title: Short-term effects of three slow expiratory airway clearance techniques in patients with bronchiectasis: a randomised crossover trial.
abstract: OBJECTIVE
  To compare the efficacy of three slow expiratory airway clearance techniques (ACTs).
  
  
  METHODS
  Randomised crossover trial.
  
  
  METHODS
  Tertiary hospital.
  
  
  METHODS
  Thirty-one outpatients with bronchiectasis and chronic sputum expectoration.
  
  
  METHODS
  Autogenic drainage (AD), slow expiration with glottis opened in lateral posture (ELTGOL), and temporary positive expiratory pressure (TPEP).
  
  
  RESULTS
  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.
  
  
  BACKGROUND
  NCT01854788.
authors.affiliation: Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d́Investigacions Biomèdiques August Pi I Sunyer - Centro de Investigación Biomédica En Red-Enfermedades Respiratorias, Barcelona, Spain; Health Sciences Faculty, San Jorge University, Zaragoza, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Herrero-Cortina
authors.affiliation: Health Sciences Faculty Blanquerna, Physiotherapy Research Group, Ramon Llull University, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Vilaró
authors.affiliation: Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d́Investigacions Biomèdiques August Pi I Sunyer - Centro de Investigación Biomédica En Red-Enfermedades Respiratorias, Barcelona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Martí
authors.affiliation: Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d́Investigacions Biomèdiques August Pi I Sunyer - Centro de Investigación Biomédica En Red-Enfermedades Respiratorias, Barcelona, Spain; University of Barcelona, Barcelona, Spain. Electronic address: atorres@clinic.ub.es.
authors.forename: A
authors.initials: A
authors.lastname: Torres
authors.affiliation: Health Sciences Faculty, San Jorge University, Zaragoza, Spain.
authors.forename: M
authors.initials: M
authors.lastname: San Miguel-Pagola
authors.affiliation: Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d́Investigacions Biomèdiques August Pi I Sunyer - Centro de Investigación Biomédica En Red-Enfermedades Respiratorias, Barcelona, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Alcaraz
authors.affiliation: Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d́Investigacions Biomèdiques August Pi I Sunyer - Centro de Investigación Biomédica En Red-Enfermedades Respiratorias, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Polverino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001987:Bronchiectasis / Q000534:rehabilitation*; D003371:Cough; D018592:Cross-Over Studies; D015916:Drainage, Postural / Q000379:methods; D045853:Exhalation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D012129:Respiratory Function Tests; D012138:Respiratory Therapy / Q000379:methods*; D013183:Sputum; D062606:Tertiary Care Centers
keywords: Bronchiectasis; Crossover studies; Mucus; Quality of life; Respiratory therapy