this relates to hospital care with more than one million inpatient ‘bed days’ per year attributable to the disease. The estimates of cost are US$88 to US$7757 per exacerbation in the United States, and across Europe, inpatient costs account for approximately Eur2.9b annually. COPD is a heterogeneous condition. Individuals commonly experience dyspnoea, but a smaller proportion may experience excessive secretions, particularly during an exacerbation. Removing these secretions may or may not be beneficial to these individuals, and this may be an individual preference. Manual chest physiotherapy (MCP) involves external manipulation of the thorax using the techniques of percussion and vibration, and recent systematic reviews have identified a limited role for MCP during an acute exacerbation of COPD. NICE guidelines recommend that all the patients are taught to use positive expiratory pressure and instructed in active cycle of breathing technique. These guidelines are based on the best evidence that is currently available. However, physiotherapy research is a growing discipline and much of the earlier evidence regarding chest physiotherapy is fundamentally flawed by small sample sizes and a lack of homogeneity within the sample studied. These studies measure short-term outcomes and in essence, consider efficacy, that is to say the effects, both positive and negative, of these techniques. In 2001, a comprehensive review of the literature regarding manual physiotherapy techniques was undertaken. This focused on patients with compromised respiratory function and impaired mucociliary clearance, who were not being mechanically ventilated. It aimed to identify studies of acceptable quality, designed to evaluate the use and the mode of manual techniques, so as to compile clear and concise clinical practice guidelines. This proved impossible to achieve, owing to the lack of suitable evidence. Whilst eight articles report designs that evaluate a specific manual technique, using secretion clearance

Airway clearance techniques in acute exacerbations of COPD: a survey of Australian physiotherapy practice

ObjectivesTo identify airway clearance techniques (ACTs) used to treat patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and identify factors underpinning their utilisation, including therapists’ knowledge of the literature. DesignCross-sectional postal survey using Likert scales and multiple-choice responses. Setting112 ‘large’ or ‘principal referral’ Australian public hospitals. Participants189 physiotherapists from 89 hospitals (response rate 81%). Main outcome measuresPurpose designed survey measuring self-reported rate of ACT prescription; perception of ACT indications, aims, importance and effectiveness; factors influencing ACT choice; and knowledge of the evidence. ResultsMost physiotherapists (123/189, 65%) prescribed ACTs for 60–100% of patients with AECOPDs. The most frequently prescribed ACTs were physical exercise (169/189, 89%), the forced expiratory technique (153/189, 81%) and the active cycle of breathing technique (149/189, 79%). Most were rated highly effective. Physiotherapists who perceived the role of ACTs to be important to patients’ overall management (137/189, 73%) and those with less than 5 years cardiorespiratory experience (113/189, 60%) prescribed ACTs significantly more frequently than others. The main factors influencing ACT choice were precautions/contraindications to individual techniques (148/189, 78%) and degree of dyspnoea (136/189, 72%). The primary aim of ACT prescription was to clear sputum (178/189, 94%). Understanding of the evidence for ACTs in AECOPDs was mixed, with 43% citing it as supportive, 30% inconclusive and 19% unsure. ConclusionsAustralian physiotherapists frequently prescribe ACTs for patients with AECOPDs and perceive their role to be important. Physical exercise is frequently prescribed for airway clearance and warrants further investigation.

Effects of chest physiotherapy and aerobic exercise training on physical fitness in young children with cystic fibrosis

BackgroundCystic fibrosis is a multisystem disease where the main problems are existing in the respiratory system. Aerobic exercise programs are effective in increasing physical fitness and muscle endurance in addition to chest physiotherapy.ObjectiveThe aim of this study was to evaluate the effects of chest physiotherapy and aerobic exercise training on physical fitness in young children with cystic fibrosis.MethodsSixteen patients with cystic fibrosis, between the ages 5-13 years, were included in this study. All children were assessed at the beginning and at the end of 6 week of the training. Modified Bruce protocol was used for assessing the cardiovascular endurance. The sit-up test was used to evaluate the dynamic endurance of abdominal muscles, standing long jump was used to test power, sit and reach, trunk lateral flexion, trunk hyperextension, trunk rotation and forward bending tests were used to assess flexibility, 20 m shuttle run test and 10-step stair climbing tests were used to assess power and agility. All patients received chest physiotherapy and aerobic training, three days a week for six weeks. Active cycle of breathing technique and aerobic exercise training program on a treadmill were applied.ResultsBy evaluating the results of the training, positive progressions in all parameters except 20 m shuttle run and 10 stairs climbing tests were observed (p < 0.05). Active cycle of breathing techniques were used together with exercise training in clinically stable cystic fibrosis patients increases thoracic mobility (p < 0.05) and the physical fitness parameters such as muscle endurance, strength and speed (p < 0.05). Comparison of the results in sit and reach and forward bending tests were not significant (p > 0.05).ConclusionIt is thought that in addition to medical approaches to the systems affected, the active cycle of breathing techniques along with aerobic training helps to enhance the aerobic performance, thoracic mobility and improves physical fitness in children with cystic fibrosis.

Airway Clearance in COPD: Need for a Breath of Fresh Air? A Systematic Review

Background: Airway clearance is a key component of respiratory physiotherapy management for patients with excess secretions, including patients with chronic obstructive pulmonary disease (COPD). The aim of this review is to give an overview of the available evidence for the use of different airway clearance techniques (ACT) and their effects in patients with COPD. Methods: A systematic literature search was performed on CEBAM, PUBMED, Cochrane CT, Science Direct and Biomed central data bases. After screening, a total of 26 articles were included. Results: Studies that provide solid evidence of the effectiveness of different airway clearance techniques in patients with COPD are rather scarce. The available evidence indicates that active breathing techniques, such as active cycle of breathing techniques, autogenic drainage and forced expiration, can be effective in the treatment of COPD. The evidence for passive techniques such as postural drainage and percussion is low. Supporting techniques such as intrapulmonary percussive ventilation, positive expiratory pressure and non-invasive ventilation have little evidence because of the small number of studies. Little evidence is found for the combined use of active techniques and supporting techniques such as (oscillating) positive expiratory pressure, postural drainage and vibration in COPD patients. There is clearly a need for well-powered controlled clinical trials on the long-term effects of (combined) airway clearance techniques in COPD.

Bronchiectasis

This 64 page document presents evidencebased clinical practice guidelines on the background, potential causes, clinical assessments, investigations, and management of adults and children with non-CF bronchiectasis. It begins with a 6-page summary of all recommendations. The guidelines then provide information on the potential underlying causes of bronchiectasis, and its associations with other pathologies. The clinical presentation in both adults and children is detailed, and evidence for diagnostic investigations is provided,such as immunological tests, radiological investigations, sputum microbiology, and lung function tests. General principles of management are indicated, followed by evidence for physiotherapy in this condition. This includes interventions such as airway clearance techniques, active cycle of breathing techniques, manual techniques, positive expiratory pressure, autogenic drainage, high frequency chest wall oscillation, and exercise. The evidence for the use of airway pharmacotherapy such as mucolytics, hyperosmolar agents, bronchodilators, inhaled corticosteroids and leukotriene receptor antagonists are detailed, followed by evidence for management using antibiotics. Recommendations are given for assessments needed in patients with acute exacerbations in the outpatient and inpatient sector, with criteria provided to determine when inpatient treatment of an acute exacerbation is required. Finally, evidence for surgery, complications and management of the advanced disease is provided. All 549 cited references are provided.

A randomised controlled equivalence trial to determine the effectiveness and cost–utility of manual chest physiotherapy techniques in the management of exacerbations of chronic obstructive pulmonary disease (MATREX)

To estimate the effect, if any, of manual chest physiotherapy (MCP) administered to patients hospitalised with chronic obstructive pulmonary disease (COPD) exacerbation on both disease-specific and generic health-related quality of life. To compare the health service costs for those receiving and not receiving MCP. A pragmatic, randomised controlled trial powered for equivalence. It was not possible to blind participants, clinicians or research staff to study arm allocation during the intervention. Four UK hospitals in Norwich, Great Yarmouth, King's Lynn and Liverpool. 526 participants aged 34-91 years were recruited between November 2005 and April 2008; of these, 372 provided evaluable data for the primary outcome. All persons hospitalised with COPD exacerbation and evidence of sputum production on examination were eligible for the trial providing there were no contraindications to performing MCP. Participants were allocated to either MCP or no MCP on an intention-to-treat (ITT) basis. However, active cycle of breathing techniques (ACBT) was used in both arms. Participants allocated to the intervention were guided to perform ACBT while the physiotherapist delivered MCP. Participants allocated to the control arm received instruction on ACBT only. The primary outcome was COPD-specific quality of life, measured using the St George's Respiratory Questionnaire (SGRQ) at 6 months post randomisation. The European Quality of Life-5 Dimensions (EQ-5D) questionnaire was used to calculate the quality-adjusted life-year (QALY) gain associated with MCP compared with no MCP. Secondary physiological outcome measures were also used. Of the 526 participants, 261 were allocated to MCP and 264 to control, with 186 participants evaluable in each arm. ITT analyses indicated no significant difference at 6 months post randomisation in total SGRQ score [adjusted effect size (no MCP - MCP) 0.03 (95% confidence interval, CI -0.14 to 0.19)], SGRQ symptom score [adjusted effect size 0.04 (95% CI -0.15 to 0.23)], SGRQ activity score [adjusted effect size -0.02 (95% CI -0.20 to 0.16)] or SGRQ impact score [adjusted effect size 0.02 (95% CI -0.15 to 0.18)]. The imputed ITT and per-protocol results were similar. No significant differences were observed in any of the outcome measures or subgroup analyses. Compared with no MCP, employing MCP was associated with a slight loss in quality of life (0.001 QALY loss) but lower health service costs (cost saving of 410.79 pounds). Based on these estimates, at a cost-effectiveness threshold of lambda = 20,000 pounds per QALY, MCP would constitute a cost-effective use of resources (net benefit = 376.14 pounds). There was, however, a high level of uncertainty associated with these results and it is possible that the lower health service costs could have been due to other factors. In terms of longer-term quality of life the use of MCP did not appear to affect outcome. However, this does not mean that MCP is of no therapeutic value to patients with COPD in specific circumstances. Although the cost-effectiveness analysis suggested that its use was cost-effective, much uncertainty was associated with this finding and it would be difficult to justify providing MCP therapy on the basis of cost-effectiveness alone. Future research should include evaluation of MCP for patients with COPD producing high volumes of sputum, and an evaluation of the effectiveness of ACBT in COPD exacerbation. Current Controlled Trials ISRCTN13825248.

Active cycle of breathing techniques contributes to pain reduction in patients with rib fractures

Aim The purpose of the study was to examine the effectiveness of the active cycle of breathing techniques (ACBT) in pain reduction and in preventing pulmonary complications in patients with rib fractures.

Efficacy of Pursed Lips Breathing with Forced Expiration Techniques and Active Cycle of Breathing Technique on Pulmonary Mucus Clearance in Healthy Subjects

Purpose) To investigate the efficacy of pursed lips breathing with forced expiration techniques (PLB & FETs) and the active cycle of breathing technique (ACBT) on pulmonary mucus clearance in healthy subjects. (Methods) Three healthy subjects volunteered for the study. Pulmonary mucus clearance was measured over 70 minutes on three different days by a radioaerosol technique. Each subject attended three sessions, one each of control (normal breathing), PLB & FETs and ACBT. (Results) The efficacy of both airway clearance techniques was similar, but better than that of normal breathing. In the central lung zone, PLB & FETs demonstrated a slight enhancement of mucus clearance as compared with ACBT and normal breathing. In the intermediate and peripheral zones, PLB & FETs and ACBT resulted in a relatively high mucus clearance as compared with normal breathing. Overall mucus clearance of normal lungs was remarkably improved by PLB & FETs and ACBT. (Conclusion) Enhanced mucus clearance in healthy subjects, particularly in the intermediate and peripheral lung zone, can be achieved by PLB & FETs and ACBT.

Chest physical therapy, breathing techniques and exercise in children with CF

Chest physiotherapy in the form of airway clearance techniques and exercise has played an important role in the treatment of cystic fibrosis. Until the 1990s the primary airway clearance technique used was postural drainage combined with percussion and vibration (PD&P). It was introduced into the treatment of CF with little evidence to support its efficacy and once established, it has been difficult ethically to perform a study comparing PD&P to no treatment. A common question, yet unanswered is when should it be commenced, especially for the newly diagnosed asymptomatic CF patient? Recently, the technique of PD&P has been modified to include only non-dependant head-down positioning due to the detrimental effects of placing a person in a Trendelenburg position. In the 1990s other airway clearance techniques gained popularity, in that they could be performed independently, in a sitting position and avoided many of the detrimental effects of PD&P. These techniques include the Active cycle of breathing technique, formally called the Forced expiration technique and Autogenic drainage. Both these breathing techniques aim at using expiratory airflow to mobilize secretions up the airways and incorporate breathing strategies to assist in the homogeneity of ventilation. Studies suggest that both these techniques are as effective if not more effective than as PD&P and offer many advantages over PD&P. It has been suggested that exercise can be used as an airway clearance technique; however the literature does not support this. Rather, when exercise is used in addition to an airway clearance technique there is enhanced secretion removal and an overall benefit to the patient. Further research needs to be directed at assessing the effects of an airway clearance technique on the individual patient using appropriate outcome measures.

A randomized evaluation of the acute efficacy, acceptability and tolerability of Flutter and active cycle of breathing with and without postural drainage in non-cystic fibrosis bronchiectasis

Airway clearance is integral to the management of bronchiectasis, yet there is no evidence as to the optimal modality. The aim of this randomized prospective study was to evaluate the acute efficacy, acceptability and tolerability of three airway clearance techniques in non-cystic fibrosis (non-CF) bronchiectasis. Flutter, active cycle of breathing technique (ACBT) and ACBT with postural drainage (ACBT-PD) were evaluated in random order over a week in 36 patients (mean age 62 years, range 33-83), with stable non-CF bronchiectasis. Total sputum wet weight for ACBT-PD was twice that of either ACBT alone or Flutter. No objective difference in treatment duration was noted. All three techniques were well accepted and tolerated. Patient preference was 16 (44%) for Flutter, eight (22%) ACBT and 12 (33%) for ACBT-PD. Patient demography, factors such as upper airways or reflux symptoms, previous use or acute efficacy did not predict preference. This is the first randomized systematic evaluation of acute efficacy, acceptability and tolerability of Flutter, ACBT and ACBT-PD in non-CF bronchiectasis. All three techniques were well tolerated but ACBT-PD proved superior in terms of acute efficacy. Patient preference for treatment modality could not be predicted.

The physiotherapy management of patients undergoing thoracic surgery: a survey of current practice in Australia and New Zealand

Physiotherapy is considered an essential component of the management of patients after thoracotomy, yet the type of interventions utilized, and evidence for their efficacy, has not been established. The aim of the present study was to ascertain the current physiotherapy management of patients undergoing thoracotomy and the factors influencing practice among different providers. A purpose-designed postal questionnaire was distributed to senior physiotherapists in all thoracic surgical units throughout Australia and New Zealand (n=57). A response rate of 81% was obtained (n=46). Pre-operatively, 16 respondents (35%) reported assessing all thoracotomy patients. The majority of respondents (n=44; 96%) indicated that all patients were seen by physiotherapists after surgery, with 29 respondents (63%) performing prophylactic physiotherapy interventions to prevent post-operative pulmonary complications. Respondents reported that physiotherapy treatment was usually commenced on day one post-operatively (n=37; 80%) with the most commonly used treatment interventions being deep breathing exercises, the active cycle of breathing techniques, cough, forced expiration techniques and sustained maximal inspirations. Most respondents reported that patients first sat out of bed (n=41; 89%), commenced shoulder range of movement (n=23; 50%) and walking (n=32; 70%) on day one post-operatively. The majority of respondents reported that they offered no post-operative pulmonary rehabilitation (n=25; 54%), outpatient follow-up (n=43; 94%) orpost-thoracotomy pain management (n=40; 87%). Respondents indicated that personal experience, literature recommendations and established practice were the factors which most influenced physiotherapy practice. Conclusion. Most patients after thoracotomy receive physiotherapy assessment and/or treatment in the immediate post-operative period, but only one-third were routinely seen pre-operatively and relatively few were reviewed following discharge from hospital. Further studies are required to guide physiotherapists in determining the efficacy of their practices for patients undergoing thoracotomy.

Airway Clearance in Bronchiectasis: A Randomized Crossover Trial of Active Cycle of Breathing Techniques versus Acapella®

Background: The efficacy of a new airway clearance device (Acapella^®) has not been previously investigated. Active cycle of breathing techniques (ACBT) is the standard airway clearance technique used in patients with bronchiectasis. Objective: The objective of this study was to compare the efficacy of ACBT with Acapella as methods of airway clearance in adults with stable, productive bronchiectasis. Methods: Twenty patients (7 males), age 58 ± 11 years (mean ± SD), FEV₁ 64 ± 22% predicted with stable (change of not greater than FEV₁ 10% predicted during 3 months prior to study), productive (history of expectoration of half an egg cup sputum/day) bronchiectasis attended the respiratory clinic on 3 days. Day 1: 40-min training session on ACBT and Acapella. Days 2 and 3: 30-min treatment session of either ACBT or Acapella. Treatment order was determined by a concealed randomization procedure. The following outcomes were measured before and after treatment spirometry, SpO₂ and breathlessness by an independent assessor who was blinded to treatment order. Weight of sputum (during treatment plus 30 min after treatment), number of coughs and patient preference were also recorded. Results: No significant differences were found at baseline indicating that patients were stable. No significant differences were found between weight of sputum expectorated with ACBT treatment and weight of sputum expectorated with Acapella treatment – mean difference 0.54 g (95% CI –0.39 to 1.46). A greater proportion of patients preferred Acapella (14/20). Conclusion: Acapella is as effective a method of airway clearance as ACBT and may offer a user-friendly alternative to ACBT for patients with bronchiectasis.

Evaluation of nebulised hypertonic saline (7%) as an adjunct to physiotherapy in patients with stable bronchiectasis

Sputum clearance is of prime importance in the management of patients with bronchiectasis. While nebulised normal isotonic saline (0.9%) (IS) has been anecdotally used to treat patients with tenacious sputum, the use of hypertonic saline (7%) (HS) could have potential muco-protective and clearance properties. 24 patients with bronchiectasis were randomised to receive four single treatment schedules in random order: (1) active cycle breathing technique (ACBT) alone, (2) nebulised terbutaline then ACBT, (3) nebulised terbutaline, nebulised IS then ACBT and (4) nebulised terbutaline, nebulised HS then ACBT. Sputum weights were significantly higher after HS than IS ( P=0.002). Ease of expectoration also differed overall ( P=<0.0001) and was significantly lower with HS than with IS ( P=0.0005). Sputum viscosity differed between treatment phases, with a significant linear trend to reduced sputum viscosity with HS ( P=0.0002). These changes were associated with small but statistically significant differences in FEV 1 ( P=0.043) and FVC ( P=0.011) between treatment phases. Nebulised hypertonic saline can be used safely and effectively as an adjunct to physiotherapy in selected patients. A long-term prospective trial is now indicated to determine its effectiveness on long-term infection rate, quality of life and lung function.

Airway clearance in bronchiectasis: a randomized crossover trial of active cycle of breathing techniques (incorporating postural drainage and vibration) versus test of incremental respiratory endurance

The purpose of this study was to compare the efficacy of the test of incremental respiratory endurance (TIRE) with active cycle of breathing techniques (ACBT) [incorporating postural drainage (PD) and vibration] as methods of airway clearance in adults with bronchiectasis. A randomized crossover study in which a single session of ACBT (incorporating PD and vibration) was compared to a single session of TIRE was carried out in 20 patients (14 female) with stable, productive bronchiectasis. Weight of sputum (treatment plus 30 min) was the primary outcome measure recorded. Pre- and post-treatment measures of lung function and SpO2 were also recorded. All 20 patients were stable during the study period. Sputum weight expectorated during and 30 min post-ACBT (incorporating PD and vibration) treatment was significantly greater than the sputum weight expectorated during and 30 min post-TIRE treatment [mean difference 2.44 g (95% CI 0.43-4.45)]. ACBT (incorporating PD and vibration) is a more effective method of airway clearance in bronchiectasis than TIRE during single treatment sessions.

A pilot study comparing two physiotherapy techniques in patietnts with cystic fibrosis

The flutter is a simple hand held device designed to facilitate the mobilisation of excess bronchial secretions by means of oscillating positive pressure. Traditionally patients at the Johannesburg Hospital Cystic Fibrosis clinic used the active cycle of breathing technique as a means of facilitating secretion mobilisation and clearance. When the flutter became available in South Africa in 1999 many cystic fibrosis patients wanted to change to this technique. Minimal research has been conducted comparing these two techniques. The aim of this pilot study was therefore to determine which technique is more effective in the mobilisation of secretions in cystic fibrosis patients. The pilot study was conducted on seven cystic fibrosis patients (mean age 28 years, range 16-42 years) admitted to the Johannesburg Hospital for antibiotic therapy. The study lasted four days and consisted of two treatment days separated by a washout day on which no physiotherapy was performed. Patients randomised into Group A performed the flutter technique on day two and the active cycle of breathing technique on day four. Group B performed the active cycle of breathing technique on day two and the flutter on day four. The techniques were performed twice a day for 15 minutes. The measurements taken were daily 24-hour sputum samples and daily lung function tests. A questionnaire to determine patient preference to a technique concluded the study. The results showed no statistical difference between the two techniques with regard to sputum weight or lung function (p&lt;0.05). The questionnaire indicated that on a whole, patients had no preference for a technique.

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.

Acute respiratory infection in patients with cystic fibrosis with mild pulmonary impairment: Comparison of two physiotherapy regimens

Chest physiotherapy is an essential part of the management of cystic fibrosis, yet comparatively few studies have investigated the commonly used forms of chest physiotherapy during acute respiratory exacerbations. Fifteen subjects with cystic fibrosis and predominantly mild pulmonary impairment completed a randomised cross-over trial with 24 hours between treatments. The active cycle of breathing techniques (ACBT) assisted by a physiotherapist was compared with the ACBT performed independently by the patient. Measurement outcomes included pulmonary function tests, indirect calorimetry and oximetry parameters. Energy expenditure was not significantly different between the two treatment regimens, though significant improvements in pulmonary function were apparent 24 hours following the therapist-assisted ACBT. In this group of subjects, neither form of treatment proved superior in terms of energy consumption, but a reduction in airways obstruction was observed as a carry-over effect following the therapist-assisted ACBT.