title: Airway clearance in bronchiectasis: a randomized crossover trial of active cycle of breathing techniques versus Acapella.
abstract: BACKGROUND
  The efficacy of a new airway clearance device (Acapella) has not been previously investigated. Active cycle of breathing techniques (ACBT) is the standard airway clearance technique used in patients with bronchiectasis.
  
  
  OBJECTIVE
  The objective of this study was to compare the efficacy of ACBT with Acapella as methods of airway clearance in adults with stable, productive bronchiectasis.
  
  
  METHODS
  Twenty patients (7 males), age 58 +/- 11 years (mean +/- SD), FEV1 64 +/- 22% predicted with stable (change of not greater than FEV1 10% predicted during 3 months prior to study), productive (history of expectoration of half an egg cup sputum/day) bronchiectasis attended the respiratory clinic on 3 days. Day 1: 40-min training session on ACBT and Acapella. Days 2 and 3: 30-min treatment session of either ACBT or Acapella. Treatment order was determined by a concealed randomization procedure. The following outcomes were measured before and after treatment spirometry, SpO2 and breathlessness by an independent assessor who was blinded to treatment order. Weight of sputum (during treatment plus 30 min after treatment), number of coughs and patient preference were also recorded.
  
  
  RESULTS
  No significant differences were found at baseline indicating that patients were stable. No significant differences were found between weight of sputum expectorated with ACBT treatment and weight of sputum expectorated with Acapella treatment--mean difference 0.54 g (95% CI -0.39 to 1.46). A greater proportion of patients preferred Acapella (14/20).
  
  
  CONCLUSIONS
  Acapella is as effective a method of airway clearance as ACBT and may offer a user-friendly alternative to ACBT for patients with bronchiectasis.
authors.affiliation: Health and Rehabilitation Sciences Research Institute, University of Ulster, Newtownabbey, Northern Ireland, UK.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Patterson
authors.forename: Judy M
authors.initials: JM
authors.lastname: Bradley
authors.forename: Oonagh
authors.initials: O
authors.lastname: Hewitt
authors.forename: Ian
authors.initials: I
authors.lastname: Bradbury
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Elborn
mesh_terms: D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000628:therapy*; D001987:Bronchiectasis / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012129:Respiratory Function Tests; D012138:Respiratory Therapy / Q000295:instrumentation* / Q000379:methods*; D013183:Sputum / Q000378:metabolism; D016896:Treatment Outcome