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Spinou A, Hererro-Cortina B, Aliberti S, Goeminne PC, Polverino E, Dimakou K, Haworth CS, Loebinger MR, De Soyza A, Vendrell M, Burgel PR, McDonnell M, Sutharsan S, Škrgat S, Maiz-Carro L, Sibila O, Stolz D, Kauppi P, Bossios A, Hill AT, Clifton I, Crichton ML, Walker P, Menendez R, Borecki S, Obradovic D, Nowinski A, Amorim A, Torres A, Lorent N, Welte T, Blasi F, Jankovic Makek M, Shteinberg M, Boersma W, Elborn JS, Chalmers JD, Ringshausen FC. Airway clearance management in people with bronchiectasis: data from the European Bronchiectasis Registry (EMBARC). Eur Respir J 2024; 63:2301689. [PMID: 38609097 PMCID: PMC11154755 DOI: 10.1183/13993003.01689-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/03/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND International guidelines recommend airway clearance management as one of the important pillars of bronchiectasis treatment. However, the extent to which airway clearance is used for people with bronchiectasis in Europe is unclear. The aim of the study was to identify the use of airway clearance management in patients with bronchiectasis across different countries and factors influencing airway clearance use. METHODS This was a prospective observational study using data from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) Registry between January 2015 and April 2022. Prespecified options for airway clearance management were recorded, including airway clearance techniques, devices and use of mucoactive drugs. RESULTS 16 723 people with bronchiectasis from 28 countries were included in the study. The mean age was 67 years (interquartile range 57-74 years, range 18-100 years) and 61% were female. 72% of the participants reported daily sputum expectoration and 52% (95% CI 51-53%) of all participants reported using regular airway clearance management. Active cycle of breathing technique was used by 28% of the participants and airway clearance devices by 16% of participants. The frequency of airway clearance management and techniques used varied significantly between different countries. Participants who used airway clearance management had greater disease severity and worse symptoms, including a higher daily sputum volume, compared to those who did not use it regularly. Mucoactive drugs were also more likely to be used in participants with more severe disease. Access to specialist respiratory physiotherapy was low throughout Europe, but particularly low in Eastern Europe. CONCLUSIONS Only a half of people with bronchiectasis in Europe use airway clearance management. Use of and access to devices, mucoactive drugs and specialist chest physiotherapy appears to be limited in many European countries.
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Affiliation(s)
- Arietta Spinou
- Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- King's Centre for Lung Health, King's College London, London, UK
- A. Spinou and B. Herrero-Cortina contributed equally to this paper
| | - Beatriz Hererro-Cortina
- Universidad San Jorge, Zaragoza, Spain
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) de Aragón, Zaragoza, Spain
- A. Spinou and B. Herrero-Cortina contributed equally to this paper
| | - Stefano Aliberti
- IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Pieter C Goeminne
- Department of Respiratory Disease, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Eva Polverino
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBERES, Barcelona, Spain
| | - Katerina Dimakou
- 5th Respiratory Department and Bronchiectasis Unit, "SOTIRIA" General Hospital of Chest Diseases Medical Practice, Athens, Greece
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital and University of Cambridge, Cambridge, UK
| | - Michael R Loebinger
- Royal Brompton and Harefield Hospitals and National Heart and Lung Institute, Imperial College London, London, UK
| | - Anthony De Soyza
- Population and Health Science Institute, Newcastle University and NIHR Biomedical Research Centre for Ageing, Freeman Hospital, Newcastle, UK
| | - Montserrat Vendrell
- Department of Pulmonology, Dr Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain
| | - Pierre Regis Burgel
- Department of Respiratory Medicine and French Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP, Paris, France
- Université Paris Cité, Inserm U1016, Institut Cochin, Paris, France
| | - Melissa McDonnell
- Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
| | - Sivagurunathan Sutharsan
- Department of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Essen, Germany
| | - Sabina Škrgat
- University Medical Centre Ljubljana, Department of Pulmonary Diseases and Allergy, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Luiz Maiz-Carro
- Chronic Bronchial Infection Unit, Pneumology Service, Ramón y Cajal Hospital, Alcalá de Henares University, Madrid, Spain
| | - Oriol Sibila
- Servicio de Neumología, Instituto Clínico de Respiratorio, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Respiratorias, ISCIII, Madrid, Spain
| | - Daiana Stolz
- Department of Pneumology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University of Basel, Basel, Switzerland
| | - Paula Kauppi
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Apostolos Bossios
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Adam T Hill
- Royal Infirmary of Edinburgh, Department of Respiratory Medicine, Edinburgh, UK
| | - Ian Clifton
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Megan L Crichton
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Paul Walker
- Liverpool University Hospitals Foundation NHS Trust, Liverpool, UK
| | - Rosario Menendez
- Pneumology Department, Hospital Universitario y Politécnico La Fe-Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Sermin Borecki
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Pulmonology Diseases, Istanbul, Turkey
| | - Dusanka Obradovic
- Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Institute for Pulmonary Diseases, University of Novi Sad, Sremska Kamenica, Serbia
| | - Adam Nowinski
- Department of Epidemiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Adelina Amorim
- Pulmonology Department, Centro Hospitalar Universitário S. João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Antoni Torres
- Department of Pulmonology Hospital Clinic of Barcelona, Spain University of Barcelona, CIBERES, IDIBAPS, ICREA Barcelona, Barcelona, Spain
| | - Natalie Lorent
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Tobias Welte
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases, Frankfurt, Germany
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mateja Jankovic Makek
- University of Zagreb School of Medicine and University Hospital Centre Zagreb, Zagreb, Croatia
- Clinic for Pulmonary Diseases, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Michal Shteinberg
- Pulmonology Institute and CF Center, Carmel Medical Center, Haifa, Israel
- The Technion, Israel Institute of Technology, The B. Rappaport Faculty of Medicine, Haifa, Israel
| | - Wim Boersma
- Department of Pulmonary Diseases, Northwest Clinics, Alkmaar, The Netherlands
| | - J Stuart Elborn
- Faculty of Medicine, Health and Life Sciences, Queen's University, Belfast, UK
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Felix C Ringshausen
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover, German Center for Lung Research, Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases, Frankfurt, Germany
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Basavaraj A, Choate R, Becker BC, Aksamit TR, Metersky ML. Severity of bronchiectasis predicts use of and adherence to high frequency chest wall oscillation therapy - Analysis from the United States Bronchiectasis and NTM research registry. Respir Med 2024; 223:107555. [PMID: 38307319 DOI: 10.1016/j.rmed.2024.107555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/30/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND High frequency chest wall oscillation (HFCWO) is a form of airway clearance therapy that has been available since the mid-1990s and is routinely used by patients suffering from retained pulmonary secretions. Patients with cystic fibrosis (CF), neuromuscular disease (NMD), and other disorders, including bronchiectasis (BE) and COPD (without BE), are commonly prescribed this therapy. Limited evidence exists describing HFCWO use in the BE population, its impact on long-term management of disease, and the specific patient populations most likely to benefit from this therapy. This study sought to characterize the clinical characteristics of patients with BE who have documented use of HFCWO at baseline and 1-year follow-up. METHODS An analysis from a large national database registry of patients with BE was performed. Demographic and clinical characteristics of all patients receiving HFCWO therapy at baseline are reported. Patients were stratified into two groups based on continued or discontinued use of HFCWO therapy at 1-year follow-up. RESULTS Over half (54.8 %) of patients who reported using HFCWO therapy had a Modified Bronchiectasis Severity Index (m-BSI) classified as severe, and the majority (81.4 %) experienced an exacerbation in the prior two years. Of patients with 1-year follow-up data, 73 % reported continued use of HFCWO. Compared to patients who discontinued therapy, these patients were more severe at baseline and at follow-up suggesting that patients with more severe disease are more likely to continue HFCWO therapy. CONCLUSIONS Patients who have more severe disease and continue to experience exacerbations and hospitalizations are more likely to continue HFCWO therapy. CLINICAL TRIAL REGISTRATION NA.
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Affiliation(s)
- Ashwin Basavaraj
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, 462 First Avenue, Administration Building OBV, A601, New York, NY, 10016, USA.
| | - Radmila Choate
- University of Kentucky College of Public Health, Lexington, KY, USA
| | - Brian C Becker
- Department of Medical Affairs, Baxter, St. Paul, Minnesota, USA
| | - Timothy R Aksamit
- Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mark L Metersky
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, Farmington, CT, USA
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Herrero-Cortina B, Spinou A, Oliveira A, O'Neill B, Jácome C, Dal Corso S, Poncin W, Muñoz G, Inal-Ince D, Alcaraz-Serrano V, Reychler G, Bellofiore A, Posthumus A, Chalmers JD, Lee AL. Airway clearance techniques and exercise in people with bronchiectasis: two different coins. Eur Respir J 2023; 62:2300741. [PMID: 37827549 DOI: 10.1183/13993003.00741-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/30/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Beatriz Herrero-Cortina
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain
- Universidad San Jorge, Zaragoza, Spain
| | - Arietta Spinou
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- King's Centre for Lung Health, King's College London, London, UK
| | - Ana Oliveira
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- West Park Healthcare Centre, Toronto, ON, Canada
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Brenda O'Neill
- School of Health Sciences, Ulster University, Coleraine, UK
| | - Cristina Jácome
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Simone Dal Corso
- Graduate Program in Rehabilitation Sciences, Universidade Nove de Julho, São Paulo, Brazil
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia
| | - William Poncin
- Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, Brussels, Belgium
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gerard Muñoz
- Department of Pneumology, Dr Josep Trueta University Hospital, Bronchiectasis Group, Girona Biomedical Research Institute, Girona, Spain
- Department of Physical Therapy, EUSES & ENTI, University of Girona and University of Barcelona, Girona, Spain
| | - Deniz Inal-Ince
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Victoria Alcaraz-Serrano
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Blanquerna School of Health Science, Ramon Llull University, Barcelona, Spain
| | - Gregory Reychler
- Institut de recherche expérimentale et clinique (IREC), pôle de Pneumologie, ORL et Dermatologie, Université Catholique de Louvain, Brussels, Belgium
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Angela Bellofiore
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Healthcare Professions Department, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Centre, Milan, Italy
| | | | - James D Chalmers
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Annemarie L Lee
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
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