• Naomi A McKoy, Ian J Saldanha, Olaide A Odelola, and Karen A Robinson.
• SSM Microbial Upstream Common Use Production, Human Genome Sciences, Inc., Rockville, Maryland, USA.
• Cochrane Db Syst Rev. 2012 Jan 1;12:CD007862.

BackgroundPeople with cystic fibrosis experience chronic airway infections as a result of mucus build up within the lungs. Repeated infections often cause lung damage and disease. Airway clearance therapies aim to improve mucus clearance, increase sputum production, and improve airway function. The active cycle of breathing technique (ACBT) is an airway clearance method that uses a cycle of techniques to loosen airway secretions including breathing control, thoracic expansion exercises, and the forced expiration technique.ObjectivesTo compare the clinical effectiveness of ACBT with other airway clearance therapies in cystic fibrosis.Search MethodsWe searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of last search: 02 August 2012.Selection CriteriaRandomised or quasi-randomised controlled clinical studies, including cross-over studies, comparing ACBT with other airway clearance therapies in cystic fibrosis.Data Collection And AnalysisTwo review authors independently screened each article, abstracted data and assessed the risk of bias of each study.Main ResultsSixty studies were identified of which 18 (375 participants) met the inclusion criteria. Five randomised controlled studies (127 participants) were included in the meta-analysis; four were of cross-over design. The 13 remaining studies were cross-over studies with inadequate reports for complete assessment.Included studies compared ACBT to autogenic drainage, airway oscillating devices, high frequency chest compression devices, conventional chest physiotherapy, and positive expiratory pressure. Patient preference varied: more patients preferred autogenic drainage over ACBT; more preferred ACBT over airway oscillating devices; and more were comfortable with ACBT versus high frequency chest compression. No significant difference was seen in sputum weight, lung function, or oxygen saturation between ACBT and autogenic drainage or between ACBT and airway oscillating devices. There was no significant difference in lung function and the number of pulmonary exacerbations between ACBT and ACBT plus conventional chest physiotherapy. All other outcomes were either not measured or had insufficient data for analysis.Authors' ConclusionsThere is insufficient evidence to support or reject the use of ACBT over any other airway clearance therapy. Five studies, with five different comparators, found that ACBT was comparable to other therapies in outcomes such as patient preference, lung function, sputum weight, oxygen saturation, and number of pulmonary exacerbations. Longer-term studies are needed to more adequately assess the effects of ACBT on outcomes important for patients such as quality of life and patient preference.

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