A Comparative Study between Vibratory PEP Device (Acapella) with ‘Usual Airway Clearance’ to see the Outcome during Acute Exacerbation of Bronchiectasis

Abstract

Background: People with bronchiectasis suffer from chronic cough and sputum production. Repeated acute exacerbation may result in increased incidence of hospitalization and decline in health related quality of life. Physiotherapy involvement in the management of bronchiectasis is supported by international guidelines which states that individuals with a chronic productive cough or difficult clearing sputum should be taught on airway clearance technique (ACT). So, during an acute exacerbation of bronchiectasis, intensive ACTs and follow up are required to facilitate expectoration of sputum from lungs. But which ACTs such as “vibratory pep device (Acapella)” or ACBT is more effective in acute exacerbation of bronchiectasis need to be determined. Objective: To compare the efficacy of vibratory pep device (Acapella) in acute exacerbation of bronchiectasis to ‘usual airway clearance’ technique. Materials and Methods: This cross-sectional study was carried out at the department of Respiratory Medicine of National Institute of Diseases of the Chest and Hospital (NIDCH), Mohakhali, Dhaka from January 2022 to December 2022. Total 60 patients of bronchiectasis were selected and they were allocated to one of the two groups according to the inclusion and exclusion criteria. Detailed physical examination and relevant investigations were done. Group 1 (n=30) was required to perform airway clearance twice daily with vibratory PEP device (Acapella). Group 2(n=30) performed ACBT. All patients were provided with a patient’s diary and 28 sputum containers; two for each day. Amount of sputum production was measured in all patients during and after the acapella and usual airway clearance technique (ACBT). Time consumption of the procedure, perception of breathlessness, cough, chest pain, exercise tolerance, hemoptysis, comfort of the procedure, pts well-being was recorded during 14 days of study period. All the information were recorded in a tabulated data sheet and all data were analyzed statistically. Results: The mean duration of time consumption was found 27.1±2.2 minutes in Acapella group and 19.9±2.3 minutes in ACBT group. The difference was statistically significant between two groups (p<0.05). At 2 weeks the mean sputum production was found 5.9±4.9 in Acapella group and 9.9±3.6 in ACBT group. Average mean sputum production was more in Acapella group that was 23.5±3.7 and 18.3±2.1 in acapella group and ACBT group respectively which was found statistically significant(p<0.05). Comparing time consumption was observed more among the acapella user rather than ACBT (27.1±2.2 to 19.9±2.3 accordingly) and it was statistically significant(p<0.05). Exercise tolerance was improved to acapella users (291.1±28.7) compared to ACBT users (250.0±25.9), and it was found significant(p<0.05). Perception of breathlessness, cough, exercise tolerance, fatigue, appetite comfort of the device was improved equally among both the study group. Conclusion: Sputum production was more in the group using Vibratory Pep Device (Acapella), most of the patient found the device user friendly, they spent more time with the device for airway clearance and found adhered with the therapy more comfortably. So, Vibratory Pep Device (Acapella) offers an user friendly alternative to “usual airway clearance (ACBT)”. Chest Heart J. 2024; 48(2) : 74-82