Active Cycle of Breathing Technique Versus Oscillating Positive Expiratory Pressure Therapy Versus Exercise With Huffing During an Exacerbation of Bronchiectasis: A Randomised, Controlled Trial

ABSTRACT Background and Objective The relative effectiveness of airway clearance techniques (ACTs) during an exacerbation of bronchiectasis is unknown. This study aimed to compare the effects of three ACTs on sputum expectoration, health‐related quality‐of‐life (HRQOL), and exacerbation rates in adults hospitalised with an exacerbation of bronchiectasis. Methods A randomised controlled trial of active cycle of breathing technique (ACBT), oscillating positive expiratory pressure (OPEP) therapy and walking with huffing. Sputum wet weight was collected during ACT sessions, 1‐h post‐session and the following 23 h on day 2 and day of discharge. HRQOL was assessed using the Quality of Life‐Bronchiectasis (QoL‐B) questionnaire and Leicester Cough Questionnaire (LCQ) on day 2 and day of discharge. Time to first exacerbation was explored for 6 months following discharge. Results Fifty‐five participants were recruited. ACBT was associated with smaller sputum wet weight 1‐h post session on day of discharge compared to walking with huffing (mean difference −2.58 g); no other significant differences between groups in sputum weights were observed. ACBT and walking with huffing significantly improved selected measures of HRQOL (LCQ total score and multiple QOL‐B domains) at hospital discharge while OPEP therapy produced minimal changes. ACBT (158 days, 95% CI 139–177) resulted in a longer time to first exacerbation than walking with huffing (118 days, 95% CI 83–154) and OPEP therapy (89 days, 95% CI 69–111) but this finding should be interpreted with caution due to loss to follow‐up. Conclusion Walking with huffing and ACBT gave similar improvements in sputum expectoration and HRQOL during hospitalisation in adults with an exacerbation of bronchiectasis. Trial Registration The study was registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12621000428864) on 16‐04‐2021