Lauwers Eline, Ides Kris, Van Hoorenbeeck Kim, Verhulst Stijn
Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2160 Wilrijk, Antwerp, Belgium.
Infla-Med Research Consortium of Excellence, University of Antwerp, Antwerp, Belgium.
Respir Res. 2020 Aug 17;21(1):217. doi: 10.1186/s12931-020-01484-z.
Airway clearance techniques (ACTs) are an important aspect of the treatment of children with chronic obstructive lung diseases. Unfortunately, a sound evidence base is lacking and airway clearance strategies are largely based on clinical expertise. One of the reasons for the limited evidence is the lack of appropriate outcome measures specifically related to the effectiveness of ACTs. This review discusses all outcome measures applied in previous research in the pediatric population to provide a baseline for future studies.
A systematic literature search was performed in PubMed, Web of Science and EMBASE databases. Search terms included chronic obstructive lung diseases and ACTs.
Studies were independently selected by the investigators according to the eligibility criteria. After screening, 49 articles remained for further analysis.
Data are summarized according to the type of outcome measure. 48 (98%) studies performed pulmonary function tests, 19 (39%) assessed expectorated sputum, 10 (20%) parameters related to disease exacerbation, 8 (16%) oxygenation, 8 (16%) patient-reported outcomes, 5 (10%) exercise capacity and 5 (10%) applied imaging techniques. The synthesis of results showed a high discrepancy between studies due to differences in study design, population and the application of techniques. Since no 'gold standard' method could be identified, a combination of different outcome measures is recommended to gain a better understanding and to identify the potential effects of ACTs. An overview of important considerations has been provided to assist researchers in their choice of outcomes in future studies.
气道廓清技术是治疗慢性阻塞性肺疾病患儿的重要方面。遗憾的是，目前缺乏可靠的证据基础，气道廓清策略很大程度上基于临床经验。证据有限的原因之一是缺乏与气道廓清技术有效性具体相关的恰当结局指标。本综述讨论了以往在儿科人群研究中应用的所有结局指标，为未来研究提供基线。
在PubMed、科学网和EMBASE数据库中进行了系统的文献检索。检索词包括慢性阻塞性肺疾病和气道廓清技术。
研究人员根据纳入标准独立选择研究。筛选后，49篇文章留待进一步分析。
根据结局指标类型对数据进行了总结。48项（98%）研究进行了肺功能测试，19项（39%）评估了咳出痰液，10项（20%）涉及疾病加重相关参数，8项（16%）评估了氧合情况，8项（16%）采用了患者报告结局，5项（10%）评估了运动能力，5项（10%）应用了成像技术。结果综合显示，由于研究设计、人群和技术应用的差异，不同研究之间存在很大差异。由于无法确定“金标准”方法，建议结合不同的结局指标，以更好地理解并确定气道廓清技术的潜在效果。提供了重要考虑因素概述，以协助研究人员在未来研究中选择结局指标。
