Abstract
Background Airway clearance (AC) is a fundamental component of bronchiectasis care. Lung clearance index (LCI) is a measurement of ventilation inhomogeneity. Its responsiveness to long-term AC is unknown. We aimed to compare two methods of daily AC over four weeks: autogenic drainage (AD) and oscillating positive airway pressure (oPEP), and to to determine effects of AC on LCI and clinical outcomes.
Methods Adults with bronchiectasis naive to airway clearance were randomised to daily AC with either AD or oPEP. Difference in LCI as primary outcome, spirometry, sputum volume and purulence, and quality of life were evaluated at randomisation and after four weeks of AC.
Results Fifty-one patients (32 women, 19 men, mean age 66.2±12.8 years) were randomised and 49 completed the study (25 AD, 24 oPEP). The LCI and forced expiratory volume in the first second (FEV1) did not change between visits between groups (difference between groups 0.02), nor between visits in either group. Sputum quantity decreased in 12/24 (50%) of the oPEP group, and in 6/25 (24%) of the AD group (p=0.044). The “treatment burden” worsened or was unchanged in 70% of participants randomised to AD and 55% randomised to oPEP (p=0.038).
Conclusion Sputum quantity decreased in more participants randomised to oPEP group after one month of daily AC, with a better treatment burden. The effects of four weeks of AC on LCI were not significant in either treatment group.
Footnotes
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Conflict of interest: Dr. Livnat has nothing to disclose.
Conflict of interest: Ms. Yaari has nothing to disclose.
Conflict of interest: Ms. Stein has nothing to disclose.
Conflict of interest: Dr. Bentur has nothing to disclose.
Conflict of interest: Ms. Hanna has nothing to disclose.
Conflict of interest: Ms. Harel has nothing to disclose.
Conflict of interest: Dr. Adir has nothing to disclose.
Conflict of interest: Dr. Shteinberg reports grants from Trudell pharma, during the conduct of the study; grants, personal fees and non-financial support from GSK, grants and personal fees from Novartis, personal fees from Bohringer- Ingelheim, personal fees from Astra Zeneca, personal fees from Kamada, personal fees from Vertex pharmaceuticals, personal fees from Teva, non-financial support from Actelion, grants, personal fees and non-financial support from GSK, grants from Novartis, non-financial support from Rafa, outside the submitted work. Dr. Shteinberg is a member of the EMBARC group
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- Received June 26, 2021.
- Accepted August 25, 2021.
- Copyright ©The authors 2021
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