Herrero-Cortina B, Vilaró J, Martí D, Torres A, San Miguel-Pagola M, Alcaraz V, Polverino E.

Link to publication page: http://www.ncbi.nlm.nih.gov/pubmed/26712530

Journal Ref: Physiotherapy. 2015 Dec 1. pii: S0031-9406(15)03852-3. doi: 10.1016/j.physio.2015.07.005. [

Abstract:

OBJECTIVE:

To compare the efficacy of three slow expiratory airway clearance techniques (ACTs).

DESIGN:

Randomised crossover trial.

SETTING:

Tertiary hospital.

PARTICIPANTS:

Thirty-one outpatients with bronchiectasis and chronic sputum expectoration.

INTERVENTIONS:

Autogenic drainage (AD), slow expiration with glottis opened in lateral posture (ELTGOL), and temporary positive expiratory pressure (TPEP).

MAIN OUTCOMES:

Sputum expectoration during each session (primary endpoint) and in the 24-hour period after each session. Leicester Cough Questionnaire (LCQ) score and spirometry results were recorded at the beginning and after each week of treatment. Data were summarised as median difference [95% confidence interval (CI)].

RESULTS:

Median (interquartile range) daily expectoration at baseline was 21.1 (15.3 to 35.6)g. During physiotherapy sessions, AD and ELTGOL expectorated more sputum than TPEP [AD vs TPEP 3.1g (95% CI 1.5 to 4.8); ELTGOL vs TPEP 3.6g (95% CI 2.8 to 7.1)], while overall expectoration in the 24-hour period after each session was similar for all techniques (P=0.8). Sputum clearance at 24hours post-intervention was lower than baseline assessment for all techniques [AD vs baseline -10.0g (95% CI -15.0 to -6.8); ELTGOL vs baseline -9.2g (95% CI -14.2 to -7.9); TPEP vs baseline -6.0g (95% CI -12.0 to -6.1)]. The LCQ score increased with all techniques (AD 0.5, 95% CI 0.1 to 0.5; ELTGOL 0.9, 95% CI 0.5 to 2.1; TPEP 0.4, 95% CI 0.1 to 1.2), being similar for all ACTs (P=0.6). No changes in lung function were observed.

CONCLUSIONS:

Slow expiratory ACTs enhance mucus clearance during treatment sessions, and reduce expectoration for the rest of the day in patients with bronchiectasis.