Researchers identify gap in European bronchiectasis treatment

New research published in the European Respiratory Journal shows that nearly half of European people with bronchiectasis do not regularly practice airway clearance management.

Bronchiectasis is a long-term condition where the airways of the lungs become widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection. International guidelines recommend airway clearance management, a range of breathing techniques, known that can help remove mucus from your lungs, as one of the important pillars of bronchiectasis treatment.

The study, led by Dr. Arietta Spinou and involving a team of international experts, is the largest and most detailed description of the use of airway clearance management in bronchiectasis or any other respiratory disease to date.

This work used data from the European Bronchiectasis Registry (EMBARC) involving 16,723 people with bronchiectasis from 28 countries and investigated pre-specified options for airway clearance management, including airway clearance techniques, devices, and the use of mucoactive drugs.

Of the participants, 72% reported daily sputum expectoration, and it was found that 52% of all participants reported using regular airway clearance management.

"Our data should serve as a call to action on two fronts, firstly to improve the global uptake of airway clearance management in bronchiectasis with the goal of reducing exacerbations, potentially avoidable antibiotic exposures and improving symptom burden and quality of life," said Spinou.

The proportion of participants performing airway clearance was similar when the analysis was limited to patients reporting daily sputum expectoration; this is despite recommendations from all the major bronchiectasis guidelines to teach airway clearance management to people with bronchiectasis and for patients to practice these techniques regularly.

Most guidelines also recommend that a specialist in respiratory physiotherapy best teaches airway clearance management, but it has been shown that less than a quarter of patients in Europe have been referred for training by a specialist.

"Our results have shown limited access to training for airway clearance management, with less than a quarter of patients receiving training from a respiratory physiotherapist. This suggests a widespread lack of implementation of airway clearance management as an intervention for people with bronchiectasis," said Spinou.

The large sample size of the EMBARC registry allowed comparisons to be made between countries in terms of the use of specific airway clearance management. Identifying marked differences between countries in Europe, with higher use of airway clearance techniques in Northern European and some Western European countries.

There were great differences throughout all of Europe in the use of interventions such as the active cycle of breathing techniques, autogenic drainage, and the use of airway clearance devices.

The scale of these differences suggests that the lack of evidence in this field leads to decisions based on local preference since differences between countries persisted even after adjustment for patient characteristics and severity.

Identifying that efforts to increase the use and standardization of airway clearance management in Europe are needed. The lack of evidence in this field also extends to mucoactive drug treatments, where large-scale trials are lacking, supporting the need for further research into all forms of bronchiectasis treatments.