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Webb EM, Holland AE, Chang AB, Burr L, Holmes-Liew CL, King PT, Middleton PG, Morgan L, Thomson RM, Wong C, Lee AL. Current physiotherapy practice for adults with bronchiectasis: Data from the Australian bronchiectasis registry. Respir Med 2024; 233:107777. [PMID: 39181278 DOI: 10.1016/j.rmed.2024.107777] [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: 05/01/2024] [Revised: 07/20/2024] [Accepted: 08/20/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Although airway clearance techniques (ACTs) and physical exercise are recommended for adults with bronchiectasis, there is little data on current practice and limited guidance predicting clinical approach. OBJECTIVE This study aimed to describe current ACT and exercise practice recorded by patients, and identify predictors of regular ACTs, ACT modalities and exercise. METHODS Physiotherapy-specific interventions, quality of life (Quality-of-Life Bronchiectasis questionnaire, QOL-B), demographics and disease severity were extracted from the Australian Bronchiectasis Registry. Multivariate analyses were undertaken to identify predictors of undertaking ACTs or exercise. RESULTS We included 461 patients; median age of 72 years (interquartile range 64-78 years). Regular ACT use was recorded by 266 (58 %) patients; the active cycle of breathing technique (n = 175, 74 %) was the most common technique. Regular exercise use was recorded by 213 (46 %) patients, with walking the most common form of exercise. A pulmonary rehabilitation referral was made for 90 (19.5 %) of patients. Regular ACT use was associated with a higher treatment burden on QOL-B (Odds ratio (OR) = 0.97, 95 % confidence interval (CI) 0.96 to 0.99). Regular exercise was more likely amongst patients with severe bronchiectasis compared to those with mild disease (OR = 9.46, 95 % CI 1.94 to 67.83) and in those with greater physical function on the QOL-B (OR = 1.02, 95 % CI 1.01 to 1.04). CONCLUSION Approximately half the adults in the registry report regular ACT or exercise; QOL and disease severity predict this engagement. This knowledge may guide the tailoring of ACTs and exercise prescription to optimise physiotherapy management in adults with bronchiectasis.
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Affiliation(s)
- Elizabeth M Webb
- Department of Physiotherapy, Alfred Health, Melbourne, Australia; Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Australia; School of Translational Medicine, Monash University, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia; Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Lucy Burr
- Department of Respiratory and Sleep Medicine, Mater Hospital Brisbane, South Brisbane, Queensland, Australia; Mater Research, University of Queensland, St Lucia, Queensland, Australia
| | - Chien-Li Holmes-Liew
- Department of Thoracic Medicine, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Paul T King
- Monash Lung Sleep Allergy and Immunology and Monash University Department of Medicine, Monash Medical Centre, Melbourne, Australia
| | - Peter G Middleton
- CITRICA, Department of Respiratory and Sleep Medicine, Westmead Hospital Westmead, New South Wales, Australia
| | - Lucy Morgan
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Department of Respiratory Medicine, Concord General Repatriation Hospital, Concord, New South Wales, Australia
| | - Rachel M Thomson
- Gallipoli Medical Research Foundation and Greenslopes Clinical Unit, The University of Queensland, Brisbane Australia
| | - Conroy Wong
- Respiratory Medicine, Middlemore Hospital, Te Whatu Ora, Auckland, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Annemarie L Lee
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia
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Blardone C, Gambazza S, Mariani A, Galgani R, Brivio A, Nobili RM, Rizza C, Tutino AL, Gramegna A, Daccò V, Contarini M, Blasi F, Laquintana D. Perceived burden of respiratory physiotherapy in people with cystic fibrosis taking elexacaftor-tezacaftor-ivacaftor combination: a 1-year observational study. Ther Adv Respir Dis 2024; 18:17534666241235054. [PMID: 38554035 PMCID: PMC10981859 DOI: 10.1177/17534666241235054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/08/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND To limit the progression of disease, people with cystic fibrosis (pwCF) perform daily respiratory physiotherapy, which is perceived as the most burdensome routine in managing their condition. The elexacaftor-tezacaftor-ivacaftor (ETI) combination has changed respiratory management. OBJECTIVE To investigate how the perceived treatment burden changed in 1 year of treatment with ETI. DESIGN Prospective observational study. METHODS Ad hoc questionnaires for the pwCF and for the caregivers of pwCF < 18 years were administered before the initiation of ETI therapy and then at 6-12 months. The Cystic Fibrosis Questionnaire-Revised (CFQ-R) and the Sinonasal Outcome Test (SNOT-22) were administered to explore disease-related symptoms and social limitations. The International Physical Activity Questionnaire was used to determine levels of physical activity. Mixed-effect models were fitted to explore whether the time engaged in respiratory physiotherapy changed during 1 year. RESULTS The study included 47/184 pwCF aged 21.4 (5.7) years, who completed 1 year of ETI therapy. At 6 months, time on aerosol therapy was decreased by 2.5 (95% CI -32.9 to 27.8) min/day, time on airway clearance therapies (ACTs) was decreased by 8.8 (95% CI -25.9 to 8.3) min/day, and time for cleaning and disinfecting respiratory equipment was decreased by 10.6 (95% CI -26.5 to 5.3) min/day. At 1 year, gains in time saved were nearly 15 min/day on average. At 1 year, 5/47 (10.6%) pwCF reported that they had discontinued positive expiratory pressure mask. CONCLUSION PwCF on ETI may note less time engaged in their daily respiratory physiotherapy routine. Nonetheless, aerosol therapy, ACTs and maintaining respiratory equipment were still perceived as time-consuming daily activities.
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Affiliation(s)
- Chiara Blardone
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Simone Gambazza
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, Via Francesco Sforza 35, Milan, Italy
| | - Alessandra Mariani
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Rachele Galgani
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Anna Brivio
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Rita Maria Nobili
- Pediatrics, Gastroenterology, Hepatology, Pediatric Transplantation and Cystic Fibrosis Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Carmela Rizza
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Anna Luisa Tutino
- Pediatrics, Gastroenterology, Hepatology, Pediatric Transplantation and Cystic Fibrosis Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- SC Pneumologia e Fibrosi Cistica, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Valeria Daccò
- Pediatrics, Gastroenterology, Hepatology, Pediatric Transplantation and Cystic Fibrosis Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Martina Contarini
- SC Pneumologia e Fibrosi Cistica, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- SC Pneumologia e Fibrosi Cistica, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Dario Laquintana
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
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Southern KW, Addy C, Bell SC, Bevan A, Borawska U, Brown C, Burgel PR, Button B, Castellani C, Chansard A, Chilvers MA, Davies G, Davies JC, De Boeck K, Declercq D, Doumit M, Drevinek P, Fajac I, Gartner S, Georgiopoulos AM, Gursli S, Gramegna A, Hansen CM, Hug MJ, Lammertyn E, Landau EEC, Langley R, Mayer-Hamblett N, Middleton A, Middleton PG, Mielus M, Morrison L, Munck A, Plant B, Ploeger M, Bertrand DP, Pressler T, Quon BS, Radtke T, Saynor ZL, Shufer I, Smyth AR, Smith C, van Koningsbruggen-Rietschel S. Standards for the care of people with cystic fibrosis; establishing and maintaining health. J Cyst Fibros 2024; 23:12-28. [PMID: 38129255 DOI: 10.1016/j.jcf.2023.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
This is the second in a series of four papers updating the European Cystic Fibrosis Society (ECFS) standards for the care of people with CF. This paper focuses on establishing and maintaining health. The guidance is produced using an evidence-based framework and with wide stakeholder engagement, including people from the CF community. Authors provided a narrative description of their topic and statements, which were more directive. These statements were reviewed by a Delphi exercise, achieving good levels of agreement from a wide group for all statements. This guidance reinforces the importance of a multi-disciplinary CF team, but also describes developing models of care including virtual consultations. The framework for health is reinforced, including the need for a physically active lifestyle and the strict avoidance of all recreational inhalations, including e-cigarettes. Progress with cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy is reviewed, including emerging adverse events and advice for dose reduction and interruption. This paper contains guidance that is pertinent to all people with CF regardless of age and eligibility for and access to modulator therapy.
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Affiliation(s)
- Kevin W Southern
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.
| | - Charlotte Addy
- All Wales Adult Cystic Fibrosis Centre, University Hospital Llandough, Cardiff and Vale University Health Board, Cardiff, UK
| | - Scott C Bell
- Department of Thoracic Medicine and Faculty of Medicine, The University of Queensland, The Prince Charles Hospital, Brisbane, Australia
| | - Amanda Bevan
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Urzula Borawska
- Institute of Mother and Child in Warsaw, Cystic Fibrosis Department and Dziekanow Lesny Hospital, Cystic Fibrosis Center, Dziekanow Lesny, Poland
| | - Catherine Brown
- West Midlands Adult CF Centre, Heartlands Hospital Birmingham, UK
| | - Pierre-Régis Burgel
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Cochin Hospital, Assistance Publique Hôpitaux de Paris (AP-HP) and Université Paris-Cité, Institut Cochin, Inserm U1016, Paris, France
| | - Brenda Button
- Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia 3181, and Department of Respiratory Medicine, Alfred Health, Melbourne 3004, Australia
| | - Carlo Castellani
- IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genova, Italy
| | - Audrey Chansard
- Epigenetics and Cell Fate Centre, UMR7216 CNRS, Université Paris Cité, Paris, France, and Cystic Fibrosis Europe, Brussels, Belgium
| | - Mark A Chilvers
- Divison of Pediatric Respiratroy Medicine, BC Childrens Hospital, Vancouver, Canada
| | - Gwyneth Davies
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jane C Davies
- National Heart & Lung Institute, Imperial College London; Imperial Biomedical Research Centre; Royal Brompton Hospital, Guy's & St Thomas' Trust, London, UK
| | | | - Dimitri Declercq
- Cystic Fibrosis Reference Center, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium; Department of Pediatrics, Center for children and adolescents with diabetes, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Pavel Drevinek
- Department of Medical Microbiology, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Isabelle Fajac
- Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | | | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Sandra Gursli
- National Resource Centre for Cystic Fibrosis, Oslo University Hospital, Oslo, Norway
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Carina Me Hansen
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
| | - Martin J Hug
- Medical Center - University of Freiburg, Pharmacy, Hugstetter St. 55, Freiburg, D-79106, Germany
| | - Elise Lammertyn
- Cystic Fibrosis Europe, Brussels, Belgium and the Belgian CF Association, Brussels, Belgium
| | - Edwina Eddie C Landau
- The Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Ross Langley
- Department of Paediatric Respiratory & Sleep Medicine, Royal Hospital for Children, Glasgow, UK
| | - Nicole Mayer-Hamblett
- Seattle Children's Research Institute, Seattle, WA and Department of Pediatrics, University of Washington, Seattle, Wa, USA
| | - Anna Middleton
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Peter G Middleton
- Westmead Clinical School, University of Sydney and CITRICA, Dept Respiratory & Sleep Medicine, Westmead Hospital, Westmead, Australia
| | - Monika Mielus
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland; Cystic Fibrosis Centre, Pediatric Hospital, Dziekanów Leśny, Poland
| | - Lisa Morrison
- West of Scotland Adult CF Centre, Queen Elizabeth University Hospital, Glasgow, UK
| | - Anne Munck
- Hospital Necker Enfants-Malades, AP-HP, CF centre, Université Paris Descartes, Paris, France
| | - Barry Plant
- Cork Centre for Cystic Fibrosis (3CF), Cork University Hospital, Cork, Ireland
| | | | - Dominique Pougheon Bertrand
- Laboratoire Educations et Promotion de la santé, LEPS, UR 3412, University of Sorbonne Paris Nord, F-93430, Villetaneuse, France
| | | | - Bradley S Quon
- Division of Respiratory Medicine, Department of Medicine. St. Paul's Hospital and the University of British Columbia. Vancouver, British Columbia, Canada
| | - Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Zoe L Saynor
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, UK and Wessex Cystic Fibrosis Unit, University Hospitals Southampton NHS Foundation Trust, UK
| | - Ilan Shufer
- CF Patient, Head of Access, Off label and Trials, Computer Science Architecture, Research and Innovation, Cystic Fibrosis Foundation of Israel, Israel
| | - Alan R Smyth
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast and NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Chris Smith
- Department of Nutrition and Dietetics, Royal Alexandra Children's Hospital, Brighton, UK
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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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Kienenberger ZE, Farber TO, Teresi ME, Milavetz F, Singh SB, Larson Ode K, Thoma T, Weiner RL, Burlage KR, Fischer AJ. Patient and Caregiver Perceptions of Airway Clearance Methods Used for Cystic Fibrosis. Can Respir J 2023; 2023:1422319. [PMID: 37547298 PMCID: PMC10403321 DOI: 10.1155/2023/1422319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/06/2023] [Accepted: 06/24/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Cystic Fibrosis Foundation guidelines recommend people with CF perform daily airway clearance. This can be difficult for patients, as some find it time consuming or uncomfortable. Data comparing airway clearance methods are limited. We surveyed patients and their families to understand which methods are preferred and identify obstacles to performing airway clearance. Methods We designed a REDCap survey and enrolled participants in 2021. Respondents reported information on airway clearance usage, time commitment, and medication use. They rated airway clearance methods for effectiveness, comfort, time commitment, importance, and compatibility with other treatments. The analysis included descriptive statistics and clustering. Results 60 respondents started and 52 completed the survey. The median patient age was 20 years. Respondents experienced a median of four airway clearance methods in their lifetime, including chest wall oscillation (vest, 92%), manual chest physical therapy (CPT, 88%), forced expiration technique (huff or cough, 77%), and exercise (75%). Past 30-day use was highest for exercise (62%) and vest (57%). The time commitment was generally less than 2 hours daily. Of those eligible for CFTR modulators, 53% reported decreased time commitment to airway clearance after starting treatment. On a scale of 0-100, respondents rated CFTR modulators as their most important treatment (median 99.5), followed by exercise (88). Discussion. Patients and caregivers are familiar with several methods of airway clearance for CF. They report distinct strengths and limitations of each method. Exercise and vest are the most common methods of airway clearance. The use of CFTR modulators may reduce patient-reported time commitment to airway clearance.
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Affiliation(s)
- Zoe E. Kienenberger
- Pediatrics, University of Iowa, Iowa City, IA, USA
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | | | | | | | | | | | | | | | - Kathryn R. Burlage
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
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Abstract
Exercise and airway clearance techniques (ACTs) have been a cornerstone of treatment for people with cystic fibrosis (pwCF) for many decades. Exercise may confer both respiratory and nonrespiratory benefits for pwCF, with greater exercise capacity associated with improved survival. A wide variety of exercise interventions for pwCF have been investigated. ACTs may assist in reducing respiratory symptoms for pwCF and are currently recommended to be performed daily, with the types of ACTs used varying globally. While recommended components of care, both exercise and ACTs are time-intensive and maintaining adherence to the recommendations over the longer term can be challenging. It has been proposed that with advances in the therapeutic options for pwCF, a rationalization of the therapeutic regimen may be possible. We summarize the current evidence for the use of exercise and ACTs by pwCF, discuss the implications of the introduction of cystic fibrosis transmembrane conductance regulator modulators on both exercise and ACTs, and highlight areas for further research.
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Phillips J, Hing W, Pope R, Canov A, Harley N, Lee AL. Active cycle of breathing technique versus oscillating PEP therapy versus walking with huffing during an acute exacerbation of bronchiectasis: a randomised, controlled trial protocol. BMC Pulm Med 2023; 23:36. [PMID: 36698169 PMCID: PMC9875756 DOI: 10.1186/s12890-023-02324-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Airway clearance techniques (ACTs) for individuals with bronchiectasis are routinely prescribed in clinical practice and recommended by international guidelines, especially during an acute exacerbation. However, there is limited evidence of the efficacy of these techniques during an exacerbation to improve sputum expectoration, health-related quality-of-life (HRQOL) or exercise tolerance. The primary aim of this study is to compare the effects of the active cycle of breathing technique (ACBT), oscillating positive expiratory pressure (O-PEP) therapy, and walking with huffing on sputum expectoration for adults hospitalised with an acute exacerbation of bronchiectasis. Secondary aims are to compare the effects of these interventions on HRQOL, health status, exacerbation rates and hospital admissions in a six-month period following hospital discharge. METHODS This multi-centre randomised controlled trial will recruit adults with an acute exacerbation of bronchiectasis requiring hospital admission. Participants will be randomised to receive one of three interventions: ACBT, O-PEP therapy, and walking with huffing. Outcome measures including sputum volume during and 1-h post ACT session, and 24-h sputum, as well as health status, HRQOL and exercise capacity will be completed during inpatient stay on day 2 and day 6 of admission, and within 24 h of hospital discharge. Time to first exacerbation, and time to first hospitalisation will be monitored via monthly phone calls for six months post hospital discharge. Health status and HRQOL will be assessed after discharge at two and six months, and exercise capacity will be assessed at six months post hospital discharge. DISCUSSION Despite recommendations regarding the importance of ACT for individuals with bronchiectasis during an acute exacerbation, there is a gap in the literature regarding effectiveness of ACT when undertaken by individuals in this clinical state. This study will add to the evidence base regarding the effectiveness of commonly implemented ACTs during a hospital admission with an exacerbation of bronchiectasis. Additionally, it will contribute to knowledge of the long term effects on important and patient-centred outcomes, including incidence of future exacerbations, and HRQOL, which has not been previously established. Trial registration Registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12621000428864).
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Affiliation(s)
- Jennifer Phillips
- Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, QLD, 4226, Australia.
- Allied Health Department, The Wesley Hospital, Uniting Care Health, 451 Coronation Drive, Auchenflower, QLD, 4066, Australia.
| | - Wayne Hing
- Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, QLD, 4226, Australia
| | - Rodney Pope
- Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, QLD, 4226, Australia
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, PO Box 789, Albury, NSW, 2640, Australia
| | - Ashleigh Canov
- Allied Health Department, The Wesley Hospital, Uniting Care Health, 451 Coronation Drive, Auchenflower, QLD, 4066, Australia
| | - Nicole Harley
- Allied Health Department, St Andrews Hospital, Uniting Care Health, 457 Wickham Terrace, Spring Hill, QLD, 4000, Australia
| | - Annemarie L Lee
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Hwy, Frankston, VIC, 3199, Australia
- Institute for Breathing and Sleep, 145 Studley Road, Heidelberg, VIC, Australia
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8
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Radtke T. Role of physical activity and airway clearance therapy in cystic fibrosis: moving forward in a rapidly changing landscape. Thorax 2023; 78:3-4. [PMID: 36180065 DOI: 10.1136/thorax-2022-219429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Thomas Radtke
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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9
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Saynor ZL, Cunningham S, Morrison L, Main E, Vogiatzis I, Reid S, Urquhart D. Exercise as airway clearance therapy (ExACT) in cystic fibrosis: a UK-based e-Delphi survey of patients, caregivers and health professionals. Thorax 2023; 78:88-91. [PMID: 36599464 DOI: 10.1136/thorax-2022-219213] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/21/2022] [Indexed: 02/07/2023]
Abstract
Replacing traditional airway clearance therapy (tACT) with exercise (ExACT) in people with cystic fibrosis (pwCF) is a top research priority. A UK-based e-Delphi consensus was performed to inform the type(s), duration and intensity of ExACT. The expert panel comprised CF physiotherapists, doctors, pwCF and parents/partners. Exercise ACT was considered to be aerobic activity, of at least 20 min duration and intense enough to elicit deep breathing. Consensus was reached that assessment breaths, coughs and huffs should accompany exercise to remove loose secretions, with support for trials to investigate ExACT versus tACT during times of stable disease but not pulmonary exacerbations.
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Affiliation(s)
- Zoe Louise Saynor
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
- Wessex Cystic Fibrosis Unit, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Steve Cunningham
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Lisa Morrison
- West of Scotland Adult CF Unit, Queen Elizabeth University Hospital (The Southern General Hospital), Glasgow, UK
| | - Eleanor Main
- Physiotherapy Section, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Simon Reid
- Person with Cystic Fibrosis, Glasgow, UK
| | - Donald Urquhart
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
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10
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Urquhart DS, Cunningham S, Taylor E, Vogiatzis I, Allen L, Lewis S, Neilson AR, Soilemezi D, Akooji N, Saynor ZL. Exercise as an Airway Clearance Technique in people with Cystic Fibrosis (ExACT-CF): rationale and study protocol for a randomised pilot trial. NIHR OPEN RESEARCH 2022; 2:64. [PMID: 37881306 PMCID: PMC10593342 DOI: 10.3310/nihropenres.13347.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 10/27/2023]
Abstract
Background Chest physiotherapy is an established cornerstone of care for people with cystic fibrosis (pwCF), but is often burdensome. Guidelines recommend at least one chest physiotherapy session daily, using various airway clearance techniques (ACTs). Exercise (with huffs and coughs) may offer an alternative ACT, however the willingness of pwCF to be randomised into a trial needs testing. The 'ExACT-CF: Exercise as an Airway Clearance Technique in people with Cystic Fibrosis' trial will test the feasibility of recruiting pwCF to be randomised to continue usual care (chest physiotherapy) or replace it with exercise ACT (ExACT) for 28-days. Secondary aims include determining the short-term clinical impact (and safety) of stopping routine chest physiotherapy and replacing it with ExACT, and effects on physical activity, sleep, mood, quality of life and treatment burden, alongside preliminary health economic measures and acceptability. Methods Multi-centre, two-arm, randomised (1:1 allocation using minimisation), pilot trial at two sites. Fifty pwCF (≥10 years, FEV 1 >40% predicted, stable on Elexacaftor/Tezacaftor/Ivacaftor (ETI)) will be randomised to an individually-customised ExACT programme (≥once daily aerobic exercise of ≥20-minutes duration at an intensity that elicits deep breathing, with huffs and coughs), or usual care. After baseline assessments, secondary outcomes will be assessed after 28-days, with additional home lung function and exacerbation questionnaires at 7, 14 and 21-days, physical activity and sleep monitoring throughout, and embedded qualitative and health-economic components. Feasibility measures include recruitment, retention, measurement completion, adverse events, interviews exploring the acceptability of trial procedures, and a trial satisfaction questionnaire. Discussion Co-designed with the UK CF community, the ExACT-CF pilot trial is the first multi-centre RCT to test the feasibility of recruiting pwCF stable on ETI into a trial investigating ExACT. This pilot trial will inform the feasibility, design, management, likely external validity for progression to a main phase randomised controlled trial. Registration Clinicaltrials.gov ( NCT05482048).
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Affiliation(s)
- Don S. Urquhart
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Steve Cunningham
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Emily Taylor
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
| | | | - Steff Lewis
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Aileen R. Neilson
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Dia Soilemezi
- Department of Psychology, University of Portsmouth, Portsmouth, UK
| | - Naseerah Akooji
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Zoe L. Saynor
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
- Wessex Cystic Fibrosis Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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11
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Audag N, Dubus JC, Combret Y. [Respiratory physiotherapy in pediatric practice]. Rev Mal Respir 2022; 39:547-560. [PMID: 35738979 DOI: 10.1016/j.rmr.2022.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/03/2022] [Indexed: 01/11/2023]
Abstract
Congestion of the upper (URT) and lower respiratory tracts (LRT) is a common symptom in several acute and chronic respiratory diseases that occur in childhood. To eliminate these secretions, airway clearance techniques (ACT) directed to the URT and LRT are frequently prescribed. The rationale for the application of these techniques is the same as in adults, but they need to be adapted to be transposed to children. The physiotherapist will be able to choose among a wide range of techniques, of which the most adequate will depend not only on the age of the child and the indication, but also on the basis of his preferences or habits, as well as those of the child. Upper airway clearance, including nasal irrigation, is now recommended for acute and chronic rhinosinusitis in children. It is also one of the symptomatic treatments recommended for infants with acute bronchiolitis. For LRT clearance, several indications, such as cystic fibrosis, primary ciliary dyskinesia and neuromuscular disease, are now widely advocated. Conversely, other indications, such as for infants with acute viral bronchiolitis, are highly controversial. Thoughtful application of these techniques is lacking in robust and precise tools to objectively assess the presence of bronchial congestion, and to treat it accordingly. Similarly, no precise and reliable evaluation of the effectiveness of these ACTs is available to date. This review is designed to explore the ACTs used by physiotherapists, to provide an overview of their current indications, and to consider complementary approaches.
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Affiliation(s)
- N Audag
- Institut de recherche expérimentale et clinique, pôle de pneumologie, ORL & dermatologie, groupe recherche en kinésithérapie respiratoire, université Catholique de Louvain, Bruxelles, Belgique; Secteur de kinésithérapie et ergothérapie, cliniques universitaires Saint-Luc, avenue Hippocrate 10, Bruxelles 1200, Belgique.
| | - J-C Dubus
- Service de médecine infantile et pneumologie pédiatrique, CHU Timone-Enfants, Marseille, France; Aix-Marseille université, IRD, AP-HM, MEPHI, IHU Méditerranée-infection, Marseille, France
| | - Y Combret
- Secteur de kinésithérapie, Groupe Hospitalier du Havre, 76600 Le Havre, France
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12
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Taheri L, Mirlashari J, Modaresi M, Pederson A. Cough in adolescent with cystic fibrosis, from nightmare to COVID-19 stigma: A qualitative thematic analysis. J Pediatr Nurs 2022; 64:119-125. [PMID: 35279332 PMCID: PMC8906655 DOI: 10.1016/j.pedn.2022.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 02/12/2022] [Accepted: 02/17/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Cough is part of the daily life of patients with Cystic fibrosis (CF) and its most common symptom. This study explored the experiences of adolescents with CF in Iran during the COVID-19 pandemic in relation to their cough. DESIGN AND METHODS In this qualitative study, we conducted 32 semi-structured interviews with 21 adolescents with CF. We analyzed the data thematically. RESULTS We identified three main themes among adolescents with CF in relation to coughing: 1. Cough is a permanent companion; 2. Coughing raises fear of double stigma; 3. Patients' individualized coping strategies to deal with coughing. Participants complained that cough interrupted daily tasks and sleep, drew unwanted attention in public places, and elicited questions about whether they were COVID-19 patients or substance users-both highly stigmatized identities. CONCLUSION Although coughing is a protective mechanism for CF patients, frequent coughing often causes major challenges, particularly during the COVID pandemic, when people were acutely sensitive and aware about coughing. During the COVID-19 pandemic, in addition to taking care of themselves and managing the disease, CF patients therefore had to also overcome issues related to social stigma and isolation. PRACTICE IMPLICATIONS Healthcare workers play an important role in increasing public awareness about CF and its symptoms, including cough. During the pandemic, healthcare workers can help reduce the stigma of coughing through public education. Healthcare workers can actively communicate with patients to identify severe and ineffective cases of cough due to exacerbation of the disease and refer them to a specialist.
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Affiliation(s)
- Leila Taheri
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Jila Mirlashari
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran; Department of OBGYN, Women's Health Research Institute, University of British Columbia, Vancouver, Canada.
| | - Mohammadreza Modaresi
- Pediatric Pulmonary Disease and Sleep Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran; Cystic Fibrosis research center, Iran CF Foundation (ICFF), Tehran, Iran.
| | - Ann Pederson
- Population Health School of Population and Public health, University of British Columbia, British Columbia, Canada.
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13
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Gruet M, Saynor ZL, Urquhart DS, Radtke T. Rethinking physical exercise training in the modern era of cystic fibrosis: A step towards optimising short-term efficacy and long-term engagement. J Cyst Fibros 2021; 21:e83-e98. [PMID: 34493444 DOI: 10.1016/j.jcf.2021.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/18/2021] [Accepted: 08/04/2021] [Indexed: 12/17/2022]
Abstract
Exercise is considered as an important component of the package of care delivered to people with cystic fibrosis (pwCF). However, despite the well-known short-term physiological and psychological benefits, training effects are heterogenous and the transfer of structured exercise programmes to the daily life of pwCF is challenging. Training concepts and strategies developed over the last decades must be adapted to consider the aging population of pwCF with associated comorbidities, and also a new generation of young pwCF that are healthier than ever. In the present review we propose a new framework for optimising the choice among available exercise training procedures and we provide a theoretical and scientifically justified rationale for considering and testing new exercise training modalities. We propose a multidisciplinary approach, considering various physiological, psychological and logistical factors, with the aim to increase effects of exercise training and build positive long-term exercise behaviour.
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Affiliation(s)
- Mathieu Gruet
- IAPS Laboratory, University of Toulon, Toulon, France..
| | - Zoe L Saynor
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Don S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, Scotland, UK.; Department of Child Life and Health, University of Edinburgh, Scotland, UK
| | - Thomas Radtke
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich & University Hospital Zurich, Zurich, Switzerland
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14
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Adami PE, Fitch K. The innovative role of Olympic sports and exercise in the promotion of health, gender equality and sustainability: past achievements and future challenges. J Sports Med Phys Fitness 2021; 61:1042-1051. [PMID: 34156183 DOI: 10.23736/s0022-4707.21.12721-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Olympic sports represent, through their athletes, an iconic source of inspiration and ambition for everyone. During every Olympiad we are reminded of the astonishing achievements that can be reached through hard work and dedication. Nevertheless, these performances are very far from the reality of those being physically active to improve their health and fitness. The technological development that humanity has gone through in the last couple of centuries, has engineered physical activity out of our lives and dramatically altered our lifestyle, leading to the development of diseases that were not so prevalent. Exercise has become an integral part of our lives and it is now regarded as a medicine to prevent and counteract chronic conditions that are associated with a sedentary lifestyle. In this context Olympic sports can play a key role in attracting people to be physically active as well as leveraging on city governments to allow, not only sport participation, but a global active lifestyle. Therefore, International Sports Federations (ISF) have a central position in ensuring sports are in line with the changes occurring in society as well as fostering its natural evolution. Examples of this evolution are gender equality and sustainability, topics that finally are becoming central in ISFs as they have been in society for decades. Therefore, Olympic sports should acknowledge the prominent role they have in society and contribute to its further development by promoting socially relevant actions.
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Affiliation(s)
- Paolo E Adami
- Department of Health and Science, World Athletics, Monaco, Monaco -
| | - Ken Fitch
- School of Human Sciences, Sport, Exercise and Health, University of Western Australia, Crawley, Australia
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15
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Dwyer T. Huff and puff of exercise for airway clearance in cystic fibrosis: how clear is the evidence? Thorax 2021; 76:thoraxjnl-2020-216622. [PMID: 33927019 DOI: 10.1136/thoraxjnl-2020-216622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Tiffany Dwyer
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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