Airways Clearance Treatments Survey in BronchiEctasis (ACT-BE)
Research type
Research Study
Full title
Airways Clearance Treatments in adults with BronchiEctasis (ACT-BE): A Northern Ireland pilot survey of patients and physiotherapists
IRAS ID
266227
Contact name
Judy Bradley
Contact email
Sponsor organisation
Queens University Belfast
Duration of Study in the UK
1 years, 6 months, 30 days
Research summary
Research Summary
People with bronchiectasis often clear lots of phlegm and have chest infections. Airway clearance treatments can help clear phlegm from the lungs. These treatments are provided by physiotherapists. However, in Northern Ireland, we do not know what airway clearance treatments adults with bronchiectasis do, or how frequently they do these treatments. Airway clearance treatments are one of the most burdensome aspects of treatment, yet we do not know whether doing airway clearance improves your wellbeing and decreases chest infections in the long term.
We aim to develop a survey to collect information from adults with bronchiectasis and from physiotherapists who care for adults with bronchiectasis in Northern Ireland. We have involved people with bronchiectasis and the public in developing the surveys to make sure they ask the right questions.The surveys will ask questions on all aspects of airway clearance treatments. People with bronchiectasis can go online and complete the survey, and also give us information on how well they feel and about their chest infections. We can use the results to find out what treatments people with bronchiectasis do and what physiotherapists in Northern Ireland provide if collecting this information via online survey is feasible.
We will also look for any link between airway clearance treatments, how well a person is and how many infections they get. These results will tell us about current practice and provide more evidence to support airway clearance treatments in bronchiectasis. These results will inform a bigger survey Europe wide and a study to improve service delivery for people with bronchiectasis.Summary of Results
Background: Bronchiectasis is a long-term respiratory condition. People living with bronchiectasis experience frequent coughing, excessive phlegm and frequent chest infections. One way people with bronchiectasis can try to manage their condition is by using airway clearance treatments. Airway clearance treatments can help loosen up phlegm and make it easier to cough out of the lungs. This can reduce the occurrence of lung infections and can improve quality of life. Despite this, bronchiectasis experts have little information on what people with bronchiectasis and physiotherapists who treat them think about airway clearance treatments.
Aims: To develop and send out an online survey to people with bronchiectasis and physiotherapists who treat them to find out about airway clearance practice in Northern Ireland. To explore the best methods for carrying out a larger version of this survey in the future. To assess if patients airway clearance practices are related to their clinical status.
Methods: We used SurveyMonkey to develop two surveys that asked questions about current airway clearance practices in Northern Ireland. Survey 1 was sent at the start of the study to 398 people with bronchiectasis. Survey 2 was sent 12 months later to 182 people with bronchiectasis. A physiotherapy survey was sent to 100 physiotherapists. We included an iPad prize draw and sent out reminders to find out if it encouraged people to respond to the survey. Upon survey completion, the survey data were matched to the patients’ clinical data from the EMBARC/Bronch-UK registry and associations between patient-reported airway clearance practices and their clinical outcome data were explored.
Results
205 people with bronchiectasis completed survey 1 and 96 people with bronchiectasis completed survey 2. 48 physiotherapists completed the physiotherapy survey. We found that some people with bronchiectasis needed help when completing the online survey but physiotherapists could complete it independently. Sending reminders encouraged patients and physiotherapists to complete the survey but the iPad prize draw had no effect.
Most people with bronchiectasis said that their physiotherapist taught them airway clearance treatments and they mainly use them to help in reducing symptoms. Most people reported using active cycle of breathing techniques, huffing and exercise forms of airway clearance treatment. Before performing airway clearance, some people said they take bronchodilators or hypertonic saline medication. How often and how long people perform airway clearance for depends on how much phlegm they have and how clear their chest feels. Most people said that seeing a bronchiectasis specialist and being taught how to do airway clearance are the most important parts to first visits with a physiotherapist. Almost half of people said they have not received follow-up appointments for airway clearance. Of those who received follow-up appointments, most said it was through a hospital-based physiotherapist. Most people said they would consider phone-based follow-up appointments.
Most physiotherapists said that chest assessment was the most important factor in a patient’s first visit, and that seeing a respiratory specialist was more important than visit location. Most physiotherapists said that the symptoms, understanding and capabilities of a patient are the most important factors when choosing airway clearance treatments. Most physiotherapists said that patient symptoms and disease severity were the most important priorities during follow-up visits. Most physiotherapists said they would consider using phone-based follow-up appointments for airway clearance treatments.
108 patients had a registry review visit within 6 months of completing survey 1 and it was found that patients’ airway clearance practices were related to their clinical status. Patients who used airway clearance treatments experienced a higher number of exacerbations, worse quality of life, were more likely to have seen a specialist physiotherapist and have received a self-management plan for airway clearance treatments than patients who had not used airway clearance treatments. Patients who used adjunct (devices e.g. acapella) airway clearance treatments were likely to be younger than patients who only used non-adjunct types (manual e.g. active cycle of breathing, huffing). Patients who used adjuncts experienced a higher number of exacerbations and a worse quality of life than patients who used non-adjuncts. Patients who used airway clearance treatments more often and for longer experienced a higher number of exacerbations, greater disease severity and worse quality of life than patients who used airway clearance treatments less often and for shorter amounts of time. Patients who used mucoactive medications experienced a higher number of exacerbations, more breathlessness and a worse quality of life than patients who did not use mucoactive medications. We found that clinical characteristics did not affect the probability of patients using airway clearance treatments. We found that the probability of using a mucoactive decreased slightly in patients who were older and in patients with better quality of life (QoL-B respiratory symptoms domain), however each additional exacerbation experienced that required hospital care in the preceding year substantially increased the probability of using a mucoactive.
Conclusion: Our survey provided information about current airway clearance practice in Northern Ireland, and provided evidence supporting their use for bronchiectasis. These findings will facilitate the design of a European wide survey and a study to improve service delivery for people with bronchiectasis.REC name
South Central - Hampshire B Research Ethics Committee
REC reference
19/SC/0528
Date of REC Opinion
10 Oct 2019
REC opinion
Favourable Opinion