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Meta-Analysis
. 2016 Jul 5;7(7):CD007862.
doi: 10.1002/14651858.CD007862.pub4.

Active cycle of breathing technique for cystic fibrosis

Naomi A Mckoy  1 , Lisa M Wilson, Ian J Saldanha, Olaide A Odelola, Karen A Robinson
Affiliations
Meta-Analysis

Active cycle of breathing technique for cystic fibrosis

Naomi A Mckoy et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: People with cystic fibrosis experience chronic airway infections as a result of mucus build up within the lungs. Repeated infections often cause lung damage and disease. Airway clearance therapies aim to improve mucus clearance, increase sputum production, and improve airway function. The active cycle of breathing technique (also known as ACBT) is an airway clearance method that uses a cycle of techniques to loosen airway secretions including breathing control, thoracic expansion exercises, and the forced expiration technique. This is an update of a previously published review.

Objectives: To compare the clinical effectiveness of the active cycle of breathing technique with other airway clearance therapies in cystic fibrosis.

Search methods: We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of last search: 25 April 2016.

Selection criteria: Randomised or quasi-randomised controlled clinical studies, including cross-over studies, comparing the active cycle of breathing technique with other airway clearance therapies in cystic fibrosis.

Data collection and analysis: Two review authors independently screened each article, abstracted data and assessed the risk of bias of each study.

Main results: Our search identified 62 studies, of which 19 (440 participants) met the inclusion criteria. Five randomised controlled studies (192 participants) were included in the meta-analysis; three were of cross-over design. The 14 remaining studies were cross-over studies with inadequate reports for complete assessment. The study size ranged from seven to 65 participants. The age of the participants ranged from six to 63 years (mean age 22.33 years). In 13 studies, follow up lasted a single day. However, there were two long-term randomised controlled studies with follow up of one to three years. Most of the studies did not report on key quality items, and therefore, have an unclear risk of bias in terms of random sequence generation, allocation concealment, and outcome assessor blinding. Due to the nature of the intervention, none of the studies blinded participants or the personnel applying the interventions. However, most of the studies reported on all planned outcomes, had adequate follow up, assessed compliance, and used an intention-to-treat analysis.Included studies compared the active cycle of breathing technique with autogenic drainage, airway oscillating devices, high frequency chest compression devices, conventional chest physiotherapy, and positive expiratory pressure. Preference of technique varied: more participants preferred autogenic drainage over the active cycle of breathing technique; more preferred the active cycle of breathing technique over airway oscillating devices; and more were comfortable with the active cycle of breathing technique versus high frequency chest compression. No significant difference was seen in quality of life, sputum weight, exercise tolerance, lung function, or oxygen saturation between the active cycle of breathing technique and autogenic drainage or between the active cycle of breathing technique and airway oscillating devices. There was no significant difference in lung function and the number of pulmonary exacerbations between the active cycle of breathing technique alone or in conjunction with conventional chest physiotherapy. All other outcomes were either not measured or had insufficient data for analysis.

Authors' conclusions: There is insufficient evidence to support or reject the use of the active cycle of breathing technique over any other airway clearance therapy. Five studies, with data from eight different comparators, found that the active cycle of breathing technique was comparable with other therapies in outcomes such as participant preference, quality of life, exercise tolerance, lung function, sputum weight, oxygen saturation, and number of pulmonary exacerbations. Longer-term studies are needed to more adequately assess the effects of the active cycle of breathing technique on outcomes important for people with cystic fibrosis such as quality of life and preference.

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Conflict of interest statement

All authors: none known.

Figures

1
1
Methodological quality summary: review authors' judgements about methodological quality items for each included study.
2
2
Methodological quality graph: review authors' judgements about methodological quality items presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 ACBT versus ACBT+CCPT, Outcome 1 FEV1%.
1.2
1.2. Analysis
Comparison 1 ACBT versus ACBT+CCPT, Outcome 2 FVC %.
1.3
1.3. Analysis
Comparison 1 ACBT versus ACBT+CCPT, Outcome 3 Pulmonary exacerbation.
2.1
2.1. Analysis
Comparison 2 ACBT versus PEP, Outcome 1 FEV1.
3.1
3.1. Analysis
Comparison 3 ACBT versus AOD (Cornet), Outcome 1 FEV1.
4.1
4.1. Analysis
Comparison 4 ACBT versus AOD (Flutter), Outcome 1 FEV1.
4.2
4.2. Analysis
Comparison 4 ACBT versus AOD (Flutter), Outcome 2 Sputum weight.
5.1
5.1. Analysis
Comparison 5 ACBT+CCPT versus AOD (Flutter), Outcome 1 FEV1.
5.2
5.2. Analysis
Comparison 5 ACBT+CCPT versus AOD (Flutter), Outcome 2 FEV1%.
5.3
5.3. Analysis
Comparison 5 ACBT+CCPT versus AOD (Flutter), Outcome 3 FVC.
5.4
5.4. Analysis
Comparison 5 ACBT+CCPT versus AOD (Flutter), Outcome 4 FVC %.
5.5
5.5. Analysis
Comparison 5 ACBT+CCPT versus AOD (Flutter), Outcome 5 Sputum weight.
5.6
5.6. Analysis
Comparison 5 ACBT+CCPT versus AOD (Flutter), Outcome 6 Oxygen saturation.
6.1
6.1. Analysis
Comparison 6 ACBT+CCPT versus HFCC (HFCWO), Outcome 1 FEV1.
6.2
6.2. Analysis
Comparison 6 ACBT+CCPT versus HFCC (HFCWO), Outcome 2 FEV1%.
6.3
6.3. Analysis
Comparison 6 ACBT+CCPT versus HFCC (HFCWO), Outcome 3 FVC.
6.4
6.4. Analysis
Comparison 6 ACBT+CCPT versus HFCC (HFCWO), Outcome 4 FVC %.
6.5
6.5. Analysis
Comparison 6 ACBT+CCPT versus HFCC (HFCWO), Outcome 5 Sputum weight.
6.6
6.6. Analysis
Comparison 6 ACBT+CCPT versus HFCC (HFCWO), Outcome 6 Oxygen saturation.
7.1
7.1. Analysis
Comparison 7 ACBT versus AD, Outcome 1 FEV1.
7.2
7.2. Analysis
Comparison 7 ACBT versus AD, Outcome 2 Sputum weight.
8.1
8.1. Analysis
Comparison 8 ACBT+CCPT versus AD, Outcome 1 FEV1.
8.2
8.2. Analysis
Comparison 8 ACBT+CCPT versus AD, Outcome 2 FEV1%.
8.3
8.3. Analysis
Comparison 8 ACBT+CCPT versus AD, Outcome 3 FVC.
8.4
8.4. Analysis
Comparison 8 ACBT+CCPT versus AD, Outcome 4 FVC %.
8.5
8.5. Analysis
Comparison 8 ACBT+CCPT versus AD, Outcome 5 Sputum weight.
8.6
8.6. Analysis
Comparison 8 ACBT+CCPT versus AD, Outcome 6 Oxygen saturation.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Bilton 1992 {published data only}
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Chatham 2004 {published data only}
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Fauroux 1999 {published data only}
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Hofmeyr 1986 {published data only}
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Holland 2003 {published data only}
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Howard 2000 {published data only}
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Kofler 1994 {published data only}
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Miller 1995 {published data only}
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Milne 2004 {published data only}
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Mortensen 1991 {published data only}
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Phillips 2004 {published data only}
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Pike 1999 {published data only}
    1. Pike SE, Machin AC, Dix KJ, Pryor JA, Hodson ME. Comparison of flutter VRPI and forced expirations (FE) with active cycle of breathing techniques (ACBT) in subjects with cystic fibrosis (CF) [abstract]. Netherlands Journal of Medicine 1999;54:S55‐S56.
Pryor 1979 {published data only}
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Pryor 1994 {published data only}
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Pryor 2010 {published data only}
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Reisman 1988 {published data only}
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Steven 1992 {published data only}
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Webber 1985 {published data only}
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    1. Webber B, Parker RA, Hofmeyr JL, Hodson ME. Evaluation of self percussion during postural drainage using the forced expiration technique (FET) [abstract]. Proceedings of 9th International Cystic Fibrosis Congress. 1984:2‐12.

References to studies excluded from this review

Andreasson 1987 {published data only}
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Asher 1982 {published data only}
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Bain 1988 {published data only}
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Baldwin 1994 {published data only}
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Braggion 1995 {published data only}
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Chatham 1998 {published data only}
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Desmond 1983 {published data only}
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Falk 1984 {published data only}
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Gursli 2013 {published data only}
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Hasani 1991 {published data only}
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Hasani 1994a {published data only}
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Hasani 1994b {published data only}
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Klig 1989 {published data only}
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Kofler 1998 {published data only}
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McDonnell 1986 {published data only}
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Oberwaldner 1986 {published data only}
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Orlik 2000 {published data only}
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Orlik 2001 {published data only}
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Prasad 1998a {published data only}
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Prasad 2000 {published data only}
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Pryor 1990a {published data only}
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Rogers 1984 {published data only}
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Rossman 1982 {published data only}
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Salh 1989 {published data only}
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Steen 1991 {published data only}
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Sutton 1983 {published data only}
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Sutton 1985 {published data only}
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Thomas 1995 {published data only}
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van Hengstum 1987 {published data only}
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Verboon 1986 {published data only}
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Webber 1986 {published data only}
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White 1997 {published data only}
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Williams 1994 {published data only}
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Williams 2000 {published data only}
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Wilson 1995 {published data only}
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Znotina 2000 {published data only}
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References to studies awaiting assessment

Castle 1994 {published data only}
    1. Castle T, Metcalfe C, Knox A. A comparison between the active cycle of breathing technique (A.C.B.T.) and positive expiratory pressure (PEP) mask plus A.C.B.T. on sputum production and lung volumes in adults with cystic fibrosis [abstract]. Proceedings of 19th European Cystic Fibrosis Conference; 1994 May 29‐June 3; Paris, France. 1994:O17.
Chatham 1999 {published data only}
    1. Chatham K, Nixon LS, Ionescu AA, Garwood R, Premier G, Shale DJ. Increased sputum expectoration in cystic fibrosis patients after repeated resisted mueller manoeuvres. Pediatric Pulmonology 1998;26(Suppl 17):348 no. 505.
    1. Chatham K, Nixon LS, Ionescu AA, Shale DJ. Repeated inspiratory manoeuvres against a fixed resistance with biofeedback is more effective than standard chest physiotherapy in aiding sputum expectoration in cystic fibrosis [abstract]. Pediatric Pulmonology 1999;28(Suppl 19):289.
Falk 1993 {published data only}
    1. Falk M, Mortensen J, Kelstrup M, Lanng S, Larsen L, Ulrik CS. Short‐term effects of positive expiratory pressure and the forced expiration technique on mucus clearance and lung function in CF [abstract]. Pediatric Pulmonology 1993;16(Suppl 9):241.
    1. Larsen L, Mortensen J, Falk M, Kelstrup M, Lanng S, Ulrik CS. Radiolabelled mucus clearance in patients with cystic fibrosis is improved by physiotherapy with positive expiratory pressure and the forced expiration technique [abstract]. Clinical Physiology 1994;14:365.
    1. Mortensen J, Falk M, Kelstrump M, Lanng S, Ulrik CS. Effect of positive expiratory pressure and the forced expiration technique on mucus clearance in patients with cystic fibrosis [abstract]. European Respiratory Journal 1993;6(Suppl 17):4409S.
Lannefors 1992 {published data only}
    1. Lannefors L, Wollmer P. Mucus clearance in cystic fibrosis (CF) ‐ a comparison between postural drainage, PEP‐mask and physical exercise [abstract]. Proceedings of 11th International Cystic Fibrosis Congress; 1992; Dublin, Ireland. 1992:AHP31. - PubMed
    1. Lannefors L, Wollmer P. Mucus clearance with three chest physiotherapy regimes in cystic fibrosis: a comparison between postural drainage, PEP and physical exercise. European Respiratory Journal 1992;5(6):748‐73. - PubMed
Parker 1984 {published data only}
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Petrone 2009 {published data only}
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References to other published versions of this review

McKoy 2012
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