Pulmonary Rehabilitation in Non Cystic Fibrosis Bronchiectasis
Pulmonary Rehabilitation in Non Cystic Fibrosis Bronchiectasis
The aim of our study is to ascertain whether chest physiotherapy + pulmonary rehabilitation
 is more efficacious than chest physiotherapy alone. The outcomes that will be used to assess
 effectiveness are relevant in terms of the direct benefit on the patient's health related
 quality of life.

 PLANNED STUDY: This randomized study will compare 8 weeks chest physiotherapy with 8 weeks
 chest physiotherapy plus pulmonary rehabilitation.
PLANNED STUDY: This randomized study will compare 8 weeks chest physiotherapy with 8 weeks
 chest physiotherapy plus pulmonary rehabilitation.

 PLAN OF INVESTIGATION: Patients will be recruited from NHS Lothian with 15 randomized to
 chest physiotherapy and 15 to chest physiotherapy plus pulmonary rehabilitation.

 Protocols:

 Chest physiotherapy Physiotherapy will be aided using a positive pressure airways device
 (Acapella) that aids sputum expectoration. They will be asked to do 10 breaths, followed by 3
 huffs and a cough. This will be repeated 3 times and repeated twice a day. Expected tiime
 10-15 minutes twice daily.

 Pulmonary rehabiliation Will be an 8-week programme twice a week in hospital with a third
 session (unsupervised) at home. It will include both cardiovascular training and upper limb
 and lower limb strengthening exercises.

 Each patient will have a baseline exercise test. Calculation of the patient's 80% peak heart
 rate will be recorded and then used to ensure that patients are working to this level during
 the pulmonary rehabilitation cardiovascular sections.

 The session will include: 5 minute warm up; 10 minutes treadmill; 10 minutes bicycle; 10
 minutes stepper; 10 minutes upper limb and lower limb strengthening exercises; 5 minutes cool
 down.

 Throughout the 8-week programme the resistance and intensity of each activity will be
 increased as they improve.

 Following commencement of their first class they will be provided with a diary for a walking
 programme at home, which they will do once a week unsupervised.

 Endpoints: Assessments below will be done at baseline, 4 weeks, 8 weeks and 3 months.

 Microbiology: A fresh sputum sample will be submitted for micobiological culture.

 Systemic inflammatory markers: 10mls venous blood for full blood count, erythrocyte
 sedimentation rate, C reactive protein, urea, electrolytes and liver function tests.

 Pulmonary physiology: Pre bronchodilator spirometry (FEV1, FVC and FEV1/FVC), mouth
 pressures, followed by an incremental shuttle walk test.

 24 hour sputum volume: This will be collected the day before each clinic visit. Sputum
 colour: Graded as mucoid, mucopurulent or purulent. Health related quality of life: Leicester
 Cough Questionnaire and St George's Respiratory Questionnaire.
Inclusion Criteria:

 -  Patients with moderate and severe bronchiectasis aged 18-75 will be recruited.
 Severity will be assessed radiologically by HRCT of the chest using the scoring method
 by Bhalla et al.

 Exclusion Criteria:

 -  cystic fibrosis

 -  emphysema on HRCT chest and FEV1<60% predicted

 -  active allergic bronchopulmonary aspergillosis or tuberculosis

 -  poorly controlled asthma

 -  pregnancy or breast feeding

 -  current smokers