LITERATURE REVIEW: Is the ACBT more effective than AD for the improvement of FVC and FEV1 in people who suffer from respiratory diseases?

Authors:

Nuno Tavares 1, Patrícia Castanheira 2

Coimbra Health School

Graduation in Physiotherapy

Clinical Education IV (2013/2014)

Poster 68 Edition 02/14

December 5, 2014

1 4th year student graduating in Physiotherapy in Coimbra Health School 2 Monitor of Curriculum Unit Clinical Education IV and physiotherapist in Unidade de Saúde de Coimbra – Fernão Mendes Pinto

ACTIVE CYCLE OF BREATHING TECHNIQUE (ACBT) [1,2,6]

Breathing control

Tidal volume breathing using the diaphragm (diaphragmatic breathing), relaxing the upper chest and shoulders (5 or 6 respiratory cycles).

Thoracic expansion exercises

Three or four deep inspirations followed by an end-inspiratory hold to get the maximum amount of air in the distal airways.

Forced expiration technique or Huffing

One or two forced active expirations (Huffing) performed without violence.

AUTOGENIC DRAINAGE (AD) [2,6]

Firstly, a deep expiration should be done by the end of the expiratory reserve volume.

Loosening peripheral secretions

Inspirations at low lung volumes, to move secretions from distal to middle airways (5 or 6 respiratory cycles).

Collecting secretion from larger airways

Inspirations at low to middle lung volumes to move secretions from middle to proximal airways. (5 or 6 respiratory cycles).

Expelling secretions

Inspirations at mid to high lung volumes to move secretions from proximal airways to trachea (5 or 6 respiratory cycles) and one ore two forced active expirations (Huffing).

FORCED EXPIRATORY VOLUME IN THE FIRST SECOND (FEV1) [1,2,6]

FORCED VITAL CAPACITY (FVC) [1,2,6]

Volume of air expeled, as quickly as possible, in the first second of forced expiration, after a maximal inspiration.

Maximum amount of air a person can expel from the lungs, during a forced expiration, after a maximal inspiration.

Vo

lum

e (

lite

rs)

Time of a forced expiration (seconds)

1 2 3 4

FEV1 FVC

Figure 1: Volume air variation (liters) during the time of forced active expiration (seconds).

Bearing in mind PICO rules, and because of the great variability in studies,

the selected population for this literature review was: people suffering from

respiratory diseases. The means of intervention chosen was the comparison

between ACBT and AD. The analyzed outcomes are two measurements which

indicate expiratory volume: FVC and FEV1.

Research was done based on meta-analysis, systematic reviews and

randomized controlled trials, written in English and published in scientific

magazines. There wasn’t any kind of restriction as to the publishing year of the

articles searched.

References were searched in the following databases: Pubmed, Cochrane,

PEDro e ScienceDirect. Some libraries were also contacted: Coimbra Health

School library, Coimbra University library and Coimbra University Hospital

library. This contact was established to ask for the whole text of relevant

articles which were displayed in the previously mentioned databases but not

available. The last research was done on the December fifteenth, 2013.

IDENTIFICATION OF THE ARTICLE

AUTHORS AND YEAR TYPE OF STUDY POPULATION FOR STUDY CONCLUSIONS PEDro SCORE

“Chest physiotherapy in cystic fibrosis: a comparative study of

autogenic drainage and the active cycle of breathing techniques

with postural drainage” [4]

S. Miller, D. O. Hall,

C. B. Clayton & R. Nelson

(1995)

Randomized Controlled

Trial

Eighteen people with Cystic Fibrosis

(10 men and 8 women), ages between 11 and 32 with their clinical condition stabilized at the moment of the study.

Week 1: sample performed AD. Week 2: sample performed ACBT.

There was an improvement of FVC when the sample performed ACBT comparing to the week when the sample performed AD. On the other hand, there was a bigger

improvement in FEV1 during the first week of treatment (when the sample performed AD). However, differences found were not considered relevant, so the authors conclude

that both methodologies improve likewise FVC and FEV1.

4/10

“A comparison of autogenic drainage and the active cycle of breathing techniques in patients

with chronic obstructive pulmonary diseases” [5]

S. Savci, D. I. Ince &

H. Arikan (2000)

Randomized Controlled

Trial

Thirty people, male, suffering from Chronic Obstructive Pulmonary Disease (COPD),

clinically stabilized. Group A: performed AD.

Group B: performed ACBT.

There was a similar increase in FVC in both groups. The group that performed AD registered a bigger improvement in FEV1 when comparing to the group that performed

ACBT. However, that difference was not considered relevant. Authors conclude that both techniques are equally effective for the improvement of FVC and FEV1. They also state that the choice of one over the other should rely on the patient and physiotherapist.

4/10

“Comparison of autogenic drainage & active cycle breathing techniques on FEV1, FVC & PEFR in chronic obstructive pulmonary

disease” [3]

G. R. Melam, A. R. Zakaria, S. Buragadda,

D. Sharma, M. A. Alghamdi

(2012)

Randomized Controlled

Trial

Thirty people, male, age between 40 and 60,

suffering from moderate Chronic Obstructive Pulmonary Disease (COPD).

Group A: performed AD. Group B: performed ACBT.

Group C: was given medication.

There was no relevant difference in FVC and FEV1 between group A and B. The conclusion is that both AD and ACBT are equally effective for the improvement of FVC and FEV1 in people who suffer from moderate Chronic Obstructive Pulmonary Disease

(COPD). It was also concluded that both techniques were more effective than medication (group C).

5/10

The results above seem to be in agreement. Both ACBT and AD improve FVC and FEV1 in a similar way in people who suffer from respiratory diseases. Even though ACBT tends to improve FVC and AD tends to improve FEV1, those differences

haven’t been shown relevant in any of the researched studies. It is important to highlight that this literature review had two major constraints. One was the lack of found articles that would answer the guiding question. Most of the studies still

focus mainly on the comparison between older techniques (such as postural drainage or percussion) and more recent ones (such as ACBT). Furthermore, the studies in this review have quite low scores in PEDro scale which suggests several

experimental errors.

After this literature review we conclude that ACBT is not more effective than AD on improving FVC and FEV1 in people who suffer from respiratory diseases. Both breathing techniques increase these indicators in a similar way and

therefore the choice of one over the other should be done by the physiotherapist. The ventilatory control of the patient might be an important criterion when making this decision since AD is a technique which demands patients’ greater

control of gas exchanges.

These two techniques aim mainly at the cephalad clearance of secretions in

the tracheobronchial tree. Thus, both consist of an initial phase of lung

inflation. Having more amount of air in the lungs will allow a larger volume and

expiratory flow, which will then enhance the probability of secretions

movement [1]. Based on the previous statements, the main aim of this

literature review is analyzing the impact of each of these breathing techniques

in the increase of two expiratory volume measures: Forced Vital Capacity (FVC)

and Forced Expiratory Volume in the first second (FEV1).

REFERENCES: 1) Fink, J. B. (September de 2007). Forced expiratory technique, directed cough and autogenic drainage. Respiratory care, 52, 1210-1223. 2) Frownfelter, D. L., & Dean, E. (1996). Principles and practice of cardiopulmonary physical therapy. St.Louis: Mosby. 3) Melam, G. R., Zakaria, A. R., Buragadda, S., Sharma, D., & Alghamdi, M. A. (2012). Comparison of autogenic drainage & active cycle breathing techniques on FEV1, FVC & PEFR in chronic obstructive pulmonary disease. World Applied Sciences Journal, 20, 818-822. 4) Miller, S., Hall, D. O., Clayton, C. B., & Nelson, R. (1995). Chest physiotherapy in cystic fibrosis: a comparative study of autogenic drainage and the active cycle of breathing techniques with postural drainage. British Medical Journal (Thorax), 50, 165-169. 5) Savci, S., Ince, D. I., & Arikan, H. (January-February de 2000). A comparison of autogenic drainage and the active cycle of breathing techniques in patients with chronic obstructive pulmonary diseases. Journal of Cardiopulmonary Rehabilitation, 20, 37-43. 6) Webber, B. A., & Pryor, J. A. (1998). Physiotherapy for respiratory and cardiac problems. Edinburgh; New York: Churchill Livingstone.

CONTACTS: Nuno Tavares: ftnunotavares@gmail.com

Patrícia Castanheira: ftcastanheira@gmail.com

Table 1: Summary table of evidence found for this literature review.