Airway Clearance Techniques in Bronchiectasis: Analysis From the United States Bronchiectasis and Non-TB Mycobacteria Research Registry

Ashwin Basavaraj, Radmila Choate, Doreen Addrizzo-Harris, Timothy R. Aksamit, Alan Barker, Charles L. Daley, M. Leigh Anne Daniels, Edward Eden, Angela DiMango, Kevin Fennelly, David E. Griffith, Margaret M. Johnson, Michael R. Knowles, Mark L. Metersky, Peadar G. Noone, Anne E. O'Donnell, Kenneth N. Olivier, Matthias A. Salathe, Andreas Schmid, Byron ThomashowGregory Tino, Kevin L. Winthrop

Research output: Contribution to journalArticlepeer-review

9 Citations (SciVal)

Abstract

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.

Original languageEnglish
Pages (from-to)1376-1384
Number of pages9
JournalChest
Volume158
Issue number4
DOIs
StatePublished - Oct 2020

Bibliographical note

Funding Information:
FUNDING/SUPPORT: This study was funded by the United States Bronchiectasis and NTM research registry, which is funded by the Richard H. Scarborough Bronchiectasis Research Fund, the Anna-Maria and Stephen Kellen Foundation, and the Bronchiectasis and NTM Industry Advisory Committee. This manuscript is also supported in part by the intramural research program at the National Heart, Lung, and Blood Institute , and the National Institutes of Health .

Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: D. A.-H. has served on a research protocol advisory board for AIT Therapeutics and has served in an educational lecture series sponsored by Insmed. T. R. A. has participated in clinical trials sponsored by Bayer , Aradigm, Zambon, and Insmed but has not received any personal or research support. A. Barker has received grant support from COPD Foundation for participation in the Bronchiectasis and NTM Research Registry. A. Basavaraj has received grant support from COPD Foundation for participation in the Bronchiectasis and NTM Research Registry and has served on the advisory board and consultant for Insmed and as a consultant for Hill-Rom. C. L. D. has received grant support from COPD Foundation and Insmed. M. L. A. D. has served on Speaker Bureau/Advisory Boards for Spark Partners and Insmed and participated in clinical trials for Zambon and Parion/Vertex. M. L. M. has received grant support from COPD Foundation. P. G. N. has received grant support from Aradigm/Grifols, Insmed, Parion/ Vertex and Bayer, and consultancy fees from Bayer, Grifols, and Smartvest. A. E. O. has received grant support from Parion, Insmed, Aradigm, Grifols, and COPD Foundation. K. N. O. has a Cooperative Research and Development Award with AIT Therapeutics (Beyond Air) and Matinas Biopharma and has participated on advisory panels with Insmed, Inc. M. A. S. has received grant support from COPD Foundation, Parion, Bayer Healthcare, and Aradigm. B. T. has received personal fees for serving on advisory boards for GlaxoSmithKline and AstraZeneca and helped cofound the COPD Foundation and served as the Foundation’s Board Chairman for ten years. G. T. has received grant support from the COPD Foundation for participation in the Bronchiectasis and NTM Research Registry and has received personal fees for serving on Advisory Boards for Bayer, Grifols, Aradigm, and Cipla. K. L. W. has received grant support and personal fees from Insmed and Bayer. None declared (R. C., A. D., E. E., K. F., D. E. G., M. M. J., M. R. K., A. S.).

Funding Information:
FUNDING/SUPPORT: This study was funded by the United States Bronchiectasis and NTM research registry, which is funded by the Richard H. Scarborough Bronchiectasis Research Fund, the Anna-Maria and Stephen Kellen Foundation, and the Bronchiectasis and NTM Industry Advisory Committee. This manuscript is also supported in part by the intramural research program at the National Heart, Lung, and Blood Institute, and the National Institutes of Health.Author contributions: A. Basavaraj had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. A. Basavaraj, D. A.-H. T. R. A. A. Barker, R. C. C. L. D. M. L. A. D. A. D. E. E. K. F. D. E. G. M. M. J. M. R. K. M. L. M. P. G. N. A. E. O. K. N. O. M. A. S. A. S. B. T. G. T. and K. L. W. contributed substantially to the study design, data analysis and interpretation, and writing of the manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: D. A.-H. has served on a research protocol advisory board for AIT Therapeutics and has served in an educational lecture series sponsored by Insmed. T. R. A. has participated in clinical trials sponsored by Bayer, Aradigm, Zambon, and Insmed but has not received any personal or research support. A. Barker has received grant support from COPD Foundation for participation in the Bronchiectasis and NTM Research Registry. A. Basavaraj has received grant support from COPD Foundation for participation in the Bronchiectasis and NTM Research Registry and has served on the advisory board and consultant for Insmed and as a consultant for Hill-Rom. C. L. D. has received grant support from COPD Foundation and Insmed. M. L. A. D. has served on Speaker Bureau/Advisory Boards for Spark Partners and Insmed and participated in clinical trials for Zambon and Parion/Vertex. M. L. M. has received grant support from COPD Foundation. P. G. N. has received grant support from Aradigm/Grifols, Insmed, Parion/ Vertex and Bayer, and consultancy fees from Bayer, Grifols, and Smartvest. A. E. O. has received grant support from Parion, Insmed, Aradigm, Grifols, and COPD Foundation. K. N. O. has a Cooperative Research and Development Award with AIT Therapeutics (Beyond Air) and Matinas Biopharma and has participated on advisory panels with Insmed, Inc. M. A. S. has received grant support from COPD Foundation, Parion, Bayer Healthcare, and Aradigm. B. T. has received personal fees for serving on advisory boards for GlaxoSmithKline and AstraZeneca and helped cofound the COPD Foundation and served as the Foundation's Board Chairman for ten years. G. T. has received grant support from the COPD Foundation for participation in the Bronchiectasis and NTM Research Registry and has received personal fees for serving on Advisory Boards for Bayer, Grifols, Aradigm, and Cipla. K. L. W. has received grant support and personal fees from Insmed and Bayer. None declared (R. C. A. D. E. E. K. F. D. E. G. M. M. J. M. R. K. A. S.). Other contributions: The authors would like to acknowledge the COPD foundation, a 501(c)(3) nonprofit organization, that manages the Bronchiectasis and NTM Research Registry. It should also be noted that this work would not have been possible without the comprehensive chart reviews and recording of data by the dedicated research coordinators and principal investigators at each of the participating registry sites. Additional information: The e-Table can be found in the Supplemental Materials section of the online article.

Publisher Copyright:
© 2020 American College of Chest Physicians

Keywords

  • airway clearance technique
  • bronchiectasis
  • sputum

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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