Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
King's Centre for Lung Health, King's College London, London, UK.
Eur Respir J. 2024 Jun 6;63(6). doi: 10.1183/13993003.01689-2023. Print 2024 Jun.
International guidelines recommend airway clearance management as one of the important pillars of bronchiectasis treatment. However, the extent to which airway clearance is used for people with bronchiectasis in Europe is unclear. The aim of the study was to identify the use of airway clearance management in patients with bronchiectasis across different countries and factors influencing airway clearance use.
This was a prospective observational study using data from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) Registry between January 2015 and April 2022. Prespecified options for airway clearance management were recorded, including airway clearance techniques, devices and use of mucoactive drugs.
16 723 people with bronchiectasis from 28 countries were included in the study. The mean age was 67 years (interquartile range 57-74 years, range 18-100 years) and 61% were female. 72% of the participants reported daily sputum expectoration and 52% (95% CI 51-53%) of all participants reported using regular airway clearance management. Active cycle of breathing technique was used by 28% of the participants and airway clearance devices by 16% of participants. The frequency of airway clearance management and techniques used varied significantly between different countries. Participants who used airway clearance management had greater disease severity and worse symptoms, including a higher daily sputum volume, compared to those who did not use it regularly. Mucoactive drugs were also more likely to be used in participants with more severe disease. Access to specialist respiratory physiotherapy was low throughout Europe, but particularly low in Eastern Europe.
Only a half of people with bronchiectasis in Europe use airway clearance management. Use of and access to devices, mucoactive drugs and specialist chest physiotherapy appears to be limited in many European countries.
国际指南建议将气道清除管理作为支气管扩张症治疗的重要支柱之一。然而，欧洲支气管扩张症患者使用气道清除的程度尚不清楚。本研究的目的是确定不同国家支气管扩张症患者使用气道清除管理的情况以及影响气道清除使用的因素。
这是一项前瞻性观察性研究，使用了欧洲多中心支气管扩张症审核和研究合作组织（EMBARC）注册中心 2015 年 1 月至 2022 年 4 月的数据。记录了气道清除管理的预定义选项，包括气道清除技术、设备和黏液溶解药物的使用。
本研究纳入了来自 28 个国家的 16723 例支气管扩张症患者。患者的平均年龄为 67 岁（四分位距 57-74 岁，范围 18-100 岁），61%为女性。72%的参与者报告每天有痰咳出，52%（95%CI 51-53%）的所有参与者报告定期使用气道清除管理。有 28%的参与者使用主动呼吸循环技术，16%的参与者使用气道清除设备。不同国家之间气道清除管理的频率和技术使用差异显著。与未定期使用气道清除管理的患者相比，使用气道清除管理的患者疾病严重程度更高，症状更严重，包括每天的痰量更大。病情更严重的患者也更有可能使用黏液溶解药物。整个欧洲获得专业呼吸物理治疗的机会较低，但在东欧尤其低。
欧洲只有一半的支气管扩张症患者使用气道清除管理。在许多欧洲国家，设备、黏液溶解药物和专业胸部物理治疗的使用和获得似乎受到限制。
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