Airway Clearance in COPD: Need for a Breath of Fresh Air? A Systematic Review

Figures & data

Figure 1.  Flow chart of the systematic literature search. Flow of studies through the review. * Papers may have been excluded for failing to meet more than one inclusion criteria.

Figure 2.  Summarized number of CT's found for each technique. PEP: positive expiratory pressure;IMT: inspiratory muscle training; NIV: non-invasive ventilation; PD: postural drainage; Fet: forced expiration technique; IPV: intra pulmonary percussive ventilation; AD: autogenic drainage; ACBT: active cycle of breathing techniques. The numbers represent the number of studies found for each technique.

Table 1.  Overview of studies: Author, year, type of technique used, number of patients, diagnose and outcome parameters

Passive techniques
	Year	Technique	n	Diagnosis	Outcome parameters
Postural drainage vibration and clapping
Singh [11]	2003	pulm rehabilitation (PLB; diaphrag, controlled cough, PD, drain position; limb excercises; ADL adjustments	40	stable COPD	spirometric, 6MWD, CRDQ
Bellone [21]	2000	PD and clapping, flutter and ELTGOL	10	Chron bronchitis	saturation; spirometry sputum weight
Olseni [22]	1994	FET and PD	14	COPD	Lungfunction; radio labelled particles
Moshenifar [23]	1985	clapping and PD	20	COPD	peakflow; lungfunction; saturation; ABG; sputumproduction
Active techniques
Coughing
Bellone [44]	2002	Pep mask and coughing vs coughing alone	30	COPD (hypersecretion and NIPPV)	sputum production; weaningtime; failing of the treatment; FEVI en VC; ABG
Van der Schans [26]	1990	Coughing, FET (on different lungvolumes)	8	emfisema/COPD/normal and decreased elastic recoil	spirometrics; radio active tracers
Forced expiration technique (FET)
Su Chien- Ling [25]	2007	PEP and FET	37	COPD	lungfunction; 6MWD; cough difficulty score; sputum production
Olseni [22]	1994	FET and PD	14	COPD	Lungfunction; radio labelled particles
Van der Schans [26]	1990	Coughing, FET (on different lungvolumes)	8	emfisema/COPD/normal and decreased elastic recoil	lung function radio active tracers
Active cycle of breathing techniques + Autogene drainge
Cesinsa [28]	1999	ACTB	19	COPD	VAS, Sputum collection, Lung function
Scavi [27]	2000	Autogenic drainage and ACBT	30	COPD	lungfunction, 6MWD, Saturation, ABG
Mechanical devices
PEP
Su Chien- Ling [25]	2007	PEP and FET	37	COPD	lungfunction, 6MWD; cough dificulty score; sputum production
Wolkove [29]	2004	flutter	17	COPD	6MWD, borg dyspnea, spirometric
Bellone [44]	2002	Pep mask and coughing vs coughing alone	30	COPD	sputum production; weaningtime; faling of the treatmetn; Lung function; ABG
Wolkove [32]	2002	Flutter and bronchodilatator	23	COPD	lungfucntion, 6MWD, HR
Haidl [30]	2002	cornett and particel deposition	14	COPD	radio isotopes
Cegla [31]	2002	Cornett	50	COPD	lungfunction, sticking to therapy
Bellone [21]	2000	PD and clapping, flutter and ELTGOL	10	Chron bronchitis	saturation, spirometric, sputum weight,
Intrapulmonal Percussive Ventilation
Vargas [35]	2006	IPV	25	COPD with expiratory flow limitation after extubation	mucus collect, gas exchange and RR
Nava [33]	2006	IPV	10	COPD minimal mucus hypersecretion	Saturation, flow, airway pressure, eusophag and gastric pressure, respiratory mechanics, dyn PEEPi, muscle strength
Vargas [34]	2005	IPV	33	COPD excacerbation on ICU	prevention of excacerbations, ABG, RR, Patient comfort, lung function
Non Invasive Ventilation
Vasiliki [37]	2008	non invasive ventilation	58	COPD	spirometeric MRC, dyspnea score, SF-36
Butcher [36]	2007	CPAP and HFCWO	11	COPD and CF and Healty	EELV Oscilating flow rate
Reuveny [39]	2005	excercise and BIPAP	19	COPD	lungfunction, ergo spirometry, expirated fraction O2 and CO2
Bellone [21]	2000	PD and tappotage, flutter and ELTGOL	10	Chron bronchitis	saturation, spirometric, is sputum weight,
Physical activity
Gimminez [43]	2000	aerobic program	7	COPD	Dyspnea, egrospirometric, ABG, Lactate,
Reuveny [39]	2005	inspanning en BIPAP	19	COPD	lungfunction, ergospirometrics, exp fraction O2 en CO2
Magadle R [41]	2007	IMT added to Pulmonary rehab	34	COPD	spirometrics 6MWD, Insp musc strenght, dyspnea,
Kamilla [42]	2008	Muscle reinforcement Lower/upper limbs bronchial Hygiene	22	COPD	atropometrics, spirometric, ergospirometric, dyspnea, distance

PEP, positive expiratory pressure; ACTB, active cycle of breathing; PD, postural drainage; FOT, forced expiration technique; ELTGOL, slow expiration with open glottis in lateral posture; IPV, intrapulmonary pressure ventilation; VC, vital capacity; RR, respiratory rate; CRDQ, Chronic Respiratory Disease Questionnaire; HR, heart rate; SF-36, Short Form (36) Health Survey; EELV, end-expiratory lung volume; Mip, maximal expiratory pressure; NIPPV, non-invasive positive pressure ventilation; VAS, visual analog scale; dyn PEEPi, dynamic intrinsic end-expiratory pressure; HFCWO, high frequency chestwall oscillations; IMT, inspiratory muscle training; Flutter and Cornett, oscillation PEP devices,

Figure 3.  Quality score of the articles using Pedro score; the X-axis represents the score, the Y-axis represents the number of studies for each score.

Butcher SJ, Pasiorowski MP, Jones RL. Effects of changes in lung volume on oscillatory flow rate during high-frequency chest wall oscillation. Can Respir J 2007; 14:153–158.

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