Exploring the barriers and enablers of airway clearance therapy and exercise amongst adults with bronchiectasis: a patient perspective

Introduction/Aim Airway clearance therapy (ACT) and physical exercise are recommended to prevent pulmonary exacerbations and improve secretion clearance and exercise tolerance in adults with bronchiectasis. Adherence with routine ACT is frequently poor, and engagement in regular exercise is relatively unknown. This study explored the barriers and enablers of performing ACT, physical exercise and attending pulmonary rehabilitation (PR) from the perspective of adults with bronchiectasis. Methods Adults with a confirmed diagnosis of bronchiectasis undertook a semi-structured interview. Interviews were recorded, transcribed verbatim and coded. Inductive content analysis was used to explore the barriers, enablers and establish key themes. Results Thirty adults were included; 18 (60%) were female, median age 74 (interquartile range 67-80) years. Positive experiences with ACT to manage respiratory symptoms facilitated engagement. Barriers to ACT were the negative emotional connotations, including stigma, monotony and the time-consuming nature of therapy. Enablers of exercise engagement were physical, psychological and respiratory health benefits, and that exercise was a time efficient form of ACT. Lack of ability or self-belief was a barrier to engaging with physical exercise. Flexibility in PR model delivery and confidence in the supervised exercise and education programme provided by healthcare providers were enablers of PR, while lack of awareness of potential benefits and geographical restrictions were barriers to PR participation. Conclusion Airway clearance therapy, PR and physical exercise were considered important for respiratory symptom management. Physical exercise was perceived to be a complementary form of ACT. Further research is needed to establish effective dosage for exercise as an ACT.