International consensus on airway clearance techniques for patients hospitalised with acute exacerbations of COPD: a European Delphi study

Introduction: Despite being a proposed treatment, there is no agreement on airway clearance management for patients hospitalised with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The aim of this work was to establish international consensus on the selection of airway clearance techniques (ACTs) for these patients and identify which ACTs are commonly used. Methods: A modified Delphi study was employed. A panel of experienced physiotherapists working in Europe (n=162, 12 countries) was invited to respond to two online Delphi survey rounds. A 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) was used; consensus was defined as a median score of ≤2 or ≥4 and 75% agreement. Results: Consensus was reached for the use of seven ACTs, including forced expiratory techniques (FETs), positive expiratory pressure (PEP) and oscillatory positive expiratory pressure (OPEP), in cases of limited treatment time, obesity, low patient motivation or for localised secretions. Consensus was reached against the use of five ACTs, including manual percussion, vibrations and shaking, in patients with resting breathlessness, frailty, obesity or high resting lung volumes. The most used ACTs among participants were PEP, FETs and active cycle of breathing techniques. Participants from nine countries identified ACTs that are commonly used by all of the country's participants. Conclusions: European-based physiotherapists report using a variety of ACTs, with some regional preferences noted in certain countries. Consensus was able to be reached regarding which ACTs should be used or avoided for patients hospitalised with AECOPD under a range of clinical circumstances.