Airway clearance techniques in patients with bronchiectasis. Data from the EMBARC Registry

Introduction: Clinical guidelines recommend airway clearance techniques (ACTs) in adults with bronchiectasis. There is a paucity of evidence about their clinical implementation, particularly in different healthcare systems. Multicentre registries can facilitate studying patterns and differences across countries. Methods: Outpatients with bronchiectasis were prospectively recruited to the multicentre European Bronchiectasis Registry EMBARC. Patient-reported ACTs were registered in 31 countries. Demographic, baseline health status, exacerbations, radiology, and treatments were recorded. Results: Data were collected between 2015 and 2018. 13,512 patients participated, mean (SD) age 64.2 (14.6) years old, 8,121 females (60.1%). Only 48.3% of the participants reported performing airway clearance regularly. The most commonly used techniques were active cycle of breathing techniques (ACBT) (26.8%) and postural drainage (6.0%). 21.2% of patients used one or more airway clearance devices. Flutter (8.9%), fixed positive expiratory pressure (PEP) (6.5%) and Acapella (4.4%) were the most commonly used ones. The vast majority of patients perform regular ACTs in Denmark (91.7%) and Finland (88.7%), compared to less than 10% of participants in Bulgaria, North Macedonia, Moldova, Romania, and Sweden. The primary reason for not doing airway clearance was that it was not required in the opinion of the clinicians (67.9%). Conclusions: Most patients with bronchiectasis do not routinely perform ACTs. Clinicians’ opinion is often that bronchiectasis patients do not require ACTs. Acknowledgments: EMBARC has received support from the EU/EFPIA Innovative Medicines Initiative Joint Undertaking iABC grant agreement no 115721.