Several studies have investigated PD using radioactive aerosol to mark mucus and evaluate its clearance during PD, but none of them has ever confirmed the assumption that gravity alone can promote mucus displacement. There are conflicting opinions in the literature about this technique. This technique exploits the force of gravity in order to facilitate the sliding of the mucus from the periphery toward the central airways where, with coughing, forced expiration (FET) or bronchial aspiration, it can be removed. Nelson ( 12) was the first to describe the use of precise postures based on the anatomy of the bronchial tree. Postural drainage (PD) was one of the first techniques used. Although our paper is not a systematic review nor a meta-analysis, we hope it can help the reader gain a better understanding on how to proceed when choosing ACTs for their patients.ĭescription of Different Airway Clearance Techniques Postural Drainage The aim of this review is to illustrate to the reader the different ACTs that are currently available ( Table 1 and Figure 1). Underlying these numerous techniques, however, are a series of different physiological mechanisms used for “unblocking” the obstruction: Therefore, it is essential always to take into account the patient's preferences, and base one's choices about which technique to use not only on the relief of symptoms, but also on the adaptability of the technique to the patient's lifestyle. Adherence to treatment is fundamental and it depends very much on the patient's satisfaction, motivation and perceived effectiveness. According to Lapin ( 11), the overall effectiveness of any technique is influenced by several factors closely related to the patient. In addition, for many patients and/or categories of patients the goal might be to combine the best effect on clearance of the airways with the lowest possible incidence of side effects and of adverse events, such as exacerbation of the underlying pathophysiology ( 10). Looking at the issue from the other side, i.e., from the patient's perspective, rarely is just one single technique used for a given pathological condition. Obviously, there is a need for more studies to increase the body of scientific evidence on this topic ( 9). This absence of evidence, however, does not necessarily mean an absence of efficacy. Their aim is to reduce airway obstruction caused by secretions occupying the airway lumen and so prevent respiratory tract infections, re-expand the collapsed areas of the lung, thus improving gas exchanges and decreasing the inflammatory response ( 1– 4).Ī wide range of treatments, techniques and devices are present in the scientific literature for managing bronchial encumbrance in respiratory physiotherapy but their very multiplicity begs the question in daily clinical practice: “which of these treatments is it better to use to obtain the better result in my patient?.” Up to now, for all ACTs there is insufficient evidence to prove their efficacy and effectiveness in different clinical scenarios or to affirm the superiority of one technique over another ( 5– 8). The term airway clearance techniques (ACTs) refers to a variety of different strategies used to eliminate excess secretions. The management of bronchial secretions is one of the main problems encountered in a wide spectrum of medical conditions ranging from respiratory disorders (e.g., COPD, bronchiectasis, cystic fibrosis) to neuromuscular disorders (e.g., ALS) to patients undergoing either thoracic or abdominal surgery. Different principles combination is a new field of investigation that goes toward an increasing of clinical complexity that will facing us. Cough Assist, Vacuum Techniques, systems that modulate airflow have more and more scientific evidence. Alongside methods with a strong background behind as postural drainage, manual techniques or PEP systems, the current orientation is increasingly aimed at devices that can mobilize and / or remove secretions. The purpose of this review is illustrate to the reader the different ACTs currently available and the related evidence present in literature. The management of bronchial secretions is one of the main problems encountered in a wide spectrum of medical conditions ranging from respiratory disorders, neuromuscular disorders and patients undergoing either thoracic or abdominal surgery. Pulmonary Rehabilitation Department, Istituti Clinici Scientifici Maugeri, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Institute of Veruno, Novara, Italy.Stefano Belli *, Ilaria Prince, Gloria Savio, Elena Paracchini, Davide Cattaneo, Manuela Bianchi, Francesca Masocco, Maria Teresa Bellanti and Bruno Balbi
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