Airway clearance techniques for patients experiencing acute exacerbations of chronic obstructive pulmonary disease in the Republic of Ireland

BACKGROUND AND OBJECTIVES: Airway clearance techniques (ACTs) are used by physiotherapists with the purpose of clearing sputum from bronchial airways. They are commonly prescribed for patients experiencing acute exacerbations of chronic obstructive pulmonary disease (AECOPD), however large variability in practice is commonly observed. This study aimed to explore current physiotherapy practice regarding ACTs for people with AECOPD in the Republic of Ireland. METHOD: An online survey was distributed to physiotherapy clinicians via direct email and the Irish Society of Chartered Physiotherapists. Main survey themes, identified from previous studies using the same survey tool, included current practice in relation to use of ACTs, perception of their effectiveness, clinical reasoning and awareness of the literature and guidelines. For the purpose of this study, ACTs were defined as techniques used by a physiotherapist for the purpose of clearing sputum from patients’ airways. RESULTS: 202 surveys were distributed and seventy responses (35%) were received. The majority of respondents (n = 56, 80%) reported prescribing ACTs for more than 60%of patients with AECOPD, the most common techniques being physical activity (n = 65, 93%) and active cycle of breathing techniques (n = 53, 90%). Sputum management (n = 66, 94%) was the most commonly reported indicator for use of ACTs. The majority of physiotherapists (n = 42, 60%) reported being unsure of the literature regarding ACTs in AECOPD. CONCLUSION: The response rate to this survey was low, however results show that physiotherapists in the Republic of Ireland regularly prescribe ACTs for patients with AECOPD. Physical activity and active cycle of breathing techniques were the most commonly used ACTs and perceived to be the most effective techniques in AECOPD, with sputum management the most commonly reported indicator for use. Further research is required to explore not only physiotherapists clinical reasoning in relation to the use of ACTs for AECOPD and the perceptions of their effectiveness, but also the lack of awareness of the literature and guidelines.

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Assessment Of Physical Activity In Patients Hospitalised With Acute Exacerbations Of Chronic Obstructive Pulmonary Disease (AECOPD)

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a5858 ◽

2012 ◽

Author(s):

Eui-Sik Suh ◽

Choo Chiap Chiau ◽

Maryam Atakhorrami ◽

Patrick Murphy ◽

Nicholas S. Hopkinson ◽

...

Keyword(s):

Physical Activity ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Acute Exacerbations

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Physical Activity and the Frequency of Acute Exacerbations in Patients with Chronic Obstructive Pulmonary Disease

Lung ◽

10.1007/s00408-014-9673-7 ◽

2014 ◽

Vol 193 (1) ◽

pp. 63-70 ◽

Cited By ~ 3

Author(s):

M. Schönmann ◽

N. A. Sievi ◽

C. F. Clarenbach ◽

T. Brack ◽

M. Brutsche ◽

...

Keyword(s):

Physical Activity ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Acute Exacerbations

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Airway clearance techniques for patients with acute exacerbations of chronic obstructive pulmonary disease: Physical therapy practice in Sweden

Chronic Respiratory Disease ◽

10.1177/1479973119855868 ◽

2019 ◽

Vol 16 ◽

pp. 147997311985586 ◽

Cited By ~ 3

Author(s):

Elisabeth Westerdahl ◽

Christian Osadnik ◽

Margareta Emtner

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Physical Therapy ◽

Pulmonary Disease ◽

Physical Therapists ◽

Work Of Breathing ◽

Chronic Obstructive ◽

Treatment Technique ◽

Obstructive Pulmonary Disease ◽

Airway Clearance ◽

Acute Exacerbations

There is considerable global variability in clinical practice regarding the prescription of airway clearance techniques (ACTs) for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Little is known about the physical therapy practice, and no international guidelines are available. The aim of this survey was to identify current physical therapy practice regarding ACT prescription for patients with AECOPD in Sweden. A cross-sectional, descriptive study was conducted via a Web-based questionnaire, sent to all ( n = 70) hospitals that offer physical therapy service for patients with AECOPD in Sweden. Responses were received from 117 physical therapists (76%) across all sites. ACTs were prescribed for more than half of all patients with an AECOPD by 75% of physical therapists. The most frequently used ACTs were positive expiratory pressure (PEP) devices (90%), directed huffing (88%) and cough (71%). Most physical therapists (89%) perceived sputum clearance to be an important aspect of the overall management of patients with AECOPD. The main factors influencing choice of ACT were the ‘degree of dyspnoea or work of breathing’ and ‘access to resources/equipment’. Physical therapists prescribe predominantly PEP-based ACTs for patients with AECOPD in Sweden. Several factors come into consideration that influences the choice of treatment technique.

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A national survey: percussion, vibration, shaking and active cycle breathing techniques used in patients with acute exacerbations of chronic obstructive pulmonary disease

Physiotherapy ◽

10.1016/j.physio.2006.07.003 ◽

2007 ◽

Vol 93 (2) ◽

pp. 110-113 ◽

Cited By ~ 13

Author(s):

Abebaw M. Yohannes ◽

Martin J. Connolly

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

National Survey ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Breathing Techniques ◽

Acute Exacerbations

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Role of the active cycle of breathing technique combined with phonophoresis for the treatment of patients with chronic obstructive pulmonary disease (COPD): study protocol for a preliminary randomized controlled trial

Trials ◽

10.1186/s13063-021-05184-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

M. D. Shen ◽

L. R. Guo ◽

Y. W. Li ◽

R. T. Gao ◽

X. Sui ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Randomized Controlled ◽

Airway Clearance ◽

Breathing Techniques ◽

Sputum Production ◽

Secondary Outcomes

Abstract Background Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease characterized by coughing, the production of excess sputum, and dyspnea. Patients with excessively thick sputum may have frequent attacks or develop more serious disease. The guidelines recommend airway clearance for patients with excessive sputum who are hospitalized with COPD. The active cycle of breathing technique is the most common non-pharmacological airway clearance technique used by physiotherapists. However, the effectiveness of the technique is not always guaranteed. Active cycle of breathing techniques require the initial dilution of the sputum, usually by inhalation drugs, which may have limited effects. Recent studies have found that phonophoresis decreases inflammation, suggesting the potential of the combined usage of active cycle of breathing techniques and phonophoresis. Therefore, the aim of this study is to explore the effectiveness and safety of combining active cycle of breathing technique and phonophoresis in treating COPD patients. Methods and analysis We propose a single-blind randomized controlled trial using 75 hospitalized patients diagnosed with COPD with excessive sputum production. The patients will be divided into three groups. The intervention group will receive active cycle of breathing techniques combined with phonophoresis. The two comparison groups will be treated with active cycle of breathing techniques and phonophoresis, respectively. The program will be implemented daily for 1 week. The primary outcomes will be changes in sputum viscosity and production, lung function, and pulse oximetry. Secondary outcomes include the assessment of COPD and anxiety, measured by the COPD Assessment Test scale and the Anxiety Inventory for Respiratory Disease, respectively; self-satisfaction; the degree of cooperation; and the length of hospital stay. All outcome measures, with the exception of sputum production and additional secondary outcomes, will be assessed at the commencement of the study and after 1 week’s intervention. Analysis of variance will be used to investigate differences between the groups, and a p-value of less than 0.05 (two-tailed) will be considered statistically significant. Discussion This study introduces a combination of active cycle of breathing techniques and phonophoresis to explore the impact of these interventions on patients hospitalized with COPD. If this combined intervention is shown to be effective, it may prove to be a better treatment for patients with COPD. Trial registration The trial was registered prospectively on the Chinese Clinical Trial Registry on 24 December 2019.ClinicalTrials.gov ChiCTR1900028506. Registered on December 2019.

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