Airway Clearance Research Articles

Pediatric physiotherapy management of airway clearance therapy and exercise: Data from the Australian Bronchiectasis Registry.

Regular airway clearance techniques (ACTs) and exercise are recommended for children with bronchiectasis, but current clinical practice and their predictors are unknown. We aimed to describe current use of ACTs and exercise among Australian children with bronchiectasis and identify associated predictors. Physiotherapy-specific data of 397 children (median age = 8 were extracted from the Australian Bronchiectasis Registry. A multivariate analysis was undertaken to identify predictors associated with the use of regular ACTs and physical exercise. Regular ACTs were undertaken by 118 (30%) children while 192 (48%) engaged in regular exercise. Physical exercise was the most common ACT modality (n = 83, 20%). The likelihood of regular ACT increased in children whose sputum isolated Pseudomonas aeruginosa (OR = 3.88, 95% CI 1.69-8.89) and was 50% higher for every respiratory exacerbation in the previous 12-months that required hospitalization (OR = 1.50, 95% CI 1.15-1.95). For every year older in age, children had increased odds of engaging in physical exercise (OR = 1.21, 95% CI 1.08-1.34) or using an ACT device (OR = 1.21, 95% CI 1.05-1.34). Regular exercise was twice as likely in the presence of bibasal bronchiectasis (OR = 2.43, 95% CI 1.14-5.16), yet less likely in those with ≥1 hospitalizations in the previous 12-months (OR = 0.76, 0.95% CI 0.57-1.03). Approximately one-third of children with bronchiectasis undertake regular ACTs while physical exercise was undertaken in approximately one in two children. Age, frequent respiratory exacerbations requiring hospitalization and the extent of disease are predictors of undertaking regular ACTs and exercise. Identification of these factors may assist in tailoring ACT, exercise and ACT modality prescription in clinical practice.

Therapeutic applications of eucalyptus essential oils.

Eucalyptus essential oils (EEOs) have gained significant attention recently anticipated to their broad range of prospective benefits in various biological applications. They have been proven to have strong antibacterial properties against a variety of bacteria, fungi, and viruses. This makes them valuable in combating infections and supporting overall hygiene. The active compounds present in these oils can help alleviate inflammation, making them valuable in addressing inflammatory conditions such as arthritis, respiratory ailments, and skin disorders. Respiratory health benefits are another prominent aspect of EEOs. Inhalation of these oils can help promote clear airways, relieve congestion, and ease symptoms of respiratory conditions like coughs, colds, and sinusitis. They are often utilized in inhalation therapies and chest rubs. They can be used topically or in massage oils to alleviate muscle and joint pain. Furthermore, these oils have shown potential in supporting wound healing. Their antimicrobial activity helps prevent infection, while their anti-inflammatory and analgesic properties contribute to reducing inflammation and pain associated with wounds. In aromatherapy, EEOs are renowned for their invigorating and uplifting qualities, promoting mental clarity, relaxation, and stress relief. Overall, EEOs hold great promise in biological applications, offering a natural and versatile approach to promote health and well-being. Continued research and exploration of their therapeutic potential will further unveil their benefits and broaden their applications in various fields.

The Neurological and Hemodynamics Safety of an Airway Clearance Technique in Patients with Acute Brain Injury: An Analysis of Intracranial Pressure Pulse Morphology Using a Non-Invasive Sensor

Patients with acute brain injury (ACI) often require mechanical ventilation (MV) and are subject to pulmonary complications, thus justifying the use of Airway Clearance Techniques (ACTs), but their effects on intracranial pressure (ICP) are unknown. This study investigates the neurological and hemodynamics safety of an ACT called ventilator hyperinflation (VHI) in patients with ACI. This was a randomized clinical equivalence trial, which included patients aged ≥ 18 years with a clinical diagnosis of hemorrhagic stroke, with symptom onset within 48 h. The participants were randomly allocated to the Experimental Group (EG, n = 15), which underwent VHI followed by tracheal aspiration (TA), and the Control Group (CG, n = 15), which underwent TA only. Neurological safety was verified by analyzing the morphology of the ICP wave through the non-invasive B4C sensor, which detects bone deformation of the skull, resulting in a P2/P1 ratio and TTP, and hemodynamics through a multi-parameter monitor. Evaluations were recorded during five instances: T1 (baseline/pre-VHI), T2 (post-VHI and before TA), T3 (post-TA), T4 and T5 (monitoring 10 and 20 min after T3). The comparison between groups showed that there was no effect of the technique on the neurological variables with a mean P2/P1 ratio [F (4,112) = 1.871; p = 0.120; np2 = 0.063] and TTP [F (4,112) = 2.252; p = 0.068; np2 = 0.074], and for hemodynamics, heart rate [F (4,112) = 1.920; p = 0.112; np2 = 0.064] and mean arterial pressure [F(2.73, 76.57) = 0.799; p = 0.488; np2 = 0.028]. Our results showed that VHI did not pose a neurological or hemodynamics risk in neurocritical patients after ACI.

Validation of SPECT-CT to assess improvement in airway clearance following expiratory muscle strength training (EMST) to reduce chronic aspiration in patients with head and neck cancer treatment related dysphagia

Validation of SPECT-CT to assess improvement in airway clearance following expiratory muscle strength training (EMST) to reduce chronic aspiration in patients with head and neck cancer treatment related dysphagia

Postoperative conditions of rehabilitative interest in lung transplantation: a systematic review.

Lung transplantation is an elective treatment option for end-stage respiratory diseases in which all medical therapy options have been exhausted. The current study aimed to identify updated information on the postoperative conditions that may impair rehabilitation after lung transplantation and to provide specific considerations of their clinical relevance during the recovery process. The present study is a systematic review conducted by searching three primary databases: the United States National Library of Medicine PubMed system, Scopus, and the Cochrane Library. The databases were searched for articles published from database inception until May 2024; at the end of the selection process, 27 documents were included in the final analysis. The retrieved material identified 19 conditions of rehabilitative interest that potentially affect the postoperative course: graft dysfunction, dysphagia, postsurgical pain, cognitive impairment, chronic lung allograft dysfunction-bronchiolitis obliterans syndrome, phrenic nerve injury, delayed extracorporeal membrane oxygenation weaning, airway clearance, refractory hypoxemia, mediastinitis, reduced oxidative capacity, sternal dehiscence, coronavirus disease 2019 (COVID-19), gastroparesis, ossification of the elbow, Takotsubo cardiomyopathy, airway dehiscence, recurrent pleural effusion, and scapular prolapse. Although some patients are not amenable to rehabilitation techniques, others can significantly improve with rehabilitation.

Nursing Care for Septic Shock Patients Using Indonesian Nursing Standards: A Case Reports

Aims: This case report aimed to identify gaps in applying the Nursing Standard Guidelines of the Indonesian Association in critical care, specifically focusing on patients with septic shock. Methods: This study used a case report with a nursing care approach that includes an assessment to evaluation. Nursing care was provided to a patient who was experiencing septic shock, was on a ventilator, and had experienced organ failure. Results: A 63-year-old man on mechanical ventilator was diagnosed with septic shock caused by community-acquired pneumonia. The nursing diagnoses for this case included impaired spontaneous ventilation related to respiratory muscle weakness, ineffective airway clearance related to the accumulation of secretions, peripheral tissue perfusion disorders related to changes in fluid regulation, and risk of infection. The study identified inappropriate nursing diagnoses, such as 'impaired spontaneous ventilation for patients on mechanical ventilation. Conclusion: This study concludes that there are still several gaps in diagnosing and managing clinical conditions in critical cases. The nursing problem of impaired spontaneous ventilation should not have been identified as the patient was already on a ventilator. Additionally, there was no actual diagnosis for impaired organ perfusion or infection. This case report recommends further developing the Nursing Standard Guidelines of the Indonesian Nursing Association to optimize coverage of critical care. Recommendations include revising the Indonesian Nursing Diagnosis Standards to align with critical care needs. This enhancement will help nurses and clinicians in critical care not experience confusion when applying the current guidelines.

Novel CYCLIN-O pathogenic variants in a patient presenting with bronchiectasis secondary to reduced generation of multiple motile cilia.

Reduced generation of multiple motile cilia (RGMC) represents a rare variant of Primary Ciliary Dyskinesia (PCD), associated with CYCLIN-O (CCNO) mutations. We report a novel compound mutation in the CCNO gene in an adult Chinese Singaporean exhibiting chronic productive cough since childhood and recurrent sino-pulmonary infections. Low nasal nitric oxide and bronchiectasis suggests PCD. Bronchoscopy for epithelial and nasal brushings for ciliary studies were repeated after adequate treatment of lower respiratory tract infections. Demonstration of oligo-cilia via transmission electron microscopy, and detection of CCNO mutation through genetic analysis were utilized to diagnose RGMC. Repeated courses of antibiotics including nebulised antibiotics were used to treat recurrent infections and exacerbations. Airway clearance techniques, immunizations and collaboration with otorhinolaryngologist form part of the long-term management. Heightened clinical suspicion and adherence to established diagnostic algorithms are essential for timely recognition of this entity.

Effects of airway clearance in hospitalized children with neurologic impairment.

Airway clearance therapies (ACT) are often used to optimize respiratory function for children with neurologic impairment (CNI) hospitalized with acute respiratory infections (ARI). In a five-center retrospective cohort study of CNI aged 1-18 years hospitalized between 2013 and 2015 with ARI, we assessed the association of admission ACT with hospital outcomes (days to return to baseline respiratory support and length of stay [LOS]). Generalized estimated equation (GEE) models examined the association between ACT and outcomes, while accounting for clustering. Propensity scores estimating the likelihood of receiving ACT were included in the GEE models as inverse probability of treatment weights to account for confounding. In adjusted analyses, children receiving admission ACT required similar time to return to respiratory baseline (adjusted risk ratio [aRR] 1.24, 95%CI: 0.95,1.62) and had similar LOS (aRR 1.08, 95%CI: 0.88,1.32) compared with children not receiving ACT. Future studies should seek to identify subpopulations of CNI who benefit most from ACT.

Effectiveness of Chest Physiotherapy toward Tuberculosis (TBC) Patient to Overcome Ineffective Airway Clearance in Dieng Inpatient Room of dr. Abdoer Rahem Hospital Situbondo: A Case Report

Tuberculosis is an infectious and potentially fatal disease in worldwide, caused by lungs inflammation due to Mycobacterium bacteria infection. Tuberculosis patient experiences coughing with phlegm, shortness of breath or dyspnea, accumulation of exudate or sputum. Excessive of sputum accumulated can lead to obstruction of breath way and increase lungs infection that related to ineffective airway clearance. Chest physiotherapy can be intervention of nursing to overcome ineffective airway clearance that helps in clearing accumulated sputum and improving oxygen saturation. This scientific work uses a case report method that describes the case of Tuberculosis patient with main problem of nursing that was called ineffective airway clearance. The sampling was consecutive sampling but only one patient included in the case. The sample of study was Mrs. M, 32 years old who had Tuberculosis patient with ineffective airway clearance. The research was conducted twice daily for 3 days began from December 21st, 2023, to December 23rd, 2023, in the Dieng Inpatient Room of dr. Abdoer Rahem Hospital Situbondo. Intervention was done in two sessions, that were morning and afternoon. Based on observations, there was no significant difference on blood pressure level, but there were decreasing pulse rate, decreasing respiratory rate, increasing oxygen saturation value, and improving ability of sputum production post intervention Chest Physiotherapy on the third day. The application of Chest Physiotherapy quietly helped in expelling phlegm and improving respiratory status.

Physiotherapy students’ academic performance and satisfaction after following a chest physiotherapy course in hybrid mode: a case-control study

Hybrid e-learning offered flexibility for students who could not attend in-person classes during the COVID-19 pandemic, but its effectiveness in teaching chest physiotherapy remains to be determined. This retrospective case-control study assessed physiotherapy students’ academic performance and satisfaction with a hybrid classroom approach adopted during the COVID-19 pandemic for teaching airway clearance techniques. Physiotherapy students participated in a ‘Critical area and airway clearance techniques’ seminar in person or remotely. The evaluation included a multiple-choice quiz (0–20 points) for theoretical knowledge, a checklist (0–10 points) for practical skills, and a total score (0–30 points). Satisfaction was measured using a 5-point Likert scale. Quartile regression tests calculated median differences, 95% confidence intervals (CIs), and Cohen’s d effect sizes for each assessment component. The analysis included 41 students (54% men, mean age: 23 ± 2.1). The face-to-face group outperformed the remote group in total scores (median difference: 6 [95% CI 2.89; 9.10], effect size: 1.48 [0.72; 2.23]) and practical skills (median difference: 4 [2.31; 5.68], effect size: 2.05 [1.35; 2.76]). However, there was no conclusive difference in theoretical knowledge (median difference: 2 [-0.24; 4.24], effect size: 0.61 [-0.07; 1.29]). Student satisfaction was similar. Physiotherapy students attending the ‘Critical area and airway clearance techniques’ seminar remotely achieved lower scores than their in-person counterparts, highlighting the potential limitations of hybrid teaching for this subject. The mean scores indicated that this method allowed students to acquire the necessary knowledge during the COVID-19 pandemic.

Are school settings restricting access to daily physical activity for children with cystic fibrosis? Parents’ perspectives and recommendations for practice

ABSTRACT Background Cystic Fibrosis (CF) is a genetic life limiting disease that impacts upon quality of life. An aim of CF care is to preserve lung function, with physical activity (PA) being an important part of daily airway clearance. Ensuring children have opportunities to engage in PA at school should be an important part of their daily routine. It is important to gain parental perspectives on this, as they manage the daily care for their children. This study aims to explore parents’ perceptions of school-based PA for their children with CF. Methods Parents of children with CF (n = 10), from three regions of the UK (England, Wales and Northern Ireland) took part in online semi-structured interviews. Data were analysed using Interpretative Phenomenological Analysis (IPA). Results Although parents recognized the benefits of school-based PA for their children, systemic barriers in the school setting often inhibit daily PA for children with CF, including teachers’ misconceptions, emotional and physical barriers, and PA not being a priority. Conclusion Recommendations for practice have been developed to help engage children with CF in daily school-based PA in an inclusive way, with the hope of maintaining health outcomes for children with CF.

Bronchiectasis Exacerbations: Are We Doing Everything We Can?

At the European Respiratory Society (ERS) Congress 2024, two experts in bronchiectasis, Pieter Goeminne, Department of Respiratory Diseases, Vitaz Saint-Nicholas Hospitals, Belgium, and Michal Shteinberg, Pulmonology Institute and CF Center – Carmel Medical Center; Israel Institute of Technology; and The B. Rappaport Faculty of Medicine, Haifa, Israel, discussed bronchiectasis’ pathogenesis and exacerbations, along with unmet needs regarding diagnosis and treatment. Bronchiectasis is a chronic and progressive inflammatory disease with a rising prevalence. Commonly associated conditions/related comorbidities of bronchiectasis include post-infective diseases and other airway conditions (such as chronic obstructive pulmonary disease [COPD] and asthma), although the cause of bronchiectasis may remain unknown in over a third of patients. Development of bronchiectasis involves the intersection of four pathogenic components: chronic infections, airway ciliary dysfunction, chronic inflammation (mostly neutrophilic), and structural lung damage, commonly known as the ‘vicious vortex.’ In particular, bronchiectasis development, progression, and exacerbation also involve upregulated and dysregulated neutrophil function. Exacerbations in bronchiectasis are marked by symptoms of increased cough, sputum changes, decreased lung function, and fatigue, among others. Careful clinical examination and awareness of bronchiectasis symptoms are needed to properly diagnose and treat the initial condition and prevent exacerbations. Triggers for exacerbations can be endogenous, such as neutrophil or eosinophil increases, as well as exogenous, including the presence of infectious agents and pollution. Research regarding treatment for bronchiectasis is limited, but European guidelines recommend airway clearance techniques and antibiotics during exacerbations. To enable more targeted treatment for bronchiectasis from first occurrence, to limit exacerbations, and during an exacerbation, there are unmet needs for better identification of resistant genes, treatments for pathogens and inflammation, and biomarkers of exacerbation triggers.

Monocyte-regulated interleukin 12 production drives clearance of Staphylococcus aureus.

Staphylococcus aureus is a versatile bacterium responsible for conditions ranging from mild skin and soft-tissue infections to serious disorders such as pneumonia and sepsis. Monocytes play a role in protection against pathogens by migrating to inflamed tissues and differentiating into macrophages but their specific role in the context of S. aureus pulmonary infection has not been fully elucidated. Using a CCR2-DTR transgenic mouse model we demonstrate that over the course of infection monocyte depletion resulted in worse airway clearance of S. aureus. The bronchoalveolar lavage fluid (BALF) of CCR2-DTR mice after S. aureus infection displayed significant decreases in interleukin-12 (IL-12), IFN-γ, IP-10, MIG and RANTES, all IFN-γ regulated, compared to wild-type (WT) infected controls. NK cells were identified as the main producers of IFN-γ, but both NK cells and IFN-γ were dispensable for clearance. We demonstrated through cytokine production and RNA-seq analysis that IL-12 and IL-12 regulated genes are strongly induced in monocytes upon S. aureus infection. Administration of IL-12 during infection restored the bacterial burdens in the BALF and lungs of monocyte-depleted CCR2-DTR mice to the levels of WT mice, independent of IFN-γ. In the absence of monocytes, alveolar macrophages are the primary phagocytic cells, and IL-12 influences their capacity to produce reactive oxygen species and clear S. aureus. These results show that production of IL-12 contributes to the control of S. aureus via its influence on alveolar macrophage function.

Peak expiratory flow predicts the occurrence of postoperative pneumonia after esophagectomy for esophageal cancer.

Expiratory flow is an important factor in the achievement of airway clearance that is required to prevent postoperative pneumonia (POP). Although peak expiratory flow (PEF) has been shown to predict the occurrence of POP in lung cancer patients after lobectomy, its predictive power in relation to esophagectomy for esophageal cancer remains unknown. This study assesses PEF as a predictor of POP in patients with esophageal cancer undergoing radical esophagectomy. We conducted a single-center, retrospective cohort study of patients who underwent radical esophagectomy with gastric tube reconstruction at our institution between January 2007 and December 2022. Preoperative pulmonary functions, including PEF, were assessed before surgery. Additionally, POP was diagnosed as a Clavien-Dindo classification of Grade II or higher. Survival and pneumonia incidence were compared using the Kaplan-Meier method. Logistic regression analysis was used to examine the relationship between these variables and POP. The study included 513 patients, of which 441 were men. POP occurred in 86 patients (16.7%). When all patients were stratified by %PEF into two groups, the group with %PEF lower that 80% had significantly poorer prognosis and higher incidence of pneumonia. Multivariable logistic regression analysis indicated that %PEF (OR: 0.986, 95%CI: 0.974-0.999, P = 0.030), along with age, BMI, preoperative treatment, and recurrent laryngeal nerve palsy were independent protective factors against POP. These results reveal that %PEF predicts the development of POP following esophagectomy for esophageal cancer.

Implementasi Latihan Batuk Efektif Dalam Upaya Pembersihan Jalan Nafas Pada Pasien Pasca Anestesi Umum Di Ruang Pemulihan

Introduction: Common side effects of general anesthesia, particularly when administered by inhalation, include sore throat, coughing, and hoarseness after surgery. An effective cough is an attempt to alleviate sore throat, cough, and hoarseness in individuals who have had general anesthesia. In order to keep the lungs clean, it is important to cough properly so that secretions may be removed swiftly and efficiently. Objective: At Jatiwinangun Surgical Specialty Hospital, we aim to teach our patients how to cough effectively so that they can reopen their airways following general anesthesia. Method: After one round of general anesthesia, 30 participants will undergo effective coughing activities as part of this activity's methodology. One technique to evaluate a cougher's ability to clear their airways is with the use of a checklist and an observation sheet for airway clearing. This method takes into account the cougher's breathing rate, the noises they make when coughing, the strength of their breathing muscles, and how easily they clear their airways. Result: Ten participants (or 33.3% of the total) fell within the 26–35 age bracket, while nineteen (or 63.3% of the total) were female, fourteen (or 46.7% of the total) had only completed high school, and ten (or 33.3% of the total) were housewives. At least 21 participants (70.0%) had more knowledge regarding how to effectively apply cough training after receiving good-quality education, whereas 6 participants (20.0%) had adequate knowledge and 3 participants (10.0%) had less. After undergoing general anesthesia, 24 subjects (80.0%) had effective coughing abilities, whereas 6 people (20%) shown less competence. When it came time to observe airway clearance, the results showed that 93.3% of participants breathed normally, 83.3% did not make any extra ronchi breath sounds, 90.0% did not use any additional breathing muscles, and 80.0% of participants had no trouble clearing their airways. Conclusion: From the results of PkM it can be concluded that effective cough training can clear the airway in patients after general anesthesia.

Enhancing Cough Motor Learning in Parkinson's Disease Through Variable Practice During Skill Training.

When re-learning a motor skill, practicing a variety of treatment targets promotes error processing and the exploration of motor control strategies, which initially disrupts accuracy during training (motor performance), but ultimately enhances generalization, retention, and transfer (motor learning). Cough skill training (CST) is feasible and efficacious to improve cough strength; however, previous studies have used the same practice target during training. Our goal was to examine the impact of CST with variable practice on motor performance, motor learning, and respiratory system adaptations. The study was a prospective three-visit single group design. Twenty individuals with Parkinson's disease (PD) and concomitant dysphagia and dystussia completed two sessions of CST involving three randomized practice targets. Cough, lung volume, and airway clearance outcomes were assessed before and after treatment sessions with long-term retention evaluated after 1 month. Peak expiratory flow rate improved after CST with variable practice for voluntary single (β = 0.35 L/s) and sequential (β = 0.22 L/s) cough, which were maintained after 1 month without treatment. The ability to expel material from the upper airway demonstrated a small magnitude of improvement (β = -1.87%). During CST, participants altered lung volume based on the treatment target and lung volume decreased during reflex cough after completing CST. Individuals with PD demonstrated improvements in several aspects of motor learning after two sessions of CST with variable practice. Increasing lung volume may not be an implicit strategy to upregulate voluntary cough strength in this treatment paradigm. The findings support the need for larger investigations exploring the potential benefits of this CST approach.

Effect of Effective Cough Education Video on Airway Clearance in Post General Anesthesia Patients

Background: Post-anesthesia disorders, particularly respiratory conditions related to hypoxia, can rapidly lead to fatal outcomes if not promptly identified and managed. Effective coughing techniques are essential for patients to expel phlegm efficiently. Purpose: This study aimed to evaluate the effectiveness of airway clearance in patient post-general anesthesia at RSI Purwokerto after viewing cough instruction videos. Methods: A quasi-experimental design, specifically the Pretest-Posttest Control Group Design, was employed. A total of 52 respondents were selected through purposive sampling. Data on airway clearance were collected using observation sheets. The Mann-Whitney U and Wilcoxon tests were utilized for data analysis. Results: Prior to viewing the instructional videos, the average airway clearance score was 1.03; this improved to 0.42 post-intervention. In the control group, the average score improved from 1.07 to 0.73 after education. The Wilcoxon test results indicated a significant difference in airway clearance before and after the intervention in both the experimental group (p = 0.001, p < 0.05) and the control group (p = 0.003, p < 0.05). Furthermore, the Mann-Whitney U test revealed a significant difference between the experimental and control groups post-intervention (p = 0.026, p < 0.05). Conclusion: The findings demonstrate that viewing cough instruction videos significantly improve airway clearance in patients who have undergone general anesthesia. This intervention is effective in enhancing respiratory outcomes in this patient population at RSI Purwokerto.

Patient-managed interventions for adults with bronchiectasis: evidence, challenges and prospects.

Bronchiectasis is a chronic lung condition which is characterised by recurrent chest infections, chronic sputum production and cough, and limited exercise tolerance. While bronchiectasis may be caused by various aetiologies, these features are shared by most patients with bronchiectasis regardless of the cause. This review consolidates the existing evidence on patient-managed interventions for adults with bronchiectasis, while also outlining areas for future research. Airway clearance techniques and hyperosmolar agents are key components of the bronchiectasis management and consistently recommended for clinical implementation. Questions around their prescription, such as optimal sequence of delivery, are still to be answered. Pulmonary rehabilitation and exercise are also recommended for patients with bronchiectasis. Relatively strong evidence underpins this recommendation during a clinically stable stage of the disease, although the role of pulmonary rehabilitation following an exacerbation is still unclear. Additionally, self-management programmes feature prominently in bronchiectasis treatment, yet the lack of consensus regarding their definition and outcomes presents hurdles to establishing a cohesive evidence base. Moreover, cough, a cardinal symptom of bronchiectasis, warrants closer examination. Although managing cough in bronchiectasis may initially appear risky, further research is necessary to ascertain whether strategies employed in other respiratory conditions can be safely and effectively adapted to bronchiectasis, particularly through identifying patient responder populations and criteria where cough may not enhance airway clearance efficacy and its control is needed. Overall, there is a growing recognition of the importance of patient-managed interventions in the bronchiectasis management. Efforts to improve research methodologies and increase research funding are needed to further advance our understanding of these interventions, and their role in optimising patient care and outcomes.

A Randomized Case-Control Study on High-Frequency Chest Wall Oscillator Versus Conventional Chest Physical Therapy in Spinal Cord Injury Subjects

Study Design: This study is a randomized case-control trial. Setting: Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India. Background: Spinal cord injury (SCI) often results in severe respiratory dysfunction, leading to increased morbidity and mortality. Respiratory complications, including atelectasis and pneumonia, are prevalent and exacerbated by compromised lung function and ineffective cough. CCPT poses risks like hypoxemia and arrhythmias. HFCWO has emerged as a promising alternative, facilitating airway clearance and improving lung function without manual intervention. Despite its efficacy in other conditions, its specific benefits in SCI require further study. Objective: To study the effect of High-Frequency Chest Wall Oscillator versus Conventional Chest Physical Therapy in candidates with Spinal Cord Injury. Methodology: A sample of 78 SCI patients was selected, with 71 completing the study. Patients were divided into Group A (HFCWO) and Group B (CCPT). Baseline vital, clinical, and radiological parameters were recorded. Group A received HFCWO twice daily for 15 minutes over 5 days, while Group B received CCPT that included positioning, percussions on the affected lobe, and mechanical vibration for 5 days as indicated. Suctioning was performed post-intervention in both groups. Parameters were re-evaluated post-treatment and after 5 days by an intensivist. Results: The median (IQR) age of participants was 32 (18 to 60). Wilcoxon signed- rank test was used for intragroup analysis. The intervention group (HFCWO) had a median age of 49, and the control group (CCPT) had a median age of 22.In the HFCWO group, RR significantly decreased and SpO2 significantly increased (p<0.05) from Day 1 to Day 5. No significant changes were observed in HR and MAP. PEEP, FiO2, and ROASSCI significantly decreased (p<0.05). In the CCPT group, RR, HR, and MAP significantly increased (p<0.05), with no significant change in SpO2. PEEP and FiO2 significantly decreased, but ROASSCI did not change. Both groups showed significant improvement in Chest X-ray scores (p<0.05). Conclusion: This study compares High-Frequency Chest Wall Oscillator (HFCWO) with conventional chest physical therapy (CCPT) in spinal cord injury patients. HFCWO showed superior improvements in clinical and radiological parameters, facilitating earlier ventilator weaning. These findings suggest that HFCWO is a more effective alternative to CCPT for airway clearance in intubated SCI patients.

Solid-state NMR compositional analysis of sputum from people with cystic fibrosis

People with the genetic disease cystic fibrosis (CF) often have chronic airway infections and produce airway secretions called sputum. A better understanding of sputum composition is desired in order to track changes in response to CF therapeutics and to improve laboratory models for the study of CF airway infections. The glycosylated protein mucin is a primary component. Along with extracellular DNA, mucin gives rise to the high viscoelasticity of sputum, which inhibits airway clearance and is thought to promote chronic airway infections in people with CF. Past studies of sputum composition identified additional biomolecular components of sputum including other proteins, both glycosylated and not glycosylated, free amino acids, and lipids. Typically, studies of sputum, as well as other complex biological materials, have focused on soluble or isolated components. Solid-state NMR is not limited to the study of soluble components. Instead, it can provide molecular-level information about insoluble biological samples. Additionally, solid-state NMR can provide information about sample composition without requiring any processing of the sample, eliminating the possibility of misestimating certain components due to insolubility or potential sample loss in isolation steps. In this study, we used both 13C and 31P CPMAS to investigate the total composition of sputum samples obtained from six people with CF. We compared these spectra to those of commercially available mucin, DNA, and phospholipid samples. Lastly, we performed complementary biochemical analyses to identify specific proteins present in the sputum samples. Overall, our findings provide insight into the composition of unprocessed sputum samples from people with CF, which can be used as a benchmark for future investigations of CF and infections in the airways of people with CF. Further, this study provides opportunities to expand the solid-state NMR approach to include dynamic nuclear polarization (DNP) to obtain high-resolution information of sputum and similar biological samples that are not feasible to isotopically enrich.