Physiotherapy Department, Prince of Wales Hospital, Randwick, New South Wales, Australia.
Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Lidcombe, New South Wales, Australia.
Physiother Res Int. 2020 Jul;25(3):e1836. doi: 10.1002/pri.1836. Epub 2020 Feb 29.
The bubble-positive expiratory pressure (PEP) device may be used for sputum clearance in people with daily sputum production. However, this device has never been studied in people with bronchiectasis. Hence, the objective of this study was to compare the effect of bubble-PEP device, the active cycle of breathing technique (ACBT) and no intervention (control) on sputum clearance in people with bronchiectasis.
This was a prospective, randomised cross-over trial with concealed allocation, assessor blinding and intention-to-treat analysis. Adult participants with stable bronchiectasis and productive of sputum daily were recruited. Participants performed 30-min of bubble-PEP, ACBT or control in random order whilst sitting, followed by 60-min of quiet sitting, on three separate days at the same time within a 10-day period. Primary outcome measure was wet weight of expectorated sputum during 30-min intervention, 60-min post intervention and total wet weight (30 min plus 60 min).
Thirty-five-participants (11 males, mean [standard deviation] age 75 [8] years, forced expiratory volume in 1 s 72 [20] % predicted) were recruited and 34 completed the study. There was no significant difference in sputum wet weight between bubble-PEP and ACBT during 30-min intervention (mean difference [95% confidence interval]) -0.59 g [-1.37, 0.19] and total wet weight (0.74 g [-0.54, 2.02]). Sputum wet weight was significantly greater in bubble-PEP than ACBT at 60-min post intervention (1.33 g [0.19, 2.47]).
Sputum wet weight was significantly greater with bubble-PEP than control at all time periods, and greater than ACBT at 60-min-post. Bubble-PEP could be considered an alternative sputum clearance technique to ACBT.
气泡式呼气压力（PEP）装置可用于每日咳痰的人群清除痰液。然而，该设备从未在支气管扩张症患者中进行过研究。因此，本研究的目的是比较气泡式 PEP 装置、主动呼吸循环技术（ACBT）和不干预（对照组）对支气管扩张症患者痰液清除的效果。
这是一项前瞻性、随机交叉试验，采用隐蔽分组、评估者盲法和意向治疗分析。招募稳定期支气管扩张且每日咳痰的成年参与者。参与者在同一时间的 10 天内，以随机顺序分别接受 30 分钟的气泡式 PEP、ACBT 或对照组治疗，同时坐在椅子上，随后在 30 分钟干预后 60 分钟和 30 分钟加 60 分钟的总湿重（60 分钟）期间安静地坐着。主要观察指标为 30 分钟干预期间、干预后 60 分钟和总湿重（30 分钟加 60 分钟）期间咳出痰液的湿重。
共招募了 35 名参与者（11 名男性，平均[标准差]年龄 75[8]岁，1 秒用力呼气容积占预计值的 72[20]%），其中 34 名完成了研究。在 30 分钟干预期间，气泡式 PEP 和 ACBT 之间的痰液湿重无显著差异（平均差值[95%置信区间]）-0.59g[-1.37，0.19]和总湿重（0.74g[-0.54，2.02]）。在干预后 60 分钟时，气泡式 PEP 的痰液湿重明显大于 ACBT（1.33g[0.19，2.47]）。
在所有时间段，气泡式 PEP 的痰液湿重均明显大于对照组，且在干预后 60 分钟时大于 ACBT。气泡式 PEP 可被视为 ACBT 的替代排痰技术。
