Airway clearance techniques and exercise in people with bronchiectasis: two different coins

For people with bronchiectasis, achieving long-term adherence to physiotherapy strategies is a major challenge. The regular use of airway clearance techniques (ACTs) reduces the burden of sputum-related symptoms (e.g. increased expectoration during ACT session and reduced need to expectorate/cough throughout the rest of the day), improves quality of life and may reduce exacerbations, according to a recent European Respiratory Society statement [1]; however, there are barriers to long-term implementation (figure 1). There are traditional (e.g. positioning, manual percussions and vibrations) and contemporary strategies (e.g. breathing techniques and devices providing vibrations and/or positive or negative pressures) for airway clearance [1]. The selection of the most appropriate ACT for an individual patient is usually determined by respiratory physiotherapists, with selection based on clinical judgement and the patient's characteristics, symptoms, understanding and preferences [2].