title: Are crackles an appropriate outcome measure for airway clearance therapy?
abstract: BACKGROUND
  There is an urgent need to develop new outcome measures for respiratory therapy, to evaluate its effectiveness. Adventitious sounds generated from the lungs (crackles and wheezes), can now be quantified and characterized objectively with computer technology. To our knowledge,  this is the first reported study designed to assess any change in lung crackles before and after a single session of airway clearance therapy.
  
  
  METHODS
  Twenty-three stable bronchiectasis patients were recruited from United Kingdom out-patient clinics and treated with a single session of airway  clearance therapy, using the active cycle of breathing technique. Sound recordings were made before and after the session at 7 anatomical chest locations. Computerized lung sound analysis was used to measure crackle parameters: 2-cycle deflection width (2CD), and crackle number per breath  cycle (nBC). Perceived breathlessness, lung function, and oxygen saturation data were also recorded.
  
  
  RESULTS
  Crackle mean 2CD and mean nBC increased post intervention. Sixteen participants (70%) showed a statistically significant difference in mean crackle 2CD before and after the session  at ≥ 1 chest location. Thirteen (57%) participants had a difference between mean crackle 2CD before and after the intervention > 1 Smallest Real Difference (SRD, mean SRD = 2.23 ms) at ≥ 1 chest location. Differences in mean crackle nBC before and after the intervention did not exceed  the SRD (mean SRD = 32 crackles per breath cycle) in any participant. Perceived breathlessness was significantly reduced post intervention; no significant changes were observed in either lung function or oxygen saturation.
  
  
  CONCLUSIONS
  Crackle duration (2CD) was found to change after a single  session of airway clearance therapy, and shows promise as a new outcome measure for respiratory therapy interventions.
authors.affiliation: School of Health Sciences, University of Aveiro, Campus de Santiago, Aveiro, Portugal. amarques@ua.pt
authors.forename: Alda
authors.initials: A
authors.lastname: Marques
authors.forename: Anne
authors.initials: A
authors.lastname: Bruton
authors.forename: Anna
authors.initials: A
authors.lastname: Barney
authors.forename: Andreia
authors.initials: A
authors.lastname: Hall
mesh_terms: D000328:Adult; D000368:Aged; D001945:Breathing Exercises; D001987:Bronchiectasis / Q000503:physiopathology* / Q000628:therapy*; D004417:Dyspnea / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010366:Peak Expiratory Flow Rate; D012135:Respiratory Sounds; D012138:Respiratory Therapy; D012815:Signal Processing, Computer-Assisted; D013637:Tape Recording; D014797:Vital Capacity