Personalising airway clearance in chronic suppurative lung diseases: a scoping review

Airway clearance technique therapy for atelectasis induced by scoliosis surgery: a case report

The patient, a 55-year-old female presenting with spinal deformity and exertional dyspnea, was referred to the hospital. Radiographic evaluation of her spine revealed an "S"-shaped scoliosis with a Cobb angle measuring 68°, indicative of severe scoliosis. Despite receiving medication for expectoration, postoperative symptoms including chest tightness, breathlessness, and ineffective coughing persisted and progressively worsened. Subsequent chest CT scans demonstrated extensive atelectasis, and pharmacological interventions proved to be ineffective. Considering the patient's clinical condition, we implemented airway clearance technique (ACT) along with prone ventilation to optimize cough effectiveness and mitigate atelectasis formation. The airway clearance techniques (ACT) employed include nebulization, continuous positive expiratory pressure (CPEP), and continuous high frequency oscillation (CHFO). Chest CT imaging confirmed that ACT substantially alleviated the patient's pulmonary atelectasis. Moreover, blood gas analysis indicated significant improvements in both the PaO2/FiO2 ratio and base excess of whole blood. Follow-up evaluation 1 year post-discharge revealed a favorable prognosis for the patient. We anticipate that our experience utilizing these novel therapeutic modalities will provide valuable insights for clinicians managing similar complications.

Physiotherapy-led, community-based airway clearance services for people with chronic lung conditions: a retrospective descriptive evaluation of an existing model of care

OBJECTIVES

Airway clearance interventions are recommended for people with chronic lung conditions and mucus hypersecretion, but there are few published models of care or descriptions of airway clearance service provision. This evaluation describes a dedicated, physiotherapy-led, community-based airway clearance service in a metropolitan local health network.

DESIGN

Retrospective evaluation using existing airway clearance service administrative database.

PARTICIPANTS

All first referrals to the airway clearance service in a 5-year period (1/1/2017 to 31/12/2021).

MAIN OUTCOME MEASURES

Available service data grouped into four domains: participant demographics, referral demographics, service provision and outcomes.

RESULTS

Of the 1335 first referrals eligible for inclusion, 1157 (87%) people attended. Bronchiectasis was the commonest condition (n = 649/1135, 49%). A total of 2996 occasions of service (face to face clinic n = 2108, 70%, phone n = 736, 25%, telehealth n = 99, 3%, home visit n = 53, 2%) were delivered. Airway clearance devices frequently prescribed were the Aerobika (525/1157, 45%), bubble-positive expiratory pressure (263/1157, 23%) and the Acapella (127/1157, 11%). On average, initial appointment with the airway clearance service occurred within 36 days of referral and people attended the service three times. Individuals voluntarily completed both pre/post service questionnaires around a third of the time. At least half of responders reported an improvement in respiratory symptom outcome measures consistent with the minimum clinically important difference.

CONCLUSIONS

This evaluation describes an airway clearance service as it exists, providing an example from which airway clearance services can be planned, implemented and improved.