Frequency of use of ACTs (n (%); N physiotherapists treating adults = 64; N physiotherapists treating paediatrics = 13) (Continued)

Frequency of use of ACTs (n (%); N physiotherapists treating adults = 64; N physiotherapists treating paediatrics = 13) (Continued)

Source publication
Article
Full-text available
Background Airway clearance techniques are recommended for individuals with bronchiectasis both in stable state and during an acute exacerbation, however the current use of airway clearance techniques in the management of individuals during an acute exacerbation is unclear. The aims of this study were to establish what current physiotherapy clinica...

Citations

... While physiotherapy is recognised as a core element of bronchiectasis care [12][13][14], it currently lacks high quality evidence of its effectiveness [15,16]. This is partly attributable to difficulties in aggregating data from clinical trials in systematic reviews, due to inconsistent outcome reporting and variation of measurement instruments, with some important outcomes, such as exacerbation, hospitalisation and side effects, commonly missing [17][18][19][20][21][22]. ...
Article
Full-text available
Background: Bronchiectasis is a chronic respiratory disease characterised by airways widening and recurrent infections, resulting in episodes of chronic cough, sputum expectoration, and dyspnoea. This leads to deterioration in daily function, repeated hospital admissions and poor quality of life. The prevalence and mortality related to bronchiectasis is increasing worldwide with growing economic burden on healthcare systems. Physiotherapy for bronchiectasis aims to decrease accumulation of sputum, dyspnoea, and improve exercise capacity and daily function. A robust evidence base to support physiotherapy in bronchiectasis is currently lacking. This is partly because of inconsistency and poor reporting of outcomes in available studies. A core outcome set is the minimum acceptable group of outcomes that should be used in clinical trials for a specific condition. This decreases research waste by improving consistency and reporting of key outcomes and facilitates the synthesis of study outcomes in systematic reviews and guidelines. The aim of the study is therefore to develop a core outcome set and outcome measurement set for physiotherapy research in adults with bronchiectasis. This will ensure outcomes important to key stakeholders are consistently used and reported in future research. Methods and analysis: This project will use the COMET Initiative and COSMIN guidelines of core outcome set development and will include three phases. In the first phase, a comprehensive list of outcomes will be developed using systematic review of reported outcomes and qualitative interviews with patients and physiotherapists. Then consensus on key outcomes will be established in phase two using a Delphi survey and a consensus meeting. Finally, in phase three, we will identify appropriate instruments to measure the core outcomes by evaluating the psychometric properties of available instruments and a stakeholders' meeting to establish consensus. Ethics: The study was reviewed and has received ethical approval from the health-related Research Ethics Committee- Edge Hill University (ETH2021-0217). Registration: This study is registered with the COMET database. https://www.comet-initiative.org/Studies/Details/1931. The full systematic review protocol is registered in PROSPERO under the number CRD42021266247.
... To optimize the prescription of ACTs and determine any potential barriers to implementation, it is important to examine the perspectives of the prescribing physiotherapists. To date there have been three postal/ online surveys of physiotherapy management of ACTs in bronchiectasis describing commonly applied ACTs in Australia/New Zealand (Lee, Button, and Denehy, 2008;Phillips, Lee, Pope, and Hing, 2021) and the United Kingdom (O'Neill, Bradley, McArdle, and MacMahon, 2002). Audits of the Australian Bronchiectasis Registry (Visser et al., 2019a) and EMBARC Registry (Herrero-Cortina et al., 2017) report the use of ACTs in only half of individuals with bronchiectasis, reflecting a potential underuse of this therapy. ...
... The financial cost of ACT devices, workload, time, and service constraints were considered by all participants as potential barriers to ACTs. Access to ACT resources, perceived time and cost-effectiveness of ACTs were also reported to impact ACT prescription by physiotherapists in a recent survey study (Phillips, Lee, Pope, and Hing, 2021). In the current study more experienced participants provided insight into their perceived challenges of service delivery of those with bronchiectasis including lack of outpatient services, lack of continuity of patient care for both inpatients and outpatients and lack of patient information and resources. ...
Article
Introduction: Our understanding regarding the personalization of airway clearance techniques (ACTs) in bronchiectasis is limited. Objective: This study aimed to determine physiotherapist perceptions regarding the prescription of ACTs in inpatients and outpatients with bronchiectasis. Methods: A single-center qualitative study using semi-structured interviews of physiotherapists who treated individuals with bronchiectasis was undertaken. All interviews were audio recorded and transcribed verbatim. Data was analyzed using the thematic framework approach described by Braun and Clark. NVivo 12 software assisted with coding and thematic analysis of the interview transcripts. Findings were summarized into major conceptual themes. Participant demographic data was also obtained. Results: Eleven physiotherapists participated in the interviews. Central to all themes was the complexity of physiotherapy clinical decision-making regarding ACT prescription. Main themes included: organizational factors (i.e. workload, scope of service, access to resources/ACTs); patient-related factors (i.e. symptom severity, finances, disease-specific knowledge, social commitments, clinical setting, and perceived benefit); and physiotherapist/profession-related factors (i.e. clinical experience, access to professional support and education, awareness of evidence of ACTs, and evaluating ACT effectiveness). Conclusion: Physiotherapists regularly and routinely prescribe ACTs for individuals with bronchiectasis allowing for a multitude of competing factors. These factors should be considered by physiotherapists to enhance the personalized prescription of ACTs and may help promote patient adherence to ACTs to improve outcomes.
... Usled oštećenja cilijarnog aparata, dolazi do zastoja viskoznog sekreta u disajnim putevima, koji dodatno ometa funkciju cilija, i olakšava infekciju odnosno kolonizaciju bakterijama. Kolonizovane bakterije luče citokine, medijatore inflamacije, proteolitičke enzime koji dovode do destrukcije plućnog tkiva odnosno hronične inflamacije [38,39]. Produkti bakterija i oštećenih epitelnih ćelija, luče hemotaksične faktore, koji uzrokuju nakupljanje neutrofila. ...
Article
Full-text available
Bronchiectasis is a chronic lung disease characterized by an abnormal dilation of the bronchial lumen caused by weakening or destruction of the muscle or elastic components of the bronchial wall, decreased mucous clearance and frequent infections of the respiratory tract. The golden standard for bronchiectasis diagnosis is high-resolution computed tomography (HRCT) of the chest. Inflammation holds a central role in the development of structural lung changes, as well as airway and lung parenchyma damage. Infection and colonization of the respiratory tract contribute to increased inflammation and further damage to the lung. Upon entry into the respiratory tract, the pathogens activate epithelial cells, macrophages and dendritic cells. Activated inflammatory cells secrete chemical mediators which activate the immune response and thus allow the phagocytosis of pathogens. Early diagnosis, appropriate treatment and interruption of the vicious circle between infection and inflammation in patients suffering from bronchiectasis, prevent the development of structural changes to the airways.
... During acute exacerbations, treatment is aimed at reducing inflammation and improving pulmonary function, especially when patients are colonized with P. aeruginosa. This can be achieved by employing a combination of antiinflammatory and antimicrobial approaches together with airway clearance [87,141]. Recent studies illustrate that severe exacerbations are associated with a persistent elevation of IL-17a, IL-6 and IL-8, a phenomenon further aggravated in presence of P. aeruginosa. ...
Article
Introduction : Bronchiectasis is a chronic endobronchial suppurative disease characterized by irreversibly dilated bronchi damaged by repeated polymicrobial infections and, predominantly neutrophilic airway inflammation. Some consider bronchiectasis a syndromic consequence of several different causes whilst others view it as an individual disease entity. In most patients, identifying an underlying cause remains challenging. The acquisition and colonization of affected airways by Pseudomonas aeruginosa represents a critical and adverse clinical consequence for its progression and management. Areas covered : In this review, we outline clinical and pre-clinical peer-reviewed research published in the last 5 years, focusing on the pathogenesis of bronchiectasis and the role of P. aeruginosa and its virulence in shaping host inflammatory and immune responses in the airway. We further detail its role in airway infection, the lung microbiome and address therapeutic options in bronchiectasis. Expert opinion P. aeruginosa represents a key pulmonary pathogen in bronchiectasis that causes acute and/or chronic airway infection. Eradication can prevent adverse clinical consequence and/or disease progression. Novel therapeutic strategies are emerging and include combination-based approaches. Addressing airway infection caused by P. aeruginosa in bronchiectasis is necessary to prevent airway damage, loss of lung function and exacerbations, all of which contribute to adverse clinical outcome.
Article
In this article, we review airway clearance techniques, mucoactive agents, and the role of pulmonary rehabilitation in the treatment of patients with bronchiectasis. Topics include the physiology of airway clearance, specific techniques and therapies, and practical considerations for ensuring adherence to the therapies and education for the patient.