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

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.