Pediatric physiotherapy management of airway clearance therapy and exercise: Data from the Australian Bronchiectasis Registry
Date
2025
Authors
Webb, E.M.
Holland, A.E.
Chang, A.B.
Middleton, P.G.
Thomson, R.
Wong, C.
Jayaram, L.
Holmes-Liew, C.L.
Morgan, L.
Lee, A.L.
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Journal article
Citation
Pediatric Pulmonology, 2025; 60(1):e27370-1-e27370-9
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Elizabeth M. Webb, Anne E. Holland, Anne B. Chang, Peter G. Middleton, Rachel Thomson, Conroy Wong, Lata Jayaram, Chien-Li Holmes-Liew, Lucy Morgan, Annemarie L. Lee
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Abstract
Background Regular airway clearance techniques (ACTs) and exercise are recommended for children with bronchiectasis, but current clinical practice and their predictors are unknown. Objective We aimed to describe current use of ACTs and exercise among Australian children with bronchiectasis and identify associated predictors. Methods Physiotherapy-specific data of 397 children (median age = 8 were extracted from the Australian Bronchiectasis Registry. A multivariate analysis was undertaken to identify predictors associated with the use of regular ACTs and physical exercise. Results Regular ACTs were undertaken by 118 (30%) children while 192 (48%) engaged in regular exercise. Physical exercise was the most common ACT modality (n = 83, 20%). The likelihood of regular ACT increased in children whose sputum isolated Pseudomonas aeruginosa (OR = 3.88, 95% CI 1.69–8.89) and was 50% higher for every respiratory exacerbation in the previous 12-months that required hospitalization (OR = 1.50, 95% CI 1.15–1.95). For every year older in age, children had increased odds of engaging in physical exercise (OR = 1.21, 95% CI 1.08–1.34) or using an ACT device (OR = 1.21, 95% CI 1.05–1.34). Regular exercise was twice as likely in the presence of bibasal bronchiectasis (OR = 2.43, 95% CI 1.14-5.16), yet less likely in those with ≥1 hospitalizations in the previous 12-months (OR = 0.76, 0.95% CI 0.57–1.03). Conclusion Approximately one-third of children with bronchiectasis undertake regular ACTs while physical exercise was undertaken in approximately one in two children. Age, frequent respiratory exacerbations requiring hospitalization and the extent of disease are predictors of undertaking regular ACTs and exercise. Identification of these factors may assist in tailoring ACT, exercise and ACT modality prescription in clinical practice.
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