Airway clearance techniques in bronchiectasis

Background: Chest physiotherapy is an important management strategy for patients with bronchiectasis. Impaired mucociliary clearance in bronchiectasis can lead to inflammation and chronic infection, which further perpetuates lung destruction in a vicious vortex pattern. Various techniques, including airway clearance techniques, mucoactive agents, and exercise may help to mobilize mucus from the airways in hopes of reducing inflammation and infection. The goal of chest physiotherapy in patients with bronchiectasis is to improve symptoms, reduce exacerbations, and improve quality of life. This is a review article summarizing airway clearance in bronchiectasis. Methods: As part of this review, a literature search was performed that used PubMed. Search terms included “bronchiectasis,” “airway clearance,” “mucoactive therapies,” “positive expiratory pressure device,” “high-frequency chest wall oscillation,” “nebulized hypertonic saline,” “pulmonary rehabilitation.” Terms were searched in combination as well as individually and were limited to those articles that reviewed bronchiectasis. Results: A number of international guidelines in bronchiectasis recommend the use of chest physiotherapy. However, the data to support these recommendations are scarce and are often based on expert opinion. Moreover, existing literature with these modalities are often conflicting, further supporting the need for high-quality research in airway clearance. Conclusion: Airway techniques in bronchiectasis is an important management strategy in patients with bronchiectasis. This manuscript provides a concise review of chest physiotherapy in bronchiectasis, and emphasizes the need for future research in this area.