A randomized controlled trial of 4 weeks of airway clearance with oscillating positive end expiratory pressure device versus autogenic drainage in people with bronchiectasis

Abstract

Background: Airway clearance (AWC) is a fundamental component of care in bronchiectasis, but evidence of efficacy are few. Lung clearance index (LCI) is a promising measurement of ventilation inhomogeneity. Its responsiveness to AWC has not been demonstrated.

Aim: To compare effects of two methods of AWC- Autogenic Drainage (AD) and Oscillating Positive Airway Pressure (oPEP) on LCI, spirometry, sputum quantity, and quality of life.

Methods: Adult patients with bronchiectasis, naive to airway clearance, were randomized and instructed to daily AWC with either AD or oPEP (Aerobika, Trudell pharma, Canada). Weekly phone calls were performed to evaluate adherence to AWC. Multiple breath washout, spirometry, sputum volume and purulence, and QOL- B questionnaire were measured at randomization and after 4 weeks of AWC.

Results: 51 patients were randomized and 49 completed the study (25 AD, 24 oPEP). Adherence was 87% (oPEP) and 88% (AD). LCI and FEV1 did not change between visits in either groups. Sputum quantity decreased in 12/24 of the oPEP group, and in 6/25 (24%) of the AD group, (p=0.044). ‘Treatment burden’ was worsened or unchanged in 70% of participants randomized to AD and 55% randomized to oPEP (p=0.038). During the study, 11 participants experienced a pulmonary exacerbation (6 AD, 5 oPEP). When these participants were excluded from the analysis, LCI improved in the oPEP group only (-0.59 vs. -0.1 in the AD group), without statistical significance (p=0.45).

Conclusions: Sputum quantity was improved after one month of oPEP, without an increase in treatment burden. No change in LCI was seen with AWC.