Abstract
Many patients with cystic fibrosis (CF) and non-CF bronchiectasis present with common
symptoms in clinical domains that appear to benefit from airway clearance strategies.
These symptoms include chronic productive cough, retention of excessive, purulent
mucus in dilated airways, impairment of normal mucociliary clearance (MCC), atelectasis,
breathlessness, fatigue, respiratory inflammation, fever, infection, and airflow obstruction.
Airway clearance strategies may involve singular and focused interventions for the
purpose of removing secretions and improving lung recruitment and gas exchange in
patients with atelectasis. Strategies may also involve indirect or adjunctive interventions
that facilitate or enhance effective airway clearance at different ages or stages
of the disease process, for example, inhalation therapy, exercise, oxygen therapy,
or noninvasive ventilation. The aim is to optimize care by selecting any one or combination
of these in responding intelligently and sensitively to individual and changing patient
requirements during their lifetime. Currently, a solid evidence base does not exist
for airway clearance strategies in CF and non-CF bronchiectasis, and much of airway
clearance clinical practice remains in the domain of clinical expertise. The paucity
of evidence is partly explained by the relatively immature research machinery in allied
health care internationally but is also partly to do with inadequate or inappropriate
research designs. This article aims to provide an overview of the nature of, and physiological
basis for, the direct and indirect airway clearance strategies in CF and non-CF bronchiectasis
with reference to the best available evidence.
Keywords
physiotherapy (techniques) - cystic fibrosis - bronchiectasis - respiratory - breathing
exercises - inhalation therapy - positive pressure respiration - rehabilitation
