Efficacy of airway clearance therapy with different autonomy degrees in nonCF-BE: Randomized cross-over trial

Airways clearance techniques are an important part of chronic treatment of non-cystic fibrosis bronchiectasis (nonCF-BE). Notwithstanding, the literature supporting their clinical use is still poor. Aim: To evaluate effectiveness in mucus clearance and tolerance of 3 respiratory techniques with different autonomy degrees: ELTGOL (physiotherapist-administered), Autogenic drainage (self-administered) and a temporary positive expiratory pressure device, named Uniko. Design: Randomized crossover trial. Population: Clinically stable adult nonCF-BE patients, sputum production ≥15ml/day. Methods: Each technique is applied in 3 sessions on alternate days (1 week washout). Sputum was registered at the end session, after 1h and 24h. Results: 7 patients were enrolled in the study (median age 69; mean FEV 1 70±16%). AD obtained the major short-time sputum production (mean values: ELTGOL 7gr; AD 15gr; Uniko 7gr). By contrast, Uniko and ELTGOL showed a higher sputum production at 24h (AD 9gr, Uniko 16gr, ELTGOL 17gr). The short-time sputum production slightly increased over time with ELTGOL (1st: 11gr; 2nd: 13gr; 3rd: 14gr), while the 24h sputum production increased with Uniko (1st: 14gr; 2nd: 17gr; 3rd: 17gr). AD was the favourite technique of 6 patients. Conclusions: The 3 techniques were well tolerated and efficacious. AD was the most rapid in favouring expectoration. However, Uniko and ELTGOL were more effective at long-term, with an increasing trend for Uniko over time. The degree of patient' autonomy for each technique, the compliance and personal preferences should be considered to select a treatment in order to individualize and optimize the respiratory therapy in nonCF-BE patients. Supported by MPR Italy.