What’s new in airway secretions clearance for adults? A systematic review

Authors

DOI:

https://doi.org/10.15584/ejcem.2021.2.7

Keywords:

bronchial mucus, rehabilitation, respiration

Abstract

Introduction.  Airway clearance techniques are an essential part of routine respiratory physiotherapy, enabling bronchial secretion clearance—the mucus overproduction and retaining results in lung function deterioration and disrupts effective pulmonary rehabilitation. Several mucus clearance methods are included in the physiotherapy daily routine of patients with chronic lung conditions; nevertheless, new techniques and approaches are continuously developed.

Aim. Thus, this systematic review summarizes novel airway clearance techniques applied in patients with chronic pulmonary conditions.

Material and methods. The PubMed, Cochrane Library, and PEDro databases were searched from 2010 to 2021, and studies were selected based on eligibility criteria. 

Analysis of the literature. 101 patients from five studies describing four different techniques were included. Novel techniques were non-invasive ventilation, intrapulmonary percussive ventilation, trachea vibration, and PEP-sound wave combination. Significant improvements were noted for ventilation homogeneity (NIV), saturation (NIV), respiratory rate (IPV), and diffusion capacity (VL), whereas cardiovascular function and exercise endurance did not change significantly. 

Conclusion. The presented methods are considered to have similar effectiveness as well-known airway clearance techniques. However, the systematic use of presented methods in routine pulmonary rehabilitation must be preceded by in-depth investigation to provide no-bias results.

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References

Lee AL, Burge AT, Holland AE. Airway clearance techniques for bronchiectasis. Cochrane Database Syst Rev. 2015;2015(11):CD008351.

Osadnik CR, McDonald CF, Jones AP, Holland AE. Airway clearance techniques for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012;(3):CD008328.

Wilson L, Morrison L, Robinson K. Airway clearance techniques for cystic fibrosis: an overview of Cochrane systematic reviews. Review. Cochrane Database Syst Rev. 2019;(1):CD011231.

Wang Y, Zhang M, Yu Y, Han T, Zhou J, Bi L. Sputum characteristics and airway clearance methods in patients with severe COVID-19. Medicine. 2020;99(46):e23257.

Dwyer T, Daviskas E, Zainuldin R, et al. Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised crossover trial. Eur Respir J. 2019;53(4):1801793.

McIlwaine M, Button B, Nevitt S. Positive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis. Review. Cochrane Database Syst Rev. 2019;11: CD003147.

Pryor J, Tannenbaum E, Scott S, et al. Beyond postural drainage and percussion: Airway clearance in people with cystic fibrosis. Article. J Cyst Fibros. 2010;9(3):187-192.

Warwick WJ, Wielinski CL, Hansen LG. Comparison of expectorated sputum after manual chest physical therapy and high-frequency chest compression. Biomed Instrum Technol. 2004;38(6):470-475.

Thompson B, Thompson H. Forced expiration exercises in asthma and their effect on FEV1. NZJP. 2012;40(2):48.

Lewis L, Williams M, Olds T. The active cycle of breathing technique: A systematic review and meta-analysis. Respiratory Med. 2012;106(2):155-172.

Agostini P, Knowles N. Autogenic drainage: the technique, physiological basis and evidence. Physiotherapy. 2007;93(2):157-163.

Olsen M, Lannefors L, Westerdahl E. Positive expiratory pressure - Common clinical applications and physiological effects. Review. Respiratory Med. 2015;109(3):297-307.

Oberwaldner B, Evans J, Zach M. Forced expirations against a variable resistance - a new chest physiotherapy method in cystic-fibrosis. Pediatr Pulmonol. 1986;2(6):358-367.

Alves L, Pitta F, Brunetto A. Performance analysis of the Flutter VRP1 under different flows and angles. Respir Care. 2008;53(3):316-323.

Simoni L, dos Santos D, de Souza H, Baddini-Martinez J, Santos M, Gastaldi A. Acute Effects of Oscillatory PEP and Thoracic Compression on Secretion Removal and Impedance of the Respiratory System in Non-Cystic Fibrosis Bronchiectasis. Respir Care. 2019;64(7):818-827.

Osman L, Roughton M, Hodson M, Pryor J. Short-term comparative study of high frequency chest wall oscillation and European airway clearance techniques in patients with cystic fibrosis. Thorax. 2010;65(3):196-200.

Agusti A, Vogelmeier C, Faner R. COPD 2020: changes and challenges. Am j physiol lung cell mol physiol. 2020;319(5):L879-L883.

Mendelson M, Nel J, Blumberg L, et al. Long-COVID: An evolving problem with an extensive impact. SAMJ. 2021;111(1):10-12.

Polastri M, Nava S, Clini E, Vitacca M, Gosselink R. COVID-19 and pulmonary rehabilitation: preparing for phase three. Europ Respir J. 2020;55(6):2001822.

Zhao Q, Meng M, Kumar R, et al. The impact of COPD and smoking history on the severity of COVID-19: A systemic review and meta-analysis. J Med Virol. 2020;92(10):1915-1921.

Chapman K, Moffett K. Cystic Fibrosis and COVID-19. Sounth Med J. 2020;113(9):422-422.

Moseley A, Elkins M, Van der Wees P, Pinheiro M. Using research to guide practice: The Physiotherapy Evidence Database (PEDro). Brazilian Journal of Physical Therapy. 2020;24(5):384-391.

Zeng X, Zhang Y, Kwong JS, et al. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta‐analysis, and clinical practice guideline: a systematic review. J Evid Based Med. 2015;8(1):2-10.

Rodriguez Hortal MC, Nygren-Bonnier M, Hjelte L. Non-invasive Ventilation as Airway Clearance Technique in Cystic Fibrosis. Physiother Res Int. 2017;22(3).

Stanford G, Parrott H, Bilton D, Agent P, Banya W, Simmonds N. Randomised cross-over trial evaluating the short-term effects of non-invasive ventilation as an adjunct to airway clearance techniques in adults with cystic fibrosis. BMJ Open Respir Res. 2019;6(1):e000399.

Paneroni M, Clini E, Simonelli C, et al. Safety and Efficacy of Short-Term Intrapulmonary Percussive Ventilation in Patients With Bronchiectasis. Respir Care. 2011;56(7):984-988.

Kamimura M, Kameyama N, Homma C, et al. A new method for enhanced expectoration of sputum by vibratory stimulation of the cervical trachea. Respir Investig. 2017;55(4):276-282.

Wheatley C, Baker S, Daines C, et al. Influence of the Vibralung Acoustical Percussor on pulmonary function and sputum expectoration in individuals with cystic fibrosis. Ther Adv Respir Dis. 2018;12:1753466618770997.

Holland A, Denehy L, Ntoumenopoulos G, Naughton M, Wilson J. Non-invasive ventilation assists chest physiotherapy in adults with acute exacerbations of cystic fibrosis. Thorax. 2003;58(10):880-884.

Reper P, Van Bos R, Van Loey K, Van Laeke P, Vanderkelen A. High frequency percussive ventilation in burn patients: hemodynamics and gas exchange. Burns. 2003;29(6):603-608.

Stock M, Downs J, Corkran M. Pulmonary-function before and after prolonged continuous positive airway pressure by mask. Crit Care Med. 1984;12(11):973-974.

Stanford G, Parrott H, Bilton D, Agent P. Positive pressure-analysing the effect of the addition of non-invasive ventilation (NIV) to home airway clearance techniques (ACT) in adult cystic fibrosis (CF) patients. Physiother Theory Pract. 2015;31(4):270-274.

Hiller K, Morgan C. High-frequency Percussive Ventilation for Severe Inhalation Injury. Anesthesiology. 2014;120(4):998-998.

Toussaint M, Guillet M, Paternotte S, Soudon P, Haan J. Intrapulmonary Effects of Setting Parameters in Portable Intrapulmonary Percussive Ventilation Devices. Respir Care. 2012;57(5):735-742.

Varekojis SM, Douce FH, Flucke RL, et al. A comparison of the therapeutic effectiveness of and preference for postural drainage and percussion, intrapulmonary percussive ventilation, and high-frequency chest wall compression in hospitalized cystic fibrosis patients. Respir Care. 2003;48(1):24-28.

Antonaglia V, Lucangelo U, Zin W, et al. Intrapulmonary percussive ventilation improves the outcome of patients with acute exacerbation of chronic obstructive pulmonary disease using a helmet. Crit Care Med. 2006;34(12):2940-2945.

de Lima L, Duarte J, Neto F, Abe P, Gastaldi A. Mechanical evaluation of a respiratory device. Med Eng Phys. 2005;27(2):181-187.

Hansen L, Warwick W, Hansen K. Mucus transport mechanisms in relation to the effect of high-frequency chest compression (HFCC) on mucus clearance. Pediatr Pulmonol. 1994;17(2):113-118.

Fink JB, Mahlmeister MJ. High-frequency oscillation of the airway and chest wall. Respir Care. 2002;47(7):797-807.

McPeck M, Faarc R. Vibralung acoustical percussor: a new paradigm in airway clearance therapy. Respir Ther. 2014;9:45-47.

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Published

2021-06-30

How to Cite

Kołodziej, M., & Kochman, M. (2021). What’s new in airway secretions clearance for adults? A systematic review. European Journal of Clinical and Experimental Medicine, 19(2), 162–169. https://doi.org/10.15584/ejcem.2021.2.7

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REVIEW PAPERS