Airway clearance techniques for patients experiencing acute exacerbations of chronic obstructive pulmonary disease in the Republic of Ireland

Abstract

BACKGROUND AND OBJECTIVES: Airway clearance techniques (ACTs) are used by physiotherapists with the purpose of clearing sputum from bronchial airways. They are commonly prescribed for patients experiencing acute exacerbations of chronic obstructive pulmonary disease (AECOPD), however large variability in practice is commonly observed. This study aimed to explore current physiotherapy practice regarding ACTs for people with AECOPD in the Republic of Ireland. METHOD: An online survey was distributed to physiotherapy clinicians via direct email and the Irish Society of Chartered Physiotherapists. Main survey themes, identified from previous studies using the same survey tool, included current practice in relation to use of ACTs, perception of their effectiveness, clinical reasoning and awareness of the literature and guidelines. For the purpose of this study, ACTs were defined as techniques used by a physiotherapist for the purpose of clearing sputum from patients’ airways. RESULTS: 202 surveys were distributed and seventy responses (35%) were received. The majority of respondents (n = 56, 80%) reported prescribing ACTs for more than 60% of patients with AECOPD, the most common techniques being physical activity (n = 65, 93%) and active cycle of breathing techniques (n = 53, 90%). Sputum management (n = 66, 94%) was the most commonly reported indicator for use of ACTs. The majority of physiotherapists (n = 42, 60%) reported being unsure of the literature regarding ACTs in AECOPD. CONCLUSION: The response rate to this survey was low, however results show that physiotherapists in the Republic of Ireland regularly prescribe ACTs for patients with AECOPD. Physical activity and active cycle of breathing techniques were the most commonly used ACTs and perceived to be the most effective techniques in AECOPD, with sputum management the most commonly reported indicator for use. Further research is required to explore not only physiotherapists clinical reasoning in relation to the use of ACTs for AECOPD and the perceptions of their effectiveness, but also the lack of awareness of the literature and guidelines.