More than 100 Cochrane Reviews of interventions for people with cystic fibrosis are now underway, with nearly ninety published in full. In October 2017*, this list was added to with a review of the effects of a breathing technique called autogenic drainage. We asked the lead author, Pamela McCormack from Alder Hey Children's Hospital in Liverpool in the UK, to tell us what they found.
* This podcast was prepared for an earlier version of the review but the findings of the updated version were not sufficiently different to warrant re-recording the podcast.
John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. More than 100 Cochrane Reviews of interventions for people with cystic fibrosis are now underway, with nearly ninety published in full. In October 2017, this list was added to with a review of the effects of a breathing technique called autogenic drainage. We asked the lead author, Pamela McCormack from Alder Hey Children's Hospital in Liverpool in the UK, to tell us what they found.
Pam: Cystic fibrosis, or CF, is a genetic disorder which affects the lungs, producing a thick, sticky mucus. This can lead to constant infections and inflammation, damage to the airways and to the function of the lungs over time. Physiotherapy can help keep the airways clear of mucus and there are many methods used to do this. As John said, we examined autogenic drainage, which is a very controlled technique of breathing using different depths and speeds of exhaled breath to move mucus up the airways, resulting in a spontaneous or voluntary cough.
We brought together the data that had been gathered on 208 people with CF, in seven studies. They had a wide range of disease severity and were aged from seven to 63 years of age, with the studies lasting from four days to two years. All the studies compared autogenic drainage to one or more other airway clearance method and, although we were interested in comparisons with exercise, none of the studies had compared autogenic drainage to this.
Our main aim was to examine the effect of autogenic drainage on lung function measurements and quality of life in people with CF and to discover whether it performs better or worse than other physiotherapy techniques for clearing the lungs. However, we found no clear evidence that autogenic drainage was better than the other airway clearance techniques for improving lung function or quality of life. This was also true for a string of secondary outcome measures such as hospital admissions, additional antibiotic treatment, exercise tolerance and oxygen saturation, but in one study autogenic drainage was the preferred technique compared to postural drainage and percussion. However, it’s worth noting that there was relatively little information for our secondary outcome measures because they were not reported by all of the studies.
In summary, we did not find that autogenic drainage was better than any other method of airway clearance. Although it may be considered as an alternative in a targeted patient group, such as people who would like more independence in their physiotherapy, it is a challenging technique that requires commitment from the individual. In order to move things forward with determining its role for patients with cystic fibrosis, we will need larger and longer trials. These should compare autogenic drainage to all other relevant methods of airway clearance, and measure the effects with meaningful outcomes for patients, including lung function, quality of life and adherence to treatment.
John: If you would like to read more about the existing research and to watch for future updates of Pam’s review if these new studies become available, just go online to Cochrane Library dot com and search 'Autogenic drainage in cystic fibrosis'.