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Cited by 124Cystic Fibrosis Research AdvancesChronic Obstructive Pulmonary Disease (COPD) ResearchRespiratory and Cough-Related Research

Personalising airway clearance in chronic lung disease

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McIlwaine, Maggie, Bradley, Judy, Elborn, J. Stuart, Moran, Fidelma·2017·European Respiratory Review
DOI 10.1183/16000617.0086-2016PMC PMC9488523
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Abstract

This review describes a framework for providing a personalised approach to selecting the most appropriate airway clearance technique (ACT) for each patient. It is based on a synthesis of the physiological evidence that supports the modulation of ventilation and expiratory airflow as a means of assisting airway clearance. Possession of a strong understanding of the physiological basis for ACTs will enable clinicians to decide which ACT best aligns with the individual patient's pathology in diseases with anatomical bronchiectasis and mucus hypersecretion. The physiological underpinning of postural drainage is that by placing a patient in various positions, gravity enhances mobilisation of secretions. Newer ACTs are based on two other physiological premises: the ability to ventilate behind obstructed regions of the lung and the capacity to achieve the minimum expiratory airflow bias necessary to mobilise secretions. After reviewing each ACT to determine if it utilises both ventilation and expiratory flow, these physiological concepts are assessed against the clinical evidence to provide a mechanism for the effectiveness of each ACT. This article provides the clinical rationale necessary to determine the most appropriate ACT for each patient, thereby improving care.

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Crossref · 10.1183/16000617.0086-2016

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  • Breathing exercise improves respiratory muscle function, ribcage flexibility, and gas exchange, and may decrease blood pressure, respiratory rate, and stress.

    “The physiological rationale behind the progress might be that breathing exercise improves respiratory muscle function, ribcage flexibility, gas exchange, and may decrease blood pressure, respiratory rate, and stress [11, 12, 28, 29]; consequently, helping patients with COVID-19 to manage their respiratory symptoms.”

    From Effects of short-term breathing exercises on respiratory recovery in patients with COVID-19: a quasi-experimental study (2022) · cites this paper as [28]

    The ‘Active cycle of breathing techniques’ section (page unavailable) says thoracic expansion exercises and a breath hold improve ventilation distribution and alveolar gas mixing. That supports a respiratory-ventilation rationale, but it does not establish improved respiratory muscle function or ribcage flexibility, improved gas exchange itself, or reductions in blood pressure, respiratory rate, or stress. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • A forced expiratory technique like huffing and coughing increases the linear velocity of the expiratory airflow and propels secretions, which helps in airway clearance [28].

    “A forced expiratory technique like huffing and coughing increases the linear velocity of the expiratory airflow and propels secretions, which help in airways clearance [28].”

    From Effects of short-term breathing exercises on respiratory recovery in patients with COVID-19: a quasi-experimental study (2022) · cites this paper as [28]

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Research works printed but not linked: 80

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Authors
McIlwaine, M., Bradley, J., Elborn, J. S., & Moran, F.
Affiliations
  • University of British Columbia (CA)
  • Queen's University Belfast (GB)
  • University of Ulster (GB)
Corresponding author
McIlwaine, Maggie
ORCID
Venue
European Respiratory Review
Publisher
European Respiratory Society (ERS)
Published
2017-02-21
Volume
26
Issue
143
Pages
160086
ISSN
  • 0905-9180 (ISSN-L)
  • 1600-0617
DOI
10.1183/16000617.0086-2016
PMC
PMC9488523
OpenAlex
W2591490325
Cited by
124
References
0
Citations by year
2026: 22 · 2025: 6 · 2024: 12 · 2023: 13 · 2022: 25 · 2021: 14 · 2020: 11 · 2019: 12 · 2018: 5 · 2017: 4
FWCI
1.60
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • European Respiratory Review (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Ulster University Research Portal (Ulster University) (acceptedVersion, other-oa)
  • Research Portal (Queen's University Belfast) (submittedVersion, cc-by-nc)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Spiral (Imperial College London) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cystic Fibrosis Research Advances
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory and Cough-Related Research
Keywords
airway clearance techniques, personalized treatment, chronic lung disease, bronchiectasis, mucus hypersecretion, postural drainage
MeSH terms
Animals, Humans, Lung, Lung Diseases, Mucociliary Clearance, Peak Expiratory Flow Rate, Respiration, Artificial, Pulmonary Ventilation, Drainage, Postural, Treatment Outcome, Patient Selection, Quality Indicators, Health Care, Patient Positioning, Precision Medicine, Quality Improvement

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