Physiology-Guided Selection of Hardware-Assisted Airway Clearance Techniques during Acute Exacerbations of Non-Cystic Fibrosis Bronchiectasis.

UNLABELLED: <p>

Introduction

The aim of this study was to assess the short-term clinical effects of individualized, hardware-assisted airway clearance techniques (ACTs) during acute non-cystic fibrosis bronchiectasis (NCFB exacerbations).

METHODS

In this prospective, controlled cohort study, 46 adults hospitalized with computed tomography-confirmed bilateral (CT-confirmed bilateral) NCFB were assigned to an intervention group (ACT plus pharmacological therapy; n = 23) or a control group (pharmacological therapy alone; n = 23). ACT modality (intrapulmonary percussive ventilation [IPV], high-frequency chest wall oscillation, or mechanical insufflation-exsufflation) was selected based on IPV tolerability and respiratory muscle strength maximum inspiratory pressure Z-score. Outcomes included 24-hour sputum volume, dyspnea (modified medical research council dyspnea scale [mMRC], Borg), spirometry, inflammatory markers, and length of hospital stay.

RESULTS

Compared with controls, the intervention group showed greater reductions in sputum volume (-15 vs. -10 mL; p = 0.005) and dyspnea (mMRC -1.0 vs. 0.0; Borg -2.0 vs. -1.0; all p < 0.05), as well as a shorter hospital stay (median 7 vs. 9 days; p < 0.05). There were no differences between groups in spirometric or inflammatory outcomes, and no serious adverse events occurred.

CONCLUSIONS

Individualized, physiology-guided device-based ACTs improved mucus clearance and dyspnea during acute NCFB exacerbations and were well tolerated, without short-term spirometric change. Larger studies with longer follow-up are needed to confirm efficacy before routine clinical implementation. </p>.