{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:03:25Z","timestamp":1791270205000,"version":"4.1.0"},"reference-count":78,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,1,16]],"date-time":"2019-01-16T00:00:00Z","timestamp":1547596800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>This paper aims to provide physiological rationale for airway clearance, mucoactive therapy and pulmonary rehabilitation (PR) (or exercise interventions) in bronchiectasis. There is increasing emphasis on the role of airway clearance techniques (ACT) in the management of bronchiectasis. No single ACT has currently shown superior effect over another. Given the large range of different techniques available, consideration of the physiological effects underpinning a technique including expiratory flow, ventilation and oscillation, is essential to effectively personalize ACT. Key clinical trials of mucoactives in bronchiectasis are underway and will provide clarity on the role of these agents in the management of patients with bronchiectasis. Prescription of mucoactive therapies should be done in conjunction with ACT and therefore the mechanism of action of mucoactive drugs and their timing with ACT should be taken into consideration. PR and\/or exercise training are recommended in all current bronchiectasis guidelines. There is a clear physiological rationale that muscle weakness and physical inactivity may play a role in disease progression as well as impacting health\u2010related quality of life, frequency of pulmonary exacerbations and ability to mobilize sputum. However, there are residual unanswered questions surrounding the delivery and accessibility to PR. This review summarizes the physiological principles and supporting evidence for airway clearance, mucoactive medication and PR, which are key components in the management of bronchiectasis.<\/jats:p>","DOI":"10.1111\/resp.13459","type":"journal-article","created":{"date-parts":[[2019,1,17]],"date-time":"2019-01-17T00:30:07Z","timestamp":1547685007000},"page":"227-237","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":70,"title":["Airway clearance, mucoactive therapies and pulmonary rehabilitation in bronchiectasis"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7080-9791","authenticated-orcid":false,"given":"Katherine","family":"O'Neill","sequence":"first","affiliation":[{"name":"The Wellcome\u2010Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Science Queen's University Belfast  Belfast UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne E.","family":"O'Donnell","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine Georgetown University Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy M.","family":"Bradley","sequence":"additional","affiliation":[{"name":"The Wellcome\u2010Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Science Queen's University Belfast  Belfast UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,1,16]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"European Respiratory Society.Chapter 15: Bronchiectasis. In:GibsonGJ LoddenkemperR SibilleY Lundb\u00e4ckB(eds)EUROPEAN LUNG White Book.European Respiratory Society Sheffield UK 2014;179\u2013180Available from URL:http:\/\/www.erswhitebook.org\/chapters\/bronchiectasis\/"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.02152"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.molimm.2012.09.011"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-015-0167-9"},{"key":"e_1_2_9_6_1","first-page":"CD011699","article-title":"Positive expiratory pressure therapy versus other airway clearance techniques for bronchiectasis","volume":"9","author":"Lee AL","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"e_1_2_9_7_1","first-page":"CD008351","article-title":"Airway clearance techniques for bronchiectasis","author":"Lee AL","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00629-2017"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2008.110726"},{"key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/thoraxjnl-2018-212463","article-title":"The BTS Guideline for Bronchiectasis in Adults","volume":"74","author":"Hill AT","year":"2019","journal-title":"Thorax"},{"key":"e_1_2_9_11_1","doi-asserted-by":"crossref","unstructured":"Herrero\u2010CortinaB AlibertiS FrancescoB MontserratV ElbornS LoebingerM MenedezR TorresA RingshausenF WelteTet al. Chest physiotherapy in European patients with bronchiectasis: data from EMBARC registry. Abstract Book \u2013 2nd World Bronchiectasis Conference Milan 2017; D23 (100):57.","DOI":"10.1183\/1393003.congress-2017.PA4071"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2466-14-107"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1987.62.3.959"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/1479972306075483"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.57.5.446"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.physio.2015.07.005"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01926-2017"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00055509"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.05214"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1013-7025(09)70037-5"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0086-2016"},{"key":"e_1_2_9_22_1","doi-asserted-by":"crossref","unstructured":"BradleyJ O'NeillK Vilar\u00f3J McIlwaineM.Chapter: Airway clearance in bronchiectasis. In:ChalmersJ PolverinoE AlibertiS(eds)EMBARC Bronchiectasis.Switzerland Springer 2017;257\u2013284. Available from URL:http:\/\/www.springer.com\/gb\/book\/9783319614519#aboutBook.","DOI":"10.1007\/978-3-319-61452-6_18"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.06.00083605"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.04570"},{"key":"e_1_2_9_25_1","unstructured":"Trudell Medical International Europe Ltd. Aerobika* oscillating positive expiratory pressure therapy system.2018. [Accessed 20 June 2018.] Available from URL:https:\/\/www.trudellmed.com\/aerobika"},{"key":"e_1_2_9_26_1","first-page":"577","article-title":"Comparative laboratory study of oscillating positive expiratory pressure waveforms from commercially available devices used in airway clearance therapy","volume":"3","author":"Suggett JA","year":"2014","journal-title":"Respir. Drug Deliv."},{"key":"e_1_2_9_27_1","unstructured":"POWERbreathe International Limited. HaB International Ltd. presentation on the shaker technique.2018. [Accessed 20 June 2018.] Available from URL:https:\/\/www.powerbreathe.com\/other-products\/expectoration"},{"key":"e_1_2_9_28_1","doi-asserted-by":"crossref","first-page":"298","DOI":"10.4187\/respcare.01685","article-title":"Mechanical behaviors of Flutter VRP1, Shaker, and Acapella devices","volume":"58","author":"Santos AP","year":"2013","journal-title":"Respir. Care"},{"key":"e_1_2_9_29_1","unstructured":"Actegy Limited. REFLEX Cain Road Bracknell RG12 1HL UK. Revitive Aerosure.2018. [Accessed 9 Oct 2018.] Available from URL:http:\/\/www.aerosure-medic.com\/"},{"key":"e_1_2_9_30_1","unstructured":"R. Cegla GmbH & Co. KG. RC\u2010Cornet\u00ae. [Accessed 15 June 2018.] Available from URL:https:\/\/www.cegla.de\/en\/products\/respiratory-physiotherapy.html"},{"key":"e_1_2_9_31_1","first-page":"20","article-title":"Comparison of quake and RC\u2010Cornet for airway clearance in bronchiectasis: a randomized crossover trial","volume":"2","author":"Vyas A","year":"2012","journal-title":"Int. J. Health Sci. Res."},{"key":"e_1_2_9_32_1","unstructured":"Eurofins. Eurofins tes report for RC\u2010Cornet device or RC\u2010Cornet PLUS device.2016."},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1989.67.2.614"},{"key":"e_1_2_9_34_1","unstructured":"Medical Acoustics LLC. The Lung Flute From Medical Acoustics. [Accessed 15 Aug 2018.] Available from URL:http:\/\/www.lungflute.com\/default.aspx"},{"key":"e_1_2_9_35_1","unstructured":"Westmed Inc.Vibralung Acoustical Percussor. [Accessed 15 June 2018.] Available from URL:https:\/\/westmedinc.com\/vibralung\/vl-aerosol\/"},{"key":"e_1_2_9_36_1","unstructured":"Dymedso. The Frequencer\u00ae. [Accessed 15 June 2018.] Available from URL:http:\/\/www.dymedso.com\/frequencer\/"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2017.00002"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31554-X"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2012-203054"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1183\/09059180.00003510"},{"key":"e_1_2_9_41_1","first-page":"CD002996","article-title":"Inhaled hyperosmolar agents for bronchiectasis","author":"Hart A","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"e_1_2_9_42_1","first-page":"CD001289","article-title":"Mucolytics for bronchiectasis","author":"Wilkinson M","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"e_1_2_9_43_1","first-page":"CD002996","article-title":"Inhaled hyperosmolar agents for bronchiectasis","author":"Wills P","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.113.5.1329"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1159\/000195910"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2007.09.003"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.154.2.8756815"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-1763"},{"key":"e_1_2_9_49_1","first-page":"1966","article-title":"Inhaled mannitol for non\u2010cystic fibrosis bronchiectasis: results of a 12 month, multi\u2010centre, double\u2010blind, controlled study","volume":"42","author":"Bilton D","year":"2013","journal-title":"Eur. Respir. J."},{"key":"e_1_2_9_50_1","first-page":"CD001506","article-title":"Nebulised hypertonic saline for cystic fibrosis","author":"Wark P","year":"2009","journal-title":"Cochrane Database Syst. Rev."},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1089\/jamp.2017.1443"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2011.07.019"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2011.12.021"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02052-2017"},{"key":"e_1_2_9_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2017.05.007"},{"key":"e_1_2_9_56_1","unstructured":"DanielsT MorrisonL LewisS. Association of chartered physiotherapists in cystic fibrosis standard of care and good clinical practice for the physiotherapy management of cystic fibrosis. Draft.2016. [Accessed Dec 2016.] Available from URL:http:\/\/www.csp.org.uk\/professional-networks\/acpcf"},{"key":"e_1_2_9_57_1","doi-asserted-by":"publisher","DOI":"10.1089\/jam.2006.19.100"},{"key":"e_1_2_9_58_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00166410"},{"key":"e_1_2_9_59_1","doi-asserted-by":"crossref","unstructured":"ISRCTN Register. A 2x2 factorial randomised open label trial to determine the CLinical and cost\u2010Effectiveness of hypertonic saline (HTS 6%) and carbocisteine for Airway cleaRance versus usual care over 52 weeks in bronchiectasis.2018. [Accessed 11 Sept 2018.] Available from URL:https:\/\/doi.org\/10.1186\/ISRCTN89040295","DOI":"10.1186\/ISRCTN89040295"},{"key":"e_1_2_9_60_1","unstructured":"Australian New Zealand Clinical Trials Registry. ACTRN12611001199909. The effect of azithromycin and hypertonic saline on quality of life lung function and exercise capacity in adults with non\u2010cystic fibrosis bronchiectasis.2012. [Accessed 11 Sept 2018.] Available from URL:https:\/\/anzctr.org.au\/Trial\/Registration\/TrialReview.aspx?id=347657&isReview=true"},{"key":"e_1_2_9_61_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201401-0129ED"},{"key":"e_1_2_9_62_1","unstructured":"EMBARC website.2017. [Accessed 5 May 2017.] Available from URL:https:\/\/www.bronchiectasis.eu\/"},{"key":"e_1_2_9_63_1","first-page":"CD001287","article-title":"Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease","author":"Poole P","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"e_1_2_9_64_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201303-0411CI"},{"key":"e_1_2_9_65_1","doi-asserted-by":"publisher","DOI":"10.5694\/mjac14.00287"},{"key":"e_1_2_9_66_1","doi-asserted-by":"publisher","DOI":"10.1157\/13128330"},{"key":"e_1_2_9_67_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201309-1634ST"},{"key":"e_1_2_9_68_1","doi-asserted-by":"publisher","DOI":"10.1183\/09059180.00005613"},{"key":"e_1_2_9_69_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2016.05.017"},{"key":"e_1_2_9_70_1","doi-asserted-by":"publisher","DOI":"10.1159\/000375170"},{"key":"e_1_2_9_71_1","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0b013e3182631314"},{"key":"e_1_2_9_72_1","doi-asserted-by":"publisher","DOI":"10.1177\/1479972310391282"},{"key":"e_1_2_9_73_1","doi-asserted-by":"publisher","DOI":"10.1159\/000380771"},{"key":"e_1_2_9_74_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2012.08.004"},{"key":"e_1_2_9_75_1","doi-asserted-by":"publisher","DOI":"10.1186\/1465-9921-15-44"},{"key":"e_1_2_9_76_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2016.08.008"},{"key":"e_1_2_9_77_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjpt.2017.06.021"},{"key":"e_1_2_9_78_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-018-0646-0"},{"key":"e_1_2_9_79_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00119114"}],"container-title":["Respirology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fresp.13459","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/resp.13459","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/resp.13459","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/resp.13459","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T21:07:59Z","timestamp":1694207279000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/resp.13459"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1,16]]},"references-count":78,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2019,3]]}},"alternative-id":["10.1111\/resp.13459"],"URL":"https:\/\/doi.org\/10.1111\/resp.13459","archive":["Portico"],"relation":{},"ISSN":["1323-7799","1440-1843"],"issn-type":[{"value":"1323-7799","type":"print"},{"value":"1440-1843","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1,16]]},"assertion":[{"value":"2018-07-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-11-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-01-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}