British Thoracic Society guidelines for non-cystic fibrosis bronchiectasis (NCFB) recommend airway clearance taught by a physiotherapist for patients with chronic sputum production or mucus plugging on CT. Various techniques and adjuncts are available and the evidence for the effectiveness of these is inconsistent. We designed a stepwise chest clearance pathway for use in a specialist NCFB clinic in a large district general hospital trust. Patients were taught and commenced on active cycle breathing technique with postural drainage, positive expiratory pressure device, mucolytic and nebulised hypertonic saline, progressing to each step until chest clearance was felt to be optimised. Quality of life was assessed using Leicester cough questionnaire (LCQ) at baseline and after each intervention including the point of optimisation. Hospital admission and general practice antibiotic prescription data were retrospectively collected for 12 months pre and post initiation of the pathway. Data were compared using Wilcoxon signed rank test.
105 patients (mean age 67, 53 female, mean FEV1 1.62l) were included although data were incomplete. Total LCQ score significantly improved at the point where chest clearance was felt to be optimised, compared to baseline, with a median difference of 1.3. Subgroup analysis revealed that patients with lower baseline LCQ showed greater improvement. Further analysis revealed that all steps in the pathway resulted in significant improvements in LCQ with the exception of mucolytics. Hospital admissions for NCFB were significantly reduced in the 12 months following initiation of the pathway. There was no significant difference in antibiotic usage according to GP prescriptions.
This retrospective study suggests that the use of a standardised chest clearance pathway may result in improved quality of life and reduction in hospital admissions in patients with NCFB.
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