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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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Nigro M, Laska IF, Traversi L, Simonetta E, Polverino E. Epidemiology of bronchiectasis. Eur Respir Rev 2024; 33:240091. [PMID: 39384303 PMCID: PMC11462313 DOI: 10.1183/16000617.0091-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/05/2024] [Indexed: 10/11/2024] Open
Abstract
Bronchiectasis is a chronic respiratory disease characterised by permanent enlargement of the airways associated with cough, sputum production and a history of pulmonary exacerbations. In the past few years, incidence and prevalence of bronchiectasis have increased worldwide, possibly due to advances in imaging techniques and disease awareness, leading to increased socioeconomic burden and healthcare costs. Consistently, a mortality increase in bronchiectasis patient cohorts has been demonstrated in certain areas of the globe, with mortality rates of 16-24.8% over 4-5 years of follow-up. However, heterogeneity in epidemiological data is consistent, as reported prevalence in the general population ranges from 52.3 to more than 1000 per 100 000. Methodological flaws in the designs of available studies are likely to underestimate the proportion of people suffering from this condition worldwide and comparisons between different areas of the globe might be unreliable due to different assessment methods or local implementation of the same method in different contexts. Differences in disease severity associated with diverse geographical distribution of aetiologies, comorbidities and microbiology might explain an additional quota of heterogeneity. Finally, limited access to care in certain geographical areas is associated with both underestimation of the disease and increased severity and mortality. The aim of this review is to provide a snapshot of available real-world epidemiological data describing incidence and prevalence of bronchiectasis in the general population. Furthermore, data on mortality, healthcare burden and high-risk populations are provided. Finally, an analysis of the geographical distribution of determinants contributing to differences in bronchiectasis epidemiology is offered.
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Affiliation(s)
- Mattia Nigro
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
| | - Irena F Laska
- Department of Respiratory and Sleep Disorders Medicine, Western Health, Footscray, Australia
| | - Letizia Traversi
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBERES, Barcelona, Spain
| | | | - 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
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Cooper L, Johnston K, Williams M. Physiotherapy-led, community-based airway clearance services for people with chronic lung conditions: a retrospective descriptive evaluation of an existing model of care. BMC Health Serv Res 2024; 24:98. [PMID: 38238725 PMCID: PMC10795339 DOI: 10.1186/s12913-024-10550-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVES Airway clearance interventions are recommended for people with chronic lung conditions and mucus hypersecretion, but there are few published models of care or descriptions of airway clearance service provision. This evaluation describes a dedicated, physiotherapy-led, community-based airway clearance service in a metropolitan local health network. DESIGN Retrospective evaluation using existing airway clearance service administrative database. PARTICIPANTS All first referrals to the airway clearance service in a 5-year period (1/1/2017 to 31/12/2021). MAIN OUTCOME MEASURES Available service data grouped into four domains: participant demographics, referral demographics, service provision and outcomes. RESULTS Of the 1335 first referrals eligible for inclusion, 1157 (87%) people attended. Bronchiectasis was the commonest condition (n = 649/1135, 49%). A total of 2996 occasions of service (face to face clinic n = 2108, 70%, phone n = 736, 25%, telehealth n = 99, 3%, home visit n = 53, 2%) were delivered. Airway clearance devices frequently prescribed were the Aerobika (525/1157, 45%), bubble-positive expiratory pressure (263/1157, 23%) and the Acapella (127/1157, 11%). On average, initial appointment with the airway clearance service occurred within 36 days of referral and people attended the service three times. Individuals voluntarily completed both pre/post service questionnaires around a third of the time. At least half of responders reported an improvement in respiratory symptom outcome measures consistent with the minimum clinically important difference. CONCLUSIONS This evaluation describes an airway clearance service as it exists, providing an example from which airway clearance services can be planned, implemented and improved.
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Affiliation(s)
- Laura Cooper
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Allied Health and Human Performance, North Terrace, Adelaide, 5000, Australia.
- Southern Adelaide Local Health Network, Respiratory GP Plus Out of Hospital Services, Noarlunga GP Plus Super Clinic, Alexander Kelly Drive, Adelaide, South Australia, 5168, Australia.
| | - Kylie Johnston
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Allied Health and Human Performance, North Terrace, Adelaide, 5000, Australia
| | - Marie Williams
- Innovation, IMPlementation And Clinical Translation in Health (IIMPACT), University of South Australia, Allied Health and Human Performance, North Terrace, Adelaide, 5000, Australia
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Duprez F, Crombin M, Daubechies I, Devries N, Durant V, El Khalil M, Audag N. [Update on manual bronchial clearance techniques (adults and adolescents)]. Rev Mal Respir 2024; 41:43-50. [PMID: 38057240 DOI: 10.1016/j.rmr.2023.10.006] [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: 09/27/2023] [Accepted: 10/07/2023] [Indexed: 12/08/2023]
Abstract
In adults and teenagers, airway clearance physiotherapy techniques (ACPT) are various and numerous. However, they for still awaiting scientific validation. Among ACPTs, Slow Expiration with the Glottis Opened in the Lateral Posture (ELTGOL), Autogenic Drainage (DA), and Active Cycling Breathing Technique (ACBT) present a Grade B level of evidence with weak recommendations. Even though these maneuvers are widely applied, precise description of chest physiotherapy (CP) is largely absent from the scientific literature; it is difficult to standardize its implementation and reproduce the results; scientific validation and faithful execution of the techniques are consequently problematic. In this paper, the authors aim to depict each of the three CP techniques as precisely as possible; with this in mind, graphic modeling of the different respiratory exercises is presented in such a way that they can be easily learned, applied and reproduced by physiotherapists.
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Affiliation(s)
- F Duprez
- Unité de recherche et d'innovation Condorcet-Epicura (URICE), hôpital Epicura, 63, rue de Mons, 7301 Tournai-Hornu, Belgique; Haute école master en sciences de la motricité, groupe kinésithérapie respiratoire, Condorcet, Tournai, Belgique.
| | - M Crombin
- Haute école master en sciences de la motricité, groupe kinésithérapie respiratoire, Condorcet, Tournai, Belgique
| | - I Daubechies
- Haute école master en sciences de la motricité, groupe kinésithérapie respiratoire, Condorcet, Tournai, Belgique
| | - N Devries
- Haute école master en sciences de la motricité, groupe kinésithérapie respiratoire, Condorcet, Tournai, Belgique
| | - V Durant
- Haute école master en sciences de la motricité, groupe kinésithérapie respiratoire, Condorcet, Tournai, Belgique
| | - M El Khalil
- Haute école master en sciences de la motricité, groupe kinésithérapie respiratoire, Condorcet, Tournai, Belgique
| | - N Audag
- Service de kinésithérapie et ergothérapie, cliniques universitaires Saint-Luc. Bruxelles, Belgique; Institut de recherche expérimentale et clinique (IREC), pôle de pneumologie, ORL et dermatologie, groupe de recherche en kinésithérapie respiratoire, université catholique de Louvain, Bruxelles, Belgique
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Goolam Mahomed A, Maasdorp SD, Barnes R, van Aswegen H, Lupton-Smith A, Allwood B, Calligaro G, Feldman C, Kalla IS. South African Thoracic Society position statement on the management of non-cystic fibrosis bronchiectasis in adults: 2023. Afr J Thorac Crit Care Med 2023; 29:10.7196/AJTCCM.2023.v29i2.647. [PMID: 37638142 PMCID: PMC10450449 DOI: 10.7196/ajtccm.2023.v29i2.647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/10/2023] [Indexed: 08/29/2023] Open
Abstract
Background Bronchiectasis is a chronic lung disorder that affects the lives of many South Africans. Post-tuberculosis (TB) bronchiectasis is an important complication of previous pulmonary TB and a common cause of bronchiectasis in South Africa (SA). No previous statements on the management of bronchiectasis in SA have been published. Objectives To provide a position statement that will act as a template for the management of adult patients with bronchiectasis in SA. Methods The South African Thoracic Society appointed an editorial committee to compile a position statement on the management of adult non-cystic fibrosis (CF) bronchiectasis in SA. Results A position statement addressing the management of non-CF bronchiectasis in adults in SA was compiled. This position statement covers the epidemiology, aetiology, diagnosis, investigations and various aspects of management of adult patients with non-CF bronchiectasis in SA. Conclusion Bronchiectasis has largely been a neglected lung condition, but new research has improved the outlook for patients. Collaboration between interprofessional team members in patient management is important. In SA, more research into the epidemiology of bronchiectasis, especially post-TB bronchiectasis and HIV-associated bronchiectasis, is required. Abstract The South African Thoracic Society mandated a multidisciplinary team of healthcare providers to compile a position statement on the management of non-cystic fibrosis bronchiectasis in South Africa (SA). International guidelines on the management of bronchiectasis were reviewed and used as a basis from which the current position statement was compiled. This is the first position statement on the management of adult non-cystic fibrosis bronchiectasis in SA. A description of the epidemiology and aetiology of bronchiectasis is provided, as well as guidance on its diagnosis and management. The position statement provides guidance on the management of bronchiectasis to healthcare providers, policymakers and regulatory authorities.
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Affiliation(s)
| | - S D Maasdorp
- Division of Pulmonology and Critical Care, Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein,
South Africa
| | - R Barnes
- Department of Physiotherapy, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - H van Aswegen
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A Lupton-Smith
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - B Allwood
- Division of Pulmonology, Department of Internal Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - G Calligaro
- Division of Pulmonology, Department of Internal Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - C Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - I S Kalla
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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6
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Schofield LM, Singh SJ, Yousaf Z, Wild JM, Hind D. Personalising airway clearance in chronic suppurative lung diseases: a scoping review. ERJ Open Res 2023; 9:00010-2023. [PMID: 37342087 PMCID: PMC10277870 DOI: 10.1183/23120541.00010-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/14/2023] [Indexed: 06/22/2023] Open
Abstract
Background Personalised airway clearance techniques are commonly recommended to augment mucus clearance in chronic suppurative lung diseases. It is unclear what current literature tells us about how airway clearance regimens should be personalised. This scoping review explores current research on airway clearance technique in chronic suppurative lung diseases, to establish the extent and type of guidance in this area, identify knowledge gaps and determine the factors which physiotherapists should consider when personalising airway clearance regimens. Methods Systematic searching of online databases (MEDLINE, EMBASE, CINAHL, PEDro, Cochrane, Web of Science) was used to identify full-text publications in the last 25 years that described methods of personalising airway clearance techniques in chronic suppurative lung diseases. Items from the TIDieR framework provided a priori categories which were modified based on the initial data to develop a "Best-fit" framework for data charting. The findings were subsequently transformed into a personalisation model. Results A broad range of publications were identified, most commonly general review papers (44%). The items identified were grouped into seven personalisation factors: physical, psychosocial, airway clearance technique (ACT) type, procedures, dosage, response and provider. As only two divergent models of ACT personalisation were found, the personalisation factors identified were then used to develop a model for physiotherapists. Conclusions The personalisation of airway clearance regimens is widely discussed in the current literature, which provides a range of factors that should be considered. This review summarises the current literature, organising findings into a proposed airway clearance personalisation model, to provide clarity in this field.
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Affiliation(s)
- Lynne M. Schofield
- Faculty of Medicine Dentistry and Health, IICD, University of Sheffield, Sheffield, UK
- Paediatric Physiotherapy, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sally J. Singh
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Zarah Yousaf
- Patient and Public Involvement Member, Leeds Teaching Hospitals NHS Trust, UK
| | - Jim M Wild
- Faculty of Medicine Dentistry and Health, IICD, University of Sheffield, Sheffield, UK
| | - Daniel Hind
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Franks LJ, Walsh JR, Hall K, Adsett JA, Morris NR. Physiotherapist perspectives of airway clearance techniques in bronchiectasis. Physiother Theory Pract 2023; 39:785-793. [PMID: 35086432 DOI: 10.1080/09593985.2022.2028326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Our understanding regarding the personalization of airway clearance techniques (ACTs) in bronchiectasis is limited. OBJECTIVE This study aimed to determine physiotherapist perceptions regarding the prescription of ACTs in inpatients and outpatients with bronchiectasis. METHODS A single-center qualitative study using semi-structured interviews of physiotherapists who treated individuals with bronchiectasis was undertaken. All interviews were audio recorded and transcribed verbatim. Data was analyzed using the thematic framework approach described by Braun and Clark. NVivo 12 software assisted with coding and thematic analysis of the interview transcripts. Findings were summarized into major conceptual themes. Participant demographic data was also obtained. RESULTS Eleven physiotherapists participated in the interviews. Central to all themes was the complexity of physiotherapy clinical decision-making regarding ACT prescription. Main themes included: organizational factors (i.e. workload, scope of service, access to resources/ACTs); patient-related factors (i.e. symptom severity, finances, disease-specific knowledge, social commitments, clinical setting, and perceived benefit); and physiotherapist/profession-related factors (i.e. clinical experience, access to professional support and education, awareness of evidence of ACTs, and evaluating ACT effectiveness). CONCLUSION Physiotherapists regularly and routinely prescribe ACTs for individuals with bronchiectasis allowing for a multitude of competing factors. These factors should be considered by physiotherapists to enhance the personalized prescription of ACTs and may help promote patient adherence to ACTs to improve outcomes.
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Affiliation(s)
- Lisa J Franks
- Physiotherapy Department, Prince Charles Hospital, Chermside, Australia
- School of Allied Health Sciences, Griffith University, Southport, Australia
| | - James R Walsh
- Physiotherapy Department, Prince Charles Hospital, Chermside, Australia
- School of Allied Health Sciences, Griffith University, Southport, Australia
- Heart Lung Institute, Prince Charles Hospital, Chermside, Australia
| | - Kathleen Hall
- Physiotherapy Department, Prince Charles Hospital, Chermside, Australia
- Physiotherapy, School of Allied Health, Australian Catholic University, Banyo, Australia
| | - Julie A Adsett
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Norman R Morris
- School of Allied Health Sciences, Griffith University, Southport, Australia
- Heart Lung Institute, Prince Charles Hospital, Chermside, Australia
- Metro North Hospital and Health Service, Prince Charles Hospital, Allied Health Research Collaborative, Chermside, Australia
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8
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Hamzeh H, Spencer S, Kelly C, Pilsworth S. Evaluation of outcome reporting in clinical trials of physiotherapy in bronchiectasis: The first stage of core outcome set development. PLoS One 2023; 18:e0282393. [PMID: 36928192 PMCID: PMC10019700 DOI: 10.1371/journal.pone.0282393] [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: 10/11/2022] [Accepted: 02/13/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION The aim of this study is to explore outcomes currently reported in physiotherapy trials for bronchiectasis and investigate the level of consistency in outcome reporting. This mapping of outcomes will be used to inform the development of a core outcome set (COS) for physiotherapy research in bronchiectasis. Outcomes reported in randomised clinical trials (RCTs) and RCT protocols were reviewed and evaluated. We included trials with physiotherapy as the main intervention, including pulmonary rehabilitation, exercise prescription, airway clearance, positive expiratory pressure devices, breathing training, self-management plans, and home exercise program. Medline, CINAHL, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and the physiotherapy evidence database (PEDro) were searched from inception using a prespecified search strategy. Records including adult patients with bronchiectasis were included. Outcomes were listed verbatim and categorised into domains based on a pre-specified system, frequency of reporting and sources of variation were inspected. RESULTS Of 2158 abstracts screened, 37 trials (1202 participants) and 17 trial protocols were identified. Eighteen different physiotherapy techniques were investigated. A total of 331 outcomes were reported. No single outcome was reported by all trials. The most reported outcomes were lung function (27 trials, 50%), health related quality of life (26 trials, 48.1%), and dyspnoea (18 trials, 33.3%). A list of 104 unique outcomes covering 23 domains was created. Trials focus on physiological outcomes, mainly those related to respiratory system functions. Outcomes related to functioning and life impact are often neglected. CONCLUSION Outcome reporting in physiotherapy research for bronchiectasis was found to be inconsistent in terms of choosing and defining outcomes. Developing a core outcome set in this area of research is needed to facilitate aggregation of future trial results in systematic reviews that will in turn inform the strength of evidence for the effectiveness of physiotherapy. Outcome choice should include all stakeholders, including patients. TRIAL REGISTRATION This study is registered in the PROSPERO registry under the number CRD42021266247.
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Affiliation(s)
- Hayat Hamzeh
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Sally Spencer
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, United Kingdom
- Cardio-Respiratory Research Centre, Edge Hill University, Ormskirk, Lancashire, United Kingdom
- Health Research Institute, Edge Hill University, Ormskirk, Lancashire, United Kingdom
| | - Carol Kelly
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, United Kingdom
- Cardio-Respiratory Research Centre, Edge Hill University, Ormskirk, Lancashire, United Kingdom
| | - Samantha Pilsworth
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, United Kingdom
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Pan CX, Shi MX, Guan WJ. Airway clearance technique in the modern era of bronchiectasis management. ERJ Open Res 2023; 9:00674-2022. [PMID: 36949966 PMCID: PMC10025999 DOI: 10.1183/23120541.00674-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 03/24/2023] Open
Abstract
There is a need and further room to strengthen airway clearance among patients with bronchiectasis in the modern era of clinical management https://bit.ly/3V5h5by.
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Affiliation(s)
- Cui-Xia Pan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- These authors contributed equally
| | - Ming-Xin Shi
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- These authors contributed equally
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Thoracic Surgery, Guangzhou Institute for Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Respiratory and Critical Care Medicine, Foshan Second People's Hospital, Affiliated Foshan Hospital of Southern Medical University, Foshan, China
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10
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McLeese RH, O'Neill K, O'Neill B, Chalmers JD, Boyd J, De Soyza A, McChrystal R, Crichton ML, Bradley JM. Airway clearance treatments in bronchiectasis: feasibility of linking survey results to registry data and a survey of patients' and physiotherapists' practices. ERJ Open Res 2023; 9:00540-2022. [PMID: 36949967 PMCID: PMC10026005 DOI: 10.1183/23120541.00540-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
Background and objective There are limited data on airway clearance treatment (ACT) practices. This study aimed to: 1) assess the feasibility of collecting online surveys on ACTs from patients and physiotherapists and linking the patient survey data to outcome data in the Bronch-UK/EMBARC Registry; 2) assess the association between ACT practices and outcome data; and 3) ascertain the factors affecting physiotherapist ACT practices. Methods Survey methodology was used to collect data from patients with bronchiectasis and physiotherapists in Northern Ireland. Associations between patient survey data and linked Bronch-UK/EMBARC Registry patient outcome data were explored. Results It was feasible to conduct an online survey with patients with bronchiectasis and link the data to the Bronch-UK/EMBARC Registry. 13% of patients did not perform ACTs. ACTs were used more often by patients who were symptomatic/had more severe disease compared to those with milder symptoms/disease. Patients used ACTs when they were symptomatic rather than as a preventative management strategy. Physiotherapists generally followed the bronchiectasis guidelines, using the stepwise approach to management. Conclusion Our survey provided information about the feasibility of linking online survey and patient registry data. This study provides up-to-date information on ACT practice throughout the course of the disease trajectory as well as insight into the implementation of bronchiectasis guidelines by physiotherapists. Future work should explore how to optimise ACT data collection to maximise the use of real-world ACT data in bronchiectasis research and inform priority ACT research questions.
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Affiliation(s)
- Rebecca H. McLeese
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
- These authors contributed equally
| | - Katherine O'Neill
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
- These authors contributed equally
| | - Brenda O'Neill
- Centre for Health and Rehabilitation Technologies, Ulster University, Coleraine, UK
| | - James D. Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | | | | | - Ryan McChrystal
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Megan L. Crichton
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Judy M. Bradley
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
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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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O’Donnell AE. Airway Clearance and Mucoactive Therapies in Bronchiectasis. Clin Chest Med 2022; 43:157-163. [DOI: 10.1016/j.ccm.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hamzeh H, Spencer S, Kelly C. Development of a core outcome set and outcome measurement set for physiotherapy trials in adults with Bronchiectasis (COS-PHyBE study): A protocol. PLoS One 2022; 17:e0263695. [PMID: 35134099 PMCID: PMC8824374 DOI: 10.1371/journal.pone.0263695] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background Bronchiectasis is a chronic respiratory disease characterised by airways widening and recurrent infections, resulting in episodes of chronic cough, sputum expectoration, and dyspnoea. This leads to deterioration in daily function, repeated hospital admissions and poor quality of life. The prevalence and mortality related to bronchiectasis is increasing worldwide with growing economic burden on healthcare systems. Physiotherapy for bronchiectasis aims to decrease accumulation of sputum, dyspnoea, and improve exercise capacity and daily function. A robust evidence base to support physiotherapy in bronchiectasis is currently lacking. This is partly because of inconsistency and poor reporting of outcomes in available studies. A core outcome set is the minimum acceptable group of outcomes that should be used in clinical trials for a specific condition. This decreases research waste by improving consistency and reporting of key outcomes and facilitates the synthesis of study outcomes in systematic reviews and guidelines. The aim of the study is therefore to develop a core outcome set and outcome measurement set for physiotherapy research in adults with bronchiectasis. This will ensure outcomes important to key stakeholders are consistently used and reported in future research. Methods and analysis This project will use the COMET Initiative and COSMIN guidelines of core outcome set development and will include three phases. In the first phase, a comprehensive list of outcomes will be developed using systematic review of reported outcomes and qualitative interviews with patients and physiotherapists. Then consensus on key outcomes will be established in phase two using a Delphi survey and a consensus meeting. Finally, in phase three, we will identify appropriate instruments to measure the core outcomes by evaluating the psychometric properties of available instruments and a stakeholders’ meeting to establish consensus. Ethics The study was reviewed and has received ethical approval from the health-related Research Ethics Committee- Edge Hill University (ETH2021-0217). Registration This study is registered with the COMET database. https://www.comet-initiative.org/Studies/Details/1931. The full systematic review protocol is registered in PROSPERO under the number CRD42021266247.
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Affiliation(s)
- Hayat Hamzeh
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, United Kingdom
- * E-mail:
| | - Sally Spencer
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, United Kingdom
- Respiratory Research Centre, Edge Hill University, Ormskirk, Lancashire, United Kingdom
- Health Research Institute, Edge Hill University, Ormskirk, Lancashire, United Kingdom
| | - Carol Kelly
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, United Kingdom
- Respiratory Research Centre, Edge Hill University, Ormskirk, Lancashire, United Kingdom
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Vidaillac C, Chotirmall SH. Pseudomonas aeruginosa in bronchiectasis: infection, inflammation, and therapies. Expert Rev Respir Med 2021; 15:649-662. [PMID: 33736539 DOI: 10.1080/17476348.2021.1906225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Bronchiectasis is a chronic endobronchial suppurative disease characterized by irreversibly dilated bronchi damaged by repeated polymicrobial infections and predominantly, neutrophilic airway inflammation. Some consider bronchiectasis a syndromic consequence of several different causes whilst others view it as an individual disease entity. In most patients, identifying an underlying cause remains challenging. The acquisition and colonization of affected airways by Pseudomonas aeruginosa represent a critical and adverse clinical consequence for its progression and management.Areas covered: In this review, we outline clinical and pre-clinical peer-reviewed research published in the last 5 years, focusing on the pathogenesis of bronchiectasis and the role of P. aeruginosa and its virulence in shaping host inflammatory and immune responses in the airway. We further detail its role in airway infection, the lung microbiome, and address therapeutic options in bronchiectasis.Expert opinion: P. aeruginosa represents a key pulmonary pathogen in bronchiectasis that causes acute and/or chronic airway infection. Eradication can prevent adverse clinical consequence and/or disease progression. Novel therapeutic strategies are emerging and include combination-based approaches. Addressing airway infection caused by P. aeruginosa in bronchiectasis is necessary to prevent airway damage, loss of lung function and exacerbations, all of which contribute to adverse clinical outcome.
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Affiliation(s)
- Celine Vidaillac
- Oxford University Clinical Research Unit, University of Oxford, Ho Chi Minh City, Vietnam.,Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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