RESUMEN
BACKGROUND: Airway clearance is a fundamental component of bronchiectasis care. Lung clearance index (LCI) is a measurement of ventilation inhomogeneity. Its responsiveness to long-term airway clearance is unknown. We aimed to compare two methods of daily airway clearance over 4â weeks: autogenic drainage (AD) and oscillating positive airway pressure (oPEP), and to determine effects of airway clearance on LCI and clinical outcomes. METHODS: Adults with bronchiectasis naive to airway clearance were randomised to daily airway clearance with either AD or oPEP. Difference in LCI as primary outcome, spirometry, sputum volume and purulence, and quality of life were at randomisation and after 4â weeks of airway clearance. RESULTS: 51 patients (32 women and 19 men, mean age 66.2±12.8â years) were randomised and 49 completed the study (25 AD and 24 oPEP). The LCI and forced expiratory volume in 1â s did not change between visits between groups (difference between groups 0.02), nor between visits in either group. Sputum quantity decreased in 12 out of 24 (50%) of the oPEP group, and in six out of 25 (24%) of the AD group (p=0.044). The "treatment burden" worsened or was unchanged in 70% of participants randomised to AD and 55% randomised to oPEP (p=0.038). CONCLUSION: Sputum quantity decreased in more participants randomised to oPEP group after 1â month of daily airway clearance, with a better treatment burden. The effects of 4â weeks of airway clearance on LCI were not significant in either treatment group.