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Review type <p>Narrative review. Search conducted in MEDLINE (PubMed), EMBASE, and Cochrane Library, inception to April 2026.</p> <p>Airway clearance techniques (ACTs) remain central to bronchiectasis management, yet the evidence base continues to be limited and real-world implementation highly variable. Bronchiectasis is increasingly recognised as a heterogeneous condition in which ACT effectiveness depends on sputum burden, microbiology, airflow limitation, comorbidity, and patient capability. Recent studies, although generally small and methodologically heterogeneous, demonstrate modest, mostly short-term improvements in sputum expectoration and symptom burden, supported by low-to-moderate certainty evidence. Effects on health-related quality of life are inconsistently demonstrated and long-term outcomes remain uncertain. Long-term adherence remains a major challenge, driven by treatment complexity, fatigue, competing therapies, and psychosocial barriers. Real-world observational data suggest that ACT utilisation patterns may reflect physiotherapy utilisation patterns that may themselves represent clinically meaningful phenotypic clusters, pending prospective validation.</p> <p>Emerging approaches emphasise personalised ACT prescription, treatment-burden assessment, and integration of digital physiotherapy, remote monitoring, and connected devices. However, substantial global inequities persist in access to specialist physiotherapy and advanced ACT technologies. Low-cost, zero-equipment modalities such as the Active Cycle of Breathing Techniques and Autogenic Drainage remain essential, particularly in low-resource settings where oscillating PEP devices, high-frequency chest wall oscillation, or smart nebuliser ecosystems may be unavailable.</p> <p>The future of ACTs is likely to depend less on novel devices and more on scalable, personalised, and implementation-focused strategies that reflect the complexity of real-world bronchiectasis care. Pragmatic trials incorporating phenotype-enriched recruitment, objective adherence monitoring, and long-term outcomes are needed to guide practice. The 2025 ERS guideline reinforces this direction, advocating for individualised ACT strategies, routine reassessment of treatment burden, and service models that support equitable access to physiotherapy.</p>

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Airway clearance techniques in bronchiectasis in 2026: evidence, adherence, and real-world implementation

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年6月23日

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  • Akhil Sawant

摘要

Review type

Narrative review. Search conducted in MEDLINE (PubMed), EMBASE, and Cochrane Library, inception to April 2026.

Airway clearance techniques (ACTs) remain central to bronchiectasis management, yet the evidence base continues to be limited and real-world implementation highly variable. Bronchiectasis is increasingly recognised as a heterogeneous condition in which ACT effectiveness depends on sputum burden, microbiology, airflow limitation, comorbidity, and patient capability. Recent studies, although generally small and methodologically heterogeneous, demonstrate modest, mostly short-term improvements in sputum expectoration and symptom burden, supported by low-to-moderate certainty evidence. Effects on health-related quality of life are inconsistently demonstrated and long-term outcomes remain uncertain. Long-term adherence remains a major challenge, driven by treatment complexity, fatigue, competing therapies, and psychosocial barriers. Real-world observational data suggest that ACT utilisation patterns may reflect physiotherapy utilisation patterns that may themselves represent clinically meaningful phenotypic clusters, pending prospective validation.

Emerging approaches emphasise personalised ACT prescription, treatment-burden assessment, and integration of digital physiotherapy, remote monitoring, and connected devices. However, substantial global inequities persist in access to specialist physiotherapy and advanced ACT technologies. Low-cost, zero-equipment modalities such as the Active Cycle of Breathing Techniques and Autogenic Drainage remain essential, particularly in low-resource settings where oscillating PEP devices, high-frequency chest wall oscillation, or smart nebuliser ecosystems may be unavailable.

The future of ACTs is likely to depend less on novel devices and more on scalable, personalised, and implementation-focused strategies that reflect the complexity of real-world bronchiectasis care. Pragmatic trials incorporating phenotype-enriched recruitment, objective adherence monitoring, and long-term outcomes are needed to guide practice. The 2025 ERS guideline reinforces this direction, advocating for individualised ACT strategies, routine reassessment of treatment burden, and service models that support equitable access to physiotherapy.