Advances in airway clearance technologies for chronic obstructive pulmonary disease

Abstract

Techniques to promote clearance of sputum from the airways (airway clearance techniques; ACTs) have existed in clinical practice for more than a century. This review examines current evidence and clinical recommendations regarding ACTs for individuals with chronic obstructive pulmonary disease. Comparisons between this literature and reports of current practice suggest that discrepancies may exist in relation to the clinical management of sputum in individuals with COPD. The novel application of newer technologies has enhanced our ability to assess the complex physiological processes underpinning airway clearance therapy. The potential for physiologically tailored ACT prescription may, however, depend on the capacity for translation of such technology from the research setting into the clinical environment. Future directions regarding this common form of therapy will be discussed, including identification of the key research priorities to optimize evidence-based practice in this area.

Keywords::

• airway clearance techniques
• airway clearance technology
• bronchopulmonary hygiene
• chronic obstructive pulmonary disease
• sputum

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Current reviews of the literature regarding airway clearance techniques (ACT) effectiveness conclude there is limited clinical value of performing ACTs in individuals with stable COPD or those experiencing an acute exacerbation.

• • Airway clearance techniques are frequently prescribed to enhance sputum clearance for many individuals with chronic obstructive pulmonary disease (COPD), particularly during acute exacerbations. This is despite a lack of convincing support in most of the major international COPD management guidelines.

• • There is discordance between reports of existing clinical practice regarding airway clearance therapy, clinician perceptions of the importance of ACTs and evidence of treatment effectiveness.

• • There have been few recent technological advances relating to the techniques used to clear sputum from the airways.

• • Novel applications of technology such as the forced oscillatory technique, multiple breath nitrogen washouts and real-time imaging to assess the effects of ACTs are emerging. These tests may aid our understanding of the physiological mechanisms underpinning how ACTs work, but do not replace more important outcomes relating to ACT effectiveness.

• • The role of physical exercise as an ACT, particularly during acute exacerbations, has not been thoroughly examined. Given the clinically important benefits associated with performing physical exercise in individuals with COPD, this modality warrants further exploration.

Notes