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. 2019 Jan 24;1(1):CD011231.
doi: 10.1002/14651858.CD011231.pub2.

Airway clearance techniques for cystic fibrosis: an overview of Cochrane systematic reviews

Lisa M Wilson  1 , Lisa Morrison, Karen A Robinson
Affiliations

Airway clearance techniques for cystic fibrosis: an overview of Cochrane systematic reviews

Lisa M Wilson et al. Cochrane Database Syst Rev. .

Abstract

Background: Cystic fibrosis is a life-limiting genetic condition in which thick mucus builds up in the lungs, leading to infections, inflammation, and eventually, deterioration in lung function. To clear their lungs of mucus, people with cystic fibrosis perform airway clearance techniques daily. There are various airway clearance techniques, which differ in terms of the need for assistance or equipment, and cost.

Objectives: To summarise the evidence from Cochrane Reviews on the effectiveness and safety of various airway clearance techniques in people with cystic fibrosis.

Methods: For this overview, we included Cochrane Reviews of randomised or quasi-randomised controlled trials (including cross-over trials) that evaluated an airway clearance technique (conventional chest physiotherapy, positive expiratory pressure (PEP) therapy, high-pressure PEP therapy, active cycle of breathing techniques, autogenic drainage, airway oscillating devices, external high frequency chest compression devices and exercise) in people with cystic fibrosis.We searched the Cochrane Database of Systematic Reviews on 29 November 2018.Two review authors independently evaluated reviews for eligibility. One review author extracted data from included reviews and a second author checked the data for accuracy. Two review authors independently graded the quality of reviews using the ROBIS tool. We used the GRADE approach for assessing the overall strength of the evidence for each primary outcome (forced expiratory volume in one second (FEV1), individual preference and quality of life).

Main results: We included six Cochrane Reviews, one of which compared any type of chest physiotherapy with no chest physiotherapy or coughing alone and the remaining five reviews included head-to-head comparisons of different airway clearance techniques. All the reviews were considered to have a low risk of bias. However, the individual trials included in the reviews often did not report sufficient information to adequately assess risk of bias. Many trials did not sufficiently report on outcome measures and had a high risk of reporting bias.We are unable to draw definitive conclusions for comparisons of airway clearance techniques in terms of FEV1, except for reporting no difference between PEP therapy and oscillating devices after six months of treatment, mean difference -1.43% predicted (95% confidence interval -5.72 to 2.87); the quality of the body of evidence was graded as moderate. The quality of the body of evidence comparing different airway clearance techniques for other outcomes was either low or very low.

Authors' conclusions: There is little evidence to support the use of one airway clearance technique over another. People with cystic fibrosis should choose the airway clearance technique that best meets their needs, after considering comfort, convenience, flexibility, practicality, cost, or some other factor. More long-term, high-quality randomised controlled trials comparing airway clearance techniques among people with cystic fibrosis are needed.

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Conflict of interest statement

Two of the authors of this overview (LMW, KAR) have contributed to the review on the active cycle of breathing technique. One author (LM) has contributed to the review on oscillating devices.

Figures

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1
Flow diagram.
2
2
Gap map summarizing the results and quality of the evidence (GRADE) for FEV1.
3
3
Gap map summarizing the results and quality of the evidence (GRADE) for participant preference.
4
4
Gap map summarizing the results and quality of the evidence (GRADE) for quality of life.
See this image and copyright information in PMC

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