Active cycle of breathing technique (ACBT) and walking with huffing demonstrate similar efficacy in improving sputum expectoration and health-related quality of life (HRQOL) in hospitalized adults with exacerbation of bronchiectasis, a study has found.
“While walking with huffing increased sputum volume in the 1-h post-airway clearance technique (ACT) session on day of discharge compared with the ACBT, this is unlikely to be clinically significant, and there were no other significant differences between ACTs in sputum wet weight measures,” the researchers said.
Fifty-five patients with bronchiectasis participated in this randomized controlled trial (RCT). The use of ACBT resulted in smaller sputum wet weight 1-h postsession on day of discharge compared with walking with huffing (mean difference ‒2.58 g), but no other significant between-group differences in sputum weights were noted. [Respirology 2026;31:787-797]
At hospital discharge, both ACBT and walking with huffing significantly improved selected measures of HRQOL, namely Quality of Life-Bronchiectasis (QoL-B) domains and Leicester Cough Questionnaire (LCQ) total score. On the other hand, oscillating positive expiratory pressure (OPEP) therapy delivered only minimal changes.
Furthermore, time to first exacerbation was much longer with ACBT than walking with huffing and OPEP therapy (158 vs 118 and 89 days), but this finding must be interpreted with caution due to loss to follow-up, according to the researchers.
“In this study, only the ACBT group experienced a reduction in 24-h expectorated sputum wet weight that exceeded the minimal clinical important difference,” the researchers said. “This indicates that ACBT may be slightly more effective than the other two ACTs in improving sputum expectoration during hospital admission, despite the difference not being significant.” [Respir Care 2020;65:1478-1487]
Exercise
Previous studies have explored exercise as an ACT in people with cystic fibrosis (CF), with the notion that increasing tidal volume and peak expiratory flow (PEF) would help move the sputum toward central airways for expectoration. Similarly, walking may induce sputum expectoration via shearing forces in the lung parenchyma. [Thorax 2021;76:763-771; Chest 2011;139:870-877]
In a systematic review on adults with CF, exercise was found to be helpful in clearing sputum compared with rest and appeared as effective as other ACTs when a huff is added. [Thorax 2021;76:763-771]
Moreover, treadmill walking (intensity 60 percent of peak oxygen consumption) and OPEP therapy combined with huffing both improved PEF and reduced sputum mechanical impedance in adults with stable CF. [BMC Pulm Med 2017;17:14]
“These findings support [those] of the current study that walking with huffing may be as effective as OPEP therapy for short-term sputum clearance,” the researchers said.
“Future research should continue to ensure studies are adequately powered to detect meaningful effects, explore the responses of specific bronchiectasis phenotypes and severities to different ACTs, and compare walking with huffing with a range of ACTs, both when stable and during an exacerbation,” they added. [Eur Respir J 2016;47:1113-1122; Eur Respir J 2018;51:1701926]
The current RCT compared ACBT, OPEP therapy, and walking with huffing in participants with bronchiectasis. The research team collected sputum wet weight during ACT session, 1-h postsession, and the following 23 h on day 2 and day of discharge. They assessed HRQOL using QoL-B questionnaire and LCQ on day 2 and day of discharge and explored time to first exacerbation for 6 months after discharge.