A review of physiotherapy practice for people with bronchiectasis

People with bronchiectasis experience chronic productive cough and acute exacerbations, which are linked to poorer quality of life and a higher rate of disease progression. The clinical guidelines for bronchiectasis management recommend physiotherapy [1, 2]. These guidelines advise the prescription of airway clearance techniques (ACTs) to improve sputum clearance and reduce symptoms [1, 2]. Mucoactive agents may be cautiously considered when required [1, 2]. Individuals with reduced exercise tolerance are recommended to engage in pulmonary rehabilitation or undertake exercise or physical activity [1,2]. Surveys of physiotherapy management for people with bronchiectasis have described commonly applied ACTs [3, 4] but have not alluded to technique combinations, a strategy considered a key approach towards personalising therapy [3–5]. Other audits have highlighted that ACTs were applied in only 49% and 52% of people with bronchiectasis in Europe and Australia respectively, reflecting a potential underuse of this therapeutic approach [6, 7]. Low referral rates to pulmonary rehabilitation have been noted [3, 7], and the prescription of exercise and physical activity beyond pulmonary rehabilitation is unknown [3]. It is acknowledged that comorbidities are common in people with bronchiectasis [1, 2]. Gastro-oesophageal reflux disease (GORD) may increase exacerbation risk [8]. Stress urinary incontinence has been linked to reduced quality of life [9]. Chronic rhinosinusitis is associated with greater disease severity and poorer HRQOL [10]. Those with bronchiectasis may be at an increased risk of cardiovascular disease, independent of established cardiovascular risk factors or comorbidities [11]. Finally, musculoskeletal disorders including osteoarthritis or osteoporosis have been noted in bronchiectasis, and may account for joint stiffness and pain [12].