European Respiratory Society statement on airway clearance techniques in adults with bronchiectasis

Beatriz Herrero-Cortina, Annemarie l. Lee, Ana Oliveira, Brenda O'neill, Cristina Jácome, Simone Dal corso, William Poncin, Gerard Muñoz, Deniz Inal-Ince, Victoria Alcaraz-Serrano, Gregory Reychler, Angela Bellofiore, Thomy Tonia, James d Chalmers, Arietta Spinou

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Airway clearance techniques (ACTs) are part of the main management strategy for patients with bronchiectasis. Despite being a priority for patients, accessibility, implementation and reporting of ACTs are variable in clinical settings and research studies. This European Respiratory Society statement summarises current knowledge about ACTs in adults with bronchiectasis and makes recommendations to improve the future evidence base. A task force of 14 experts and two patient representatives (10 countries) determined the scope of this statement through consensus and defined six questions. The questions were answered based on systematic searches of the literature. The statement provides a comprehensive review of the physiological rationale for ACTs in adults with bronchiectasis, and the mechanisms of action along with the advantages and disadvantages of each ACT. Evidence on ACTs in clinical practice indicates that the most frequently used techniques are active cycle of breathing techniques, positive expiratory pressure devices and gravity-assisted drainage, although there is limited evidence on the type of ACTs used in specific countries. A review of 30 randomised trials for the effectiveness of ACTs shows that these interventions increase sputum clearance during or after treatment, reduce the impact of cough and the risk of exacerbations, and improve health-related quality of life. Furthermore, strategies for reducing the risk of bias in future studies are proposed. Finally, an exploration of patients' perceptions, barriers and enablers related to this treatment is also included to facilitate implementation and adherence to ACTs.

Original languageEnglish
Article number2202053
Number of pages171
JournalEuropean Respiratory Journal
Issue number1
Early online date4 May 2023
Publication statusPublished online - 4 May 2023

Bibliographical note

Funding Information:
The task force panel, which represented 10 countries, included 13 expert respiratory physiotherapists, two patient representatives and a respiratory physician with clinical and research expertise in bronchiectasis. Expert physiotherapists were selected by the task force chairs to ensure wide representation, i.e. inclusion of early career researchers and individuals from different countries, after an open invitation to all members of the ERS Group 9.02 – Physiotherapists. The patient representatives were suggested by the European Lung Foundation, with representation from one patient who is adherent to ACTs and one who is not. The patient representatives were included in the working teams, actively participating in the online meetings and providing input throughout the project, particularly on topics related to patients’ feedback. The panel was supported by an experienced ERS methodologist.

Publisher Copyright:
Copyright © The authors 2023.


  • Adult
  • Bronchiectasis/therapy
  • Cough
  • Humans
  • Physical Therapy Modalities
  • Quality of Life
  • Respiratory Therapy/methods


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