• Ashwin Basavaraj, Radmila Choate, Doreen Addrizzo-Harris, Timothy R Aksamit, Alan Barker, Charles L Daley, Anne Daniels M Leigh ML University of North Carolina at Chapel Hill, Chapel Hill, NC., Edward Eden, Angela DiMango, Kevin Fennelly, David E Griffith, Margaret M Johnson, Michael R Knowles, Mark L Metersky, Peadar G Noone, Anne E O'Donnell, Kenneth N Olivier, Matthias A Salathe, Andreas Schmid, Byron Thomashow, Gregory Tino, and Kevin L Winthrop.
• New York University School of Medicine, New York, NY. Electronic address: Ashwin.basavaraj@nyulangone.org.
• Chest. 2020 Oct 1; 158 (4): 1376-1384.

BackgroundIn patients with bronchiectasis, airway clearance techniques (ACTs) are important management strategies.Research QuestionWhat are the differences in patients with bronchiectasis and a productive cough who used ACTs and those who did not? What was the assessment of bronchiectasis exacerbation frequency and change in pulmonary function at 1-year follow up?Study Design And MethodsAdult patients with bronchiectasis and a productive cough in the United States Bronchiectasis and NTM Research Registry were included in the analyses. ACTs included the use of instrumental devices and manual techniques. Stratified analyses of demographic and clinical characteristics were performed by use of ACTs at baseline and follow up. The association between ACT use and clinical outcomes was assessed with the use of unadjusted and adjusted multinomial logistic regression models.ResultsOf the overall study population (n = 905), 59% used ACTs at baseline. A greater proportion of patients who used ACTs at baseline and follow up continuously had Pseudomonas aeruginosa (47% vs 36%; P = .021) and experienced an exacerbation (81% vs 59%; P < .0001) or hospitalization for pulmonary illness (32% vs 22%; P = .001) in the prior two years, compared with those patients who did not use ACTs. Fifty-eight percent of patients who used ACTs at baseline did not use ACTs at 1-year follow up. There was no significant change in pulmonary function for those who used ACTs at follow up, compared with baseline. Patients who used ACTs at baseline and follow up had greater odds for experiencing exacerbations at follow up compared with those patients who did not use ACTs.InterpretationIn patients with bronchiectasis and a productive cough, ACTs are used more often if the patients have experienced a prior exacerbation, hospitalization for pulmonary illness, or had P aeruginosa. There is a significant reduction in the use of ACTs at 1-year follow up. The odds of the development of a bronchiectasis exacerbation are higher in those patients who use ACTs continuously, which suggests more frequent use in an ill bronchiectasis population.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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