Robinson Karen A, McKoy Naomi, Saldanha Ian, Odelola Olaide A
Department of Medicine, Johns Hopkins University, 1830 E. Monument St., Suite 8069, Baltimore, MD, USA, 21287.
Cochrane Database Syst Rev. 2010 Nov 10(11):CD007862. doi: 10.1002/14651858.CD007862.pub2.
People with cystic fibrosis (CF) experience chronic airway infections as a result of mucus build up within the lungs. Repeated infections often cause lung damage and disease. Airway clearance therapies aim to improve mucus clearance, increase sputum production, and improve airway function. The active cycle of breathing technique (ACBT) is an airway clearance method that uses a cycle of techniques to loosen airway secretions including breathing control, thoracic expansion exercises, and the forced expiration technique.
To compare the clinical effectiveness of ACBT with other airway clearance therapies in CF.
We searched the Cochrane CF Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Last search: 05 August 2010.
Randomised or quasi-randomised controlled clinical studies, including crossover studies, comparing ACBT with other airway clearance therapies in CF.
Two review authors independently screened each article, abstracted data and assessed the risk of bias of each study.
Fifty-eight studies were identified of which 17 (346 participants) met the inclusion criteria. Four randomised controlled studies (98 participants) were included in the meta-analysis; three were of crossover design. The 13 remaining studies were crossover studies with inadequate reports for complete assessment.Included studies compared ACBT to autogenic drainage, airway oscillating devices, high frequency chest compression devices, and conventional chest physiotherapy. Patient preference varied: more patients preferred autogenic drainage over ACBT, more preferred ACBT over airway oscillating devices, and more were comfortable with ACBT versus high frequency chest compression. No significant difference was seen in sputum weight between ACBT and autogenic drainage or between ACBT and airway oscillating devices. There was no significant difference in lung function and the number of pulmonary exacerbations between ACBT and ACBT plus conventional chest physiotherapy. All other outcomes were either not measured or had insufficient data for analysis.
AUTHORS' CONCLUSIONS: There is insufficient evidence to support or reject the use of ACBT over any other airway clearance therapy. Four studies, with four different comparators, found that ACBT was comparable to other therapies in outcomes such as patient preference, lung function, sputum weight, oxygen saturation, and number of pulmonary exacerbations. Longer-term studies are needed to more adequately assess the effects of ACBT on outcomes important for patients such as quality of life and patient preference.
囊性纤维化（CF）患者由于肺部黏液积聚而经历慢性气道感染。反复感染常导致肺损伤和疾病。气道清除疗法旨在改善黏液清除、增加痰液生成并改善气道功能。主动呼吸循环技术（ACBT）是一种气道清除方法，它使用一系列技术来松解气道分泌物，包括呼吸控制、胸廓扩张练习和用力呼气技术。
比较ACBT与其他气道清除疗法在CF中的临床效果。
我们检索了Cochrane CF试验注册库，该注册库通过电子数据库检索以及对期刊和会议摘要书籍的手工检索汇编而成。我们还检索了相关文章和综述的参考文献列表。上次检索时间：2010年8月5日。
随机或半随机对照临床研究，包括交叉研究，比较ACBT与其他气道清除疗法在CF中的效果。
两位综述作者独立筛选每篇文章，提取数据并评估每项研究的偏倚风险。
共识别出58项研究，其中17项（346名参与者）符合纳入标准。荟萃分析纳入了4项随机对照研究（98名参与者）；3项为交叉设计。其余13项研究为交叉研究，但报告不充分，无法进行全面评估。纳入研究将ACBT与自体引流、气道振荡装置、高频胸部按压装置和传统胸部物理治疗进行了比较。患者偏好各不相同：更多患者更喜欢自体引流而非ACBT，更多患者更喜欢ACBT而非气道振荡装置，更多患者对ACBT比对高频胸部按压更满意。ACBT与自体引流之间或ACBT与气道振荡装置之间在痰液重量方面无显著差异。ACBT与ACBT加传统胸部物理治疗在肺功能和肺部急性加重次数方面无显著差异。所有其他结局要么未测量，要么数据不足无法分析。
没有足够的证据支持或反对使用ACBT而非任何其他气道清除疗法。四项研究，采用四种不同的对照方法，发现ACBT在患者偏好、肺功能、痰液重量、血氧饱和度和肺部急性加重次数等结局方面与其他疗法相当。需要进行更长期的研究，以更充分地评估ACBT对患者重要结局如生活质量和患者偏好的影响。
