TY - JOUR
T1 - Airway Clearance Techniques in Bronchiectasis
T2 - Analysis From the United States Bronchiectasis and Non-TB Mycobacteria Research Registry
AU - Basavaraj, Ashwin
AU - Choate, Radmila
AU - Addrizzo-Harris, Doreen
AU - Aksamit, Timothy R.
AU - Barker, Alan
AU - Daley, Charles L.
AU - Anne Daniels, M. Leigh
AU - Eden, Edward
AU - DiMango, Angela
AU - Fennelly, Kevin
AU - Griffith, David E.
AU - Johnson, Margaret M.
AU - Knowles, Michael R.
AU - Metersky, Mark L.
AU - Noone, Peadar G.
AU - O'Donnell, Anne E.
AU - Olivier, Kenneth N.
AU - Salathe, Matthias A.
AU - Schmid, Andreas
AU - Thomashow, Byron
AU - Tino, Gregory
AU - Winthrop, Kevin L.
N1 - Publisher Copyright:
© 2020 American College of Chest Physicians
PY - 2020/10
Y1 - 2020/10
N2 - Background: In patients with bronchiectasis, airway clearance techniques (ACTs) are important management strategies. Research Question: What are the differences in patients with bronchiectasis and a productive cough who used ACTs and those who did not? What was the assessment of bronchiectasis exacerbation frequency and change in pulmonary function at 1-year follow up? Study Design and Methods: Adult patients with bronchiectasis and a productive cough in the United States Bronchiectasis and NTM Research Registry were included in the analyses. ACTs included the use of instrumental devices and manual techniques. Stratified analyses of demographic and clinical characteristics were performed by use of ACTs at baseline and follow up. The association between ACT use and clinical outcomes was assessed with the use of unadjusted and adjusted multinomial logistic regression models. Results: Of the overall study population (n = 905), 59% used ACTs at baseline. A greater proportion of patients who used ACTs at baseline and follow up continuously had Pseudomonas aeruginosa (47% vs 36%; P =.021) and experienced an exacerbation (81% vs 59%; P <.0001) or hospitalization for pulmonary illness (32% vs 22%; P =.001) in the prior two years, compared with those patients who did not use ACTs. Fifty-eight percent of patients who used ACTs at baseline did not use ACTs at 1-year follow up. There was no significant change in pulmonary function for those who used ACTs at follow up, compared with baseline. Patients who used ACTs at baseline and follow up had greater odds for experiencing exacerbations at follow up compared with those patients who did not use ACTs. Interpretation: In patients with bronchiectasis and a productive cough, ACTs are used more often if the patients have experienced a prior exacerbation, hospitalization for pulmonary illness, or had P aeruginosa. There is a significant reduction in the use of ACTs at 1-year follow up. The odds of the development of a bronchiectasis exacerbation are higher in those patients who use ACTs continuously, which suggests more frequent use in an ill bronchiectasis population.
AB - Background: In patients with bronchiectasis, airway clearance techniques (ACTs) are important management strategies. Research Question: What are the differences in patients with bronchiectasis and a productive cough who used ACTs and those who did not? What was the assessment of bronchiectasis exacerbation frequency and change in pulmonary function at 1-year follow up? Study Design and Methods: Adult patients with bronchiectasis and a productive cough in the United States Bronchiectasis and NTM Research Registry were included in the analyses. ACTs included the use of instrumental devices and manual techniques. Stratified analyses of demographic and clinical characteristics were performed by use of ACTs at baseline and follow up. The association between ACT use and clinical outcomes was assessed with the use of unadjusted and adjusted multinomial logistic regression models. Results: Of the overall study population (n = 905), 59% used ACTs at baseline. A greater proportion of patients who used ACTs at baseline and follow up continuously had Pseudomonas aeruginosa (47% vs 36%; P =.021) and experienced an exacerbation (81% vs 59%; P <.0001) or hospitalization for pulmonary illness (32% vs 22%; P =.001) in the prior two years, compared with those patients who did not use ACTs. Fifty-eight percent of patients who used ACTs at baseline did not use ACTs at 1-year follow up. There was no significant change in pulmonary function for those who used ACTs at follow up, compared with baseline. Patients who used ACTs at baseline and follow up had greater odds for experiencing exacerbations at follow up compared with those patients who did not use ACTs. Interpretation: In patients with bronchiectasis and a productive cough, ACTs are used more often if the patients have experienced a prior exacerbation, hospitalization for pulmonary illness, or had P aeruginosa. There is a significant reduction in the use of ACTs at 1-year follow up. The odds of the development of a bronchiectasis exacerbation are higher in those patients who use ACTs continuously, which suggests more frequent use in an ill bronchiectasis population.
KW - airway clearance technique
KW - bronchiectasis
KW - sputum
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U2 - 10.1016/j.chest.2020.06.050
DO - 10.1016/j.chest.2020.06.050
M3 - Article
C2 - 32622820
AN - SCOPUS:85091381304
SN - 0012-3692
VL - 158
SP - 1376
EP - 1384
JO - Chest
JF - Chest
IS - 4
ER -