Physiotherapy for large airway collapse: an ABC approach

• Main Authors: Gangadharan, S. (Author), Grillo, L.J.F (Author), Housley, G.M (Author), Hull, J.H (Author), Majid, A. (Author)
• Format: Article
• Language: English
• Published: European Respiratory Society 2022
• Subjects: artificial ventilation; asthma; atelectasis; breathing pattern; breathing rate; bronchiectasis; bronchoscopy; chronic obstructive lung disease; collapse; comorbidity; coughing; daily life activity; disease surveillance; dyspnea; exercise; exertional dyspnea; expiratory flow; fibrosis; flow kinetics; functional residual capacity; human; hypertension; large airway collapse; length of stay; lower respiratory tract infection; lung clearance; lung function; maximal inspiratory pressure; mouth breathing; mucolytic agent; oxygen saturation; pathophysiology; physiotherapy; pulmonary rehabilitation; pulse oximetry; quality of life; resistance training; respiration control; respiratory tract infection; Review; risk factor; spirometry; systematic review; thoracotomy; thorax pain; thorax pressure; thorax radiography; tidal volume; total lung capacity; trachea; viscoelasticity
• Online Access: View Fulltext in Publisher

 Large airway collapse (LAC) describes the phenomenon of excessive, abnormal, inward movement of the large airways (i.e. trachea and/or main bronchi and/or bronchus intermedius) occurring during the expiratory phase of the respiratory cycle. It is an increasingly well-recognised problem and a prevalent comorbidity in other chronic respiratory conditions (e.g. COPD and asthma). LAC is associated with pervasive respiratory features such as a barking cough, exertional dyspnoea and an increased propensity to lower respiratory tract infection. These symptoms are unpleasant, and patients are often limited in their daily life and their function. The pathophysiology of this condition impairs airway clearance and can cause breathlessness and exercise intolerance, due to a loss of airway patency during expiratory flow. Dysfunctional adaptations to breathing and coughing may further amplify symptoms. This article provides, for the first time, clinically focused physiotherapeutic intervention advice based on our understanding of the pathophysiology of LAC, to support conservative management. It uses the available evidence from LAC, transferable evidence from other conditions and knowledge based on clinical experience. It proposes a practical “ABC model” to ensure physiotherapy assessment and treatments are centred around optimising three key clinical areas: Airways, including airway clearance and cough; Breathing, including breathlessness and breathing pattern; and Capacity for exercise, including an assessment of functional exercise ability. © The authors 2022.