Original Article 101
Efficacy of pulmonary rehabilitation plus chest physiotherapy
versus chest physiotherapy alone in patients with bronchiectasis
Asmaa M. Abdo1, Hanan M. Elsaadany2, Ayman S. El dib3, Amira A. Elkholy3,
Hoda M. Bahr3
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a
Kafr Elsheikh Chest Hospital, Ministry of Health,
Kafr Elsheikh, bDepartment of Physical Medicine,
Rheumatology and Rehabilitation, Faculty
of Medicine, Tanta University, Tanta, cChest
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Diseases Department, Faculty of Medicine, Tanta
University, Tanta, Egypt
Correspondence to Asmaa M. Abdo, MSc,
Kafr Elsheikh 33516, Egypt
Tel: +20 101 142 2028;
Fax: 0473215175;
e-mail: asmaahemada830@gmail.com
Received: 16 February 2023
Revised: 28 May 2023
Accepted: 20 June 2023
Published: 18 January 2024
The Egyptian Journal of Chest Diseases and
Tuberculosis 2024, 73:101–107
Introduction
Bronchiectasis is an abnormal dilatation of the bronchi
that causes alteration of pulmonary mechanics, inefficient
gas exchange, and decreased muscle mass [1,2].
Chest physiotherapy is a group of therapies
for mobilizing pulmonary secretions. Regular
physiotherapy was standard in bronchiectasis as the
effect of medical treatment is unsatisfactory. Alone, it
has unsatisfactory results in bronchiectasis [3].
© 2024 The Egyptian Journal of Chest Diseases and Tuberculosis | Published by Wolters Kluwer - Medknow
Context
Bronchiectasis is a chronic airway disease characterized by cough, dyspnoea,
expectoration, and poor quality of life. Besides medical treatment, regular chest
physiotherapy and Pulmonary rehabilitation (PR) may be an effective approach for
bronchiectasis.
Aims
To compare the effects of PR and chest physiotherapy with chest physiotherapy
alone in bronchiectasis.
Settings and design
This randomized controlled trial observational research enrolled 40 cases with
bronchiectasis who were categorized into two groups: (group I); 20 cases received
PR and chest physiotherapy in addition to medical treatment, (group II): 20 cases
received chest physiotherapy in addition to medical treatment.
Methods and material
Cases were assessed with modified borg scale, 6-minute walk test (6-MWT),
arterial blood gases, Spirometry and underwent PR program.
Statistical analysis used
The same group’s quantitative data were compared using the paired Student’s t-test. The
frequency and percentage (%) of qualitative characteristics were displayed.
Results
In (group I), there was a statistically notable improvement in modified Borg Scale,
6-MWT, arterial oxygen pressure (PaO2), partial pressure of carbon dioxide
(PaCO2), arterial oxygen saturation, FEV1 (actual and predicted %values), FVC
(actual and predicted %values), FEV1/FVC actual value, sputum volume and
training intensity. In (group II) there was a statistically notable improvement in
6-MWT, PaO2, PaCO2, FEV1 (actual and predicted %values), FVC (actual and
predicted %values), FEV1/FVC actual value, and sputum volume. The percentage
of improvement in all parameters was significantly higher among group (I).
Conclusions
PR in addition to chest physiotherapy is superior to chest physiotherapy alone in
the improvement of symptoms and exercise tolerance in bronchiectasis.
Keywords:
bronchiectasis, chest physiotherapy, pulmonary rehabilitation
Key Messages:
Pulmonary rehabilitation in addition to chest physiotherapy are superior than chest
physiotherapy alone in improvement of symptoms and exercise tolerance in cases with
bronchiectasis.
Egypt J Chest Dis Tuberc 2024, 73:101–107
© 2024 The Egyptian Journal of Chest Diseases and Tuberculosis
2090-9950
Pulmonary rehabilitation (PR) is an approach to reduce
symptoms, increase functional ability [4,5].
The aim of this work was to compare the effects of
PR and chest physiotherapy with chest physiotherapy
alone in cases with bronchiectasis.
This is an open access journal, and articles are distributed under
the terms of the Creative Commons Attribution-NonCommercial-
ShareAlike 4.0 License, which allows others to remix, tweak, and
build upon the work non-commercially, as long as appropriate credit
is given and the new creations are licensed under the identical terms.
DOI: 10.4103/ecdt.ecdt_10_23
 102 The Egyptian Journal of Chest Diseases and Tuberculosis, Vol. 73 No. 1, January-March 2024
Patients and methods
This randomized controlled trial observational research
was carried out in two departments in the University
Hospital on 40 cases with bronchiectasis started from
October 2019 to January 2022. All of them were ex-
smoker.
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The research was done after approval from the
University’s Ethical Committee. An informed written
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consent was obtained from the case or his relatives.
Inclusion criteria were cases who were diagnosed
clinically and radiologically by high resolution
computed tomography (HRCT) as bronchiectasis and
all cases were clinically and laboratory stable for at least
four weeks of the rehabilitation program.
Exclusion criteria were any chest condition other
than bronchiectasis, no current participation in
another rehabilitation program, cases with unstable
cardiovascular diseases. cases with mobility problems
that make exercise performing impossible, cases with
significant psychiatric or cognitive impairment who
were unable to follow simple instructions, cases who
received oral steroids or antibiotics during the period
of the program, and severe exercise induced hypoxemia.
Cases were allocated into two groups: group I: included
20 cases who were submitted to PR program and
chest physiotherapy in addition to medical treatment.
Group II: included 20 cases who were submitted to
chest physiotherapy in addition to medical treatment.
Distribution of the cases in each group depended on
simple randomized trial in which all the odd number
case were belonged to group (I) and all the even-
number case were belonged to group (II) [6].
All cases were subjected to full detailed history taking
and clinical examination; general and local chest
examination and routine laboratory tests to assess
any chest infection, Ziehl-Nielsen stained smear
of sputum for acid-fast bacilli for successive three-
morning samples to exclude pulmonary tuberculosis,
electrocardiography and echocardiography when
needed and plain chest radiography and HRCT to
confirm the diagnosis and exclude any concomitant
chest disease.
All cases received their regular medical treatment in
the form of mucolytic, expectorant, and inhaled or oral
bronchodilators if needed.
Assessment of the cases before and after the
intervention by the followings: 1- Modified Borg
scale for evaluation of exertional dyspnoea was used
to evaluate the level of breathlessness between 0-10
during exercise [7]. The scale has a range from 0 to
10 (with 0 being no exertion and 10 being maximum
effort). This scale corresponds more with a feeling of
breathlessness.
2- 6-minute walk test (6-MWT): The distance walked
over a time of 6 min was used as the outcome by which
changes in performance capacity were compared. The
cases were prohibited to do any heavy exercise before
the test by at least two hours. Reasons for immediate
stopping a 6-MWT included the following: chest pain,
intolerable dyspnoea, Leg cramps, Sweating and Pale
face appearance. 3- Arterial blood gases: PaO2 (partial
pressure of arterial oxygen), PaCO2 (partial pressure
of arterial carbon dioxide), SaO2 (arterial oxygen
saturation), PH (power of hydrogen) and HCO3
(Hydrogen bicarbonate) were evaluated.
4- Spirometry: was used to measure FEV1 (forced
expiratory volume in 1 s), FVC (forced vital capacity)
and FEV1/FVC before and after intervention.
All cases in group I were subjected to the following:
(A) Chest physiotherapy: It involved rhythmically
clapping on the chest wall over the affected area to
facilitate drainage of secretions and Sputum volume
collection was done through: Postural drainage was
done three times daily (before breakfast, before lunch
and before bedtime), and avoided shortly after meals as
it may induce vomiting.
(B) PR program: The duration of that program was
continued for at least six weeks. Each week included
two sessions. Each session lasted for 45 min That
program included the following:1. Education session
(all cases were educated about the proper use of
medications, breathing strategies, impact of exercise
and physical activity) on their conditions. 2. Nutritional
intervention; all cases were told about the importance
of the healthy balanced diet as previously mentioned
[8]. 3. Exercise training: A) Upper limb exercise: Cases
performed upper resistance training by pushing weight
started by 10 Kg and increased gradually according
to case tolerance. Cases were asked to hold on their
breathing at the end of inspiration for 5 s and then
expire slowly. The duration of this exercise was 10 min
and repeated two times/week. B) Lower limb exercise:
Cases started this exercise at a speed 1 mil/h and the
speed increased gradually by 0.2 mil/h, the speed of
the exercise was increased gradually during the sessions
and was guided by maximal heart rate which calculated
through the formula (220-age) and modified Borg
scale. C) Respiratory muscle training: (Inspiratory
 PR plus chest physiotherapy Vs chest physiotherapy in bronchiectasis Abdo et al. 103

muscle training and Expiratory muscle training).
Depending on the type of exercise training methods
those were divided into two types: (1) Resistance
training [9] (case breathed through Tri-ball incentive
spirometer). (2) Endurance training according to
American Thoracic Society [10]: Endurance exercise
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II. 6-MWT, PaO2, PaCO2, were significantly improved
at the end of the program compared with baseline in
both groups. Modified Borg Scale and SaO2 were
significantly improved at the end of the program
compared with baseline in group I. Table 2.

training through which simultaneous training of both
respiratory muscles and lower limb muscles were done
through (A) Walking exercise (treadmill), (B) Pushing
foot, the duration of that exercise was 10 min, two
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At the end of the program, the sputum volume was
significantly higher in group I compared with group II.
Regarding to FEV1 (actual value), FEV1% predicted,
FVC (actual value), FVC % predicted, FEV1/FVC and

times/week. sputum volume was significantly improved in group

All cases in group II were subjected to the following:
Chest physiotherapy only.
Statistical analysis
SPSS v25 performed the statistical analysis (IBM
Inc., Chicago, IL, USA). The same group’s quantitative
data were given as mean and standard deviation
(SD) and compared using the paired Student’s t-
test. The frequency and percentage (%) of qualitative
characteristics were displayed. A two-tailed P value
0.05 was deemed statistically significant.
Results
There was no statistically significant difference
between both groups regarding age, sex and affected
lobe. Table 1
Regarding to Modified Borg Scale, 6-MWT, PaO2,
PaCO2, SaO2, there was no significant difference at
baseline while there was a notable improvement at the
end of the program in group, I compared with group
I and group II at the end of the program compared
with baseline. Table 3
There was statistically significant increase in heart rate,
training intensity and SaO2 over 12 sessions in group
I. Table 4.
Discussion
Bronchiectasis is an irreversible and gradual
enlargement of the airways caused by structural
abnormalities. It may be congenital or acquired (more
common), due to a wide range of reasons including
lung infections, such as severe pneumonia after
measles, pertussis, and TB. Chronic fibrotic lung
illnesses, such as those after necrotizing pneumonia
or aspiration of foreign substances, and inhalation
of hazardous gases or particles can contribute to
bronchiectasis development. Bronchiectasis can also
be caused by congenital conditions such as cystic
fibrosis, primary ciliary dyskinesia, -1 antitrypsin
deficiency, and immunodeficiencies Annoni and
colleagues [11].

Table 1 Comparison between studied groups regarding demographic data and affected lobe
Groups Test
Group I (PR) Group II (PT)
N=20 N=20 P value
Age (year):
Mean±SD 51.95 ± 15.22 51.45 ± 13.35 0.913
Sex
Female 12 (60%) 11 (55%) 0.749
Male 8 (40%) 9 (45%)
Affected lobe
Unilateral
  Upper 1 (5%) 1 (5%)
  Middle/lingula 0 1 (5%)
  Lower 2 (10%) 1 (5%)
  Diffuse 1 (5%) 2 (10%) 0.702
Bilateral
  Upper 2 (10%) 2 (10%)
  Middle/lingula 3 (15%) 2 (10%)
  Lower 6 (30%) 6 (30%)
  Diffuse 5 (25%) 5 (25%)
Data was presented as mean±SD or frequency and percentage.
PR, Pulmonary rehabilitation; PT, physiotherapy.
 104 The Egyptian Journal of Chest Diseases and Tuberculosis, Vol. 73 No. 1, January-March 2024

Table 2 Comparison between studied groups regarding Modified Borg scale, 6- minutes walk test, PaO2, PaCO2, SaO2
Scale Group I (PR) Group II (PT) P value
Modified Borg Scale Baseline N=20 N=20
Very mild 3 (15%) 3 (15%) 0.671
Mild 7 (35%) 5 (25%)
Moderate 10 (50%) 12 (60%)
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End of program N=16 N=16

Very mild 5 (31.3%) 1 (6.3%) 0.046*
Mild 8 (50%) 8 (50%)
Moderate 3 (18.2%) 7 (43.8%)
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P value 0.005* 0.414

6 min’ walk Test (m) Baseline N=20 N=20
Mean±SD 241.45 ± 39.66 230.7 ± 33.66 0.361
End of program N=16 N=16
Mean±SD 260.31 ± 34.22 233.5 ± 34.22 0.048*
P (Pt) <0.001** <0.001**
PaO2 (mmHg) Baseline N=20 N=20
Mean±SD 77.5 ± 4.65 76.2 ± 4.25 0.362
End of program N=16 N=16
Mean±SD 80.63 ± 3.93 76.94 ± 4.63 0.021*
P (Pt) <0.001** <0.001**
PaCO2 (mmHg) Baseline N=20 N=20
Mean±SD 44.4 ± 3.39 44.25 ± 3.18 0.886
End of program N=16 N=16
Mean±SD 41.25 ± 3.86 43.94 ± 2.67 0.03*
P (Pt) <0.001** <0.001**
SaO2 (%) Baseline N=20 N=20
Mean±SD 91.85 ± 4.65 91.65 ± 1.14 0.547
End of program N=16 N=16
Mean±SD 93.31 ± 1.14 92.19 ± 1.33 0.015*
P (Pt) <0.001** 0.11
pt paired sample; t test t independent sample t test.
*P less than 0.05 was statistically significant.
**P less than or equal to 0.001 was statistically highly significant.
PaCO2, Partial pressure of carbon dioxide; PaO2, Partial pressure of oxygen; PR, Pulmonary rehabilitation; PT, physiotherapy; SaO2, Oxygen
saturation.

The comprehensive treatment for bronchiectasis seeks
to manage symptoms, increase life expectancy, avoid
progressive lung damage, minimize the frequency of
exacerbations, and preserve pulmonary functioning.
Recently, a treatment strategy depending on the
severity of the disease has been advocated, comprising
the frequent use of respiratory physiotherapy at various
disease stages ODonnell and colleagues [10].
by the case during the exercise training. Regarding
to modified Borg scale in the present research; at the
base line, there were no significant difference between
both studied groups. However, at the end of the PR
program, there were notable improvement in group
I as compared with group II (P = 0.046), with notable
improvement within group I as compared with base
line. (P = 0.005).

Regarding to affected lobe in the present research;
bronchiectasis was commonly seen as bilateral affection
mainly in both lower lobes. Bilateral affection involved
(80%) of cases in group I and (75%) of cases in group
II. The diffuse affection of the lung involved (30%)
of cases in group I and (35%) of cases in group II. In
agreement with this research van Zeller and colleagues
[12] showed that all cases had multiple lung segments
involvement (more than 1 lobe).
In the present research modified Borg scale was used
to evaluate the breathlessness and fatigue perceived
The explanation of this improvement in modified
Borg scale in the present research in both groups was
due to the effect of physiotherapy in group II and
physiotherapy plus PR program and in group I. In
agreement with this research Zanini and colleagues
[13] reported that after PR program, there was a
notable improvement in Borg scale. (P = 0.022).
Regarding to 6-MWT in the present research, it was
comparable in both studied groups with no significant
difference between them at base line. However at
the end of PR program there were higher notable
 PR plus chest physiotherapy Vs chest physiotherapy in bronchiectasis Abdo et al. 105

Table 3 Comparison between both studied groups regarding FEV1 (actual value), FEV1% predicted, FVC, FVC % predicted, FEV1/
FVC and sputum volume at base line and at end of program
Group I (PR) Group II (PT) P value
FEV1 (L) Base line N=20 N=20
Mean±SD 1.41 ± 0.63 1.38 ± 0.73 0.807
End of program N=16 N=16
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Mean±SD 1.53 ± 0.89 1.45 ± 0.83 0.611

P (Wx) 0.001** 0.003*
FEV1%predicted Base line N=20 N=20
Mean±SD 54.74 ± 25.19 54.18 ± 24.78 0.839
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End of program N=16 N=16

Mean±SD 56.88 ± 25.93 54.44 ± 24.84 0.72
P (Wx) <0.001** 0.002*
FVC (L) Base line N=20 N=20
Before
Mean±SD 2.1 ± 0.83 2.12 ± 0.88 0.779
End of program N=16 N=16
Mean±SD 2.26 ± 0.99 2.18 ± 0.97 0.509
P (Wx) 0.001** 0.003*
FVC (%) predicted Baseline N=20 N=20
Mean±SD 66.64 ± 20.09 65.65 ± 20.33 0.888
End of program N=16 N=16
Mean±SD 68.05 ± 20.25 65.82 ± 20.39 0.759
P (Wx) <0.001** 0.026*
FEV1/FVC Base line N=20 N=20
Mean±SD 63.47 ± 9.77 62.7 ± 8.45 0.793
End of program N=16 N=16
Mean±SD 64.39 ± 9.86 63.25 ± 9.31 0.739
P (Pt) <0.001* 0.002*
Sputum volume (ml)/day Base line N=20 N=20
Mean±SD 36.75 ± 18.44 35.25 ± 17.58 0.935
End of program N=16 N=16
Mean±SD 65.88 ± 34.88 44.25 ± 23.47 0.045*
P (Wx) <0.001** 0.002*
Wx Wilcoxon signed rank test; pt paired sample; t test t independent sample t test.
*P less than 0.05 was statistically significant.
**P less than or equal to 0.001 was statistically highly significant.
FEV, Forced expiratory volume; FVC, Forced vital capacity; PR, Pulmonary rehabilitation; PT, physiotherapy.

Table 4 Change in heart rate, training intensity and SaO2 over sessions in rehabilitation group
Beat/minute Mean±SD
Heart rate Training intensity Sao2
1st session 83.85 ± 4.95 1.17 ± 0.15 92.3 ± 0.8
2nd session 85.05 ± 5.03 1.31 ± 0.17 92.7 ± 1.26
3rd session 86.95 ± 4.85 1.41 ± 0.15 92.95 ± 1.5
4th session 88.65 ± 5.01 1.54 ± 0.17 93.3 ± 1.59
5th session 90.3 ± 5.69 1.67 ± 0.19 93.7 ± 1.89
6th session 91.8 ± 6.09 1.76 ± 0.23 93.95 ± 1.99
7th session 93.1 ± 6.23 1.86 ± 0.31 93.8 ± 1.85
8th session 94.85 ± 6.1 1.98 ± 0.27 94.05 ± 1.91
9th session 95.9 ± 6.05 2.07 ± 0.31 94.2 ± 1.74
10th session 97.0 ± 5.36 2.18 ± 0.3 94.2 ± 1.96
11th session 97.9 ± 5.15 2.3 ± 0.32 93.95 ± 1.7
12th session 98.7 ± 4.59 2.32 ± 0.35 94.0 ± 1.52
P value <0.001** <0.001** <0.001**
Percent change 17.68% 2.18 100%
**P less than or equal to 0.001 is statistically highly significant; SaO2: Oxygen saturation.
 106 The Egyptian Journal of Chest Diseases and Tuberculosis, Vol. 73 No. 1, January-March 2024
improvement in group I compared with base line and
group II. (P = 0.048).
In agreement with this research Zanini and colleagues
[13] reported that after PR program, there was a
notable improvement in 6MWD (P < 0.0001). But
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this improvement in 6MWD was higher in cases with
airflow obstruction when compared with cases without
airflow obstruction (P = 0.046).
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Regarding to arterial blood gases in the present research;
the arterial blood gases was comparable in both studied
groups at base line with no significant difference
between them, however at the end of PR program
there were higher notable improvement in group
I compared with base line and group II. In agreement
with this research, Abdel Halim and colleagues [14]
carried out a research on 30 bronchiectatic case to
compare the efficacy of twice daily physiotherapy for
14 successive days using active cycles of the breathing
method with postural drainage (ACBT-PD) against
conventional chest physiotherapy. They showed
that there was notable improvement in both groups
regarding PaCO2 and PaO2 with P value of (0.0000),
and (0.000), respectively in (ACBT-PD) group. and
(0.002) and (0.000), respectively in conventional chest
physiotherapy group.
In contrast of this research; van Zeller and colleagues
[12] showed that although median SaO2 increased
after PR (from 94.7% to 95.6%,), changes in
median SaO2 values were not statistically significant
(P = 0.116). They showed also that changes in median
PaCO2, values were not statistically significant
(P = 0.702). They explained this result as there were
25 cases had severed air way obstruction and 19
cases were colonized with bacteria.
Regarding to spirometric data in the present research;
spirometric data were comparable in both studied
groups at base line with no significant difference,
however at the end of PR program there were higher
notable improvement in FEV1 (actual value and % of
predicted), FVC (actual value and % of predicted) and
FEV1/FVC (actual value) in group I compared with
base line and group II.
In agreement with this research Yang and colleagues
[15] carried out a research (meta -analysis) on five
randomized controlled trials (RCTs) with a total
number of 198 cases with bronchiectasis to assess
the effectiveness of exercise training on their exercise
capacity, pulmonary function, and quality of life. They
concluded that PR improves pulmonary function
(specifically FEV1) P = 0.0002.
Regarding to sputum volume in this research within
group I and group II before and after the program; In
the present research, sputum volume was comparable
in both studied groups at base line with no significant
difference, However, at the end of PR program there
was higher significant increase in sputum volume in
group I (P < 0.001) compared with base line and group
II (P = 0.002).
In agreement with this research; Murray and colleagues
[16] reported that there were 15% change in the
volume of sputum expectorated over 24 h with increase
in mean volume by two (0–6) mL with twice daily
chest physiotherapy. They explained that the volume
of 24 h sputum collections in clinically stable outcases
might be limited by case compliance and confounded
by factors such as swallowed secretions.
Regarding change in training intensity over sessions in
rehabilitation group in the present research; There were
statistically significant increase in training intensity
over 12 sessions; (P < 0.001) and percentage of change
ranged (0–3.26%).
In agreement with this research, Ong and colleagues
[1] compared efficacy of PR in bronchiectatic cases
group with matched COPD cases group. In individuals
with bronchiectasis, PR led to a considerable increase in
exercise tolerance and health status. This improvement
was equivalent to that of the COPD group that
received PR.
Regarding change of HR during sessions in
rehabilitation group in the present research; There was
statistically significant increase in heart rate during 12
sessions; (P < 0.001). The explanation of these results
was due to increase in case tolerance in performing
exercise training, increase in training intensity over
the sessions, and improvement of degree of dyspnoea
which calculated by modified Borg scale during each
session. In agreement with this study, Swerts et al.[18]
, carried out a study to compare the effect of 11 min
treadmill walking procedure and 11 min corridor
walking procedure on exercise tolerance of 11 patients
with severe COPD and they showed that during both
walking procedures, heart rates increased significantly
(P < 0001).
In contrast to this research, Santamato and colleagues
[17] illustrated that the HR decreased with the PR
in three cases over the long period of time as the
following; Case (A) HR was (100, 88, 86) beat/min
at base line, after 5 months of PR, and after 6 months
follow-up. Case (B) HR was (112, 100, 94) beat/min
at base line, after 5 months of PR and after 6 months
 PR plus chest physiotherapy Vs chest physiotherapy in bronchiectasis Abdo et al. 107
follow-up. Case (C) HR was (98, 86, 82) beat/min at
base line, after 5 months of PR, and after 6 months
follow-up. The explanation of these results might be
because of the long period of this research.
Limitations: The size of the studied groups was small
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number. Psychological background was not assessed.
Nutritional status assessment and support were not
full investigated. The drop out of 8 cases during this
research so their results were vague. Some cases refused
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to complete in this research as they could not give up
smoking for a long time.
Conclusions
Pulmonary physiotherapy played an important role in
mobilization of pulmonary secretions so it was effective
in airway clearance. PR improved exercise capacity
and health related quality of life. Combination of
pulmonary physiotherapy with PR achieved superior
improvement as there was improvement in respiratory
symptoms of those cases such as (dyspnoea, cough,
fatigue and expectoration).
Acknowledgements
There is none to be declared.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1 Ong HK, Lee AL, Hill CJ, Holland AE, Denehy L. Effects of pulmonary
rehabilitation in bronchiectasis: A retrospective study. Chron Respir Dis
2011; 8:21–30.
2 ten Hacken NH, Wijkstra PJ, Kerstjens HA. Treatment of bronchiectasis in
adults. BMJ 2007; 335:1089–1093.
3 Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, et al.
Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical
Practice Guidelines. Chest 2007; 131:4s–42s.
4 Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, et al.
American Thoracic Society/European Respiratory Society statement on
pulmonary rehabilitation. Am J Respir Crit Care Med 2006; 173:1390–1413.
5 Nici L, ZuWallack R. An official American Thoracic Society workshop report:
the integrated care of the COPD patient. Proc Am Thorac Soc 2012; 9:9–18.
6 Altman DG, Bland JM. Treatment allocation in controlled trials: why
randomise?. BMJ 1999; 318:1209.
7 Hareendran A, Leidy NK, Monz BU, Winnette R, Becker K, Mahler DA.
Proposing a standardized method for evaluating patient report of the
intensity of dyspnea during exercise testing in COPD. Int J Chron Obstruct
Pulmon Dis 2012; 7:345–355.
8 Pinheiro Volp A, de Oliveira F, Duarte Moreira Alves R, Esteves E,
Bressan J. Energy expenditure: components and evaluation methods. Nutr
Hosp 2011; 26:430–440.
9 Eastwood P, Hillman D. A threshold loading device for testing of inspiratory
muscle performance. Eur Respir J 1995;8:463–466.
10 O’Donnell DE, McGuire M, Samis L, Webb KA. General exercise training
improves ventilatory and peripheral muscle strength and endurance in
chronic airflow limitation. Am J Respir Crit Care Med 1998; 157:1489–1497.
11 Annoni S, Bellofiore A, Repossini E, Lazzeri M, Nicolini A, Tarsia P.
Effectiveness of chest physiotherapy and pulmonary rehabilitation in
patients with non-cystic fibrosis bronchiectasis: a narrative review. Monaldi
Arch Chest Dis 2020; 90:43–57.
12 van Zeller M, Mota PC, Amorim A, Viana P, Martins P, Gaspar L, et al.
Pulmonary rehabilitation in patients with bronchiectasis: pulmonary
function, arterial blood gases, and the 6-minute walk test. J Cardiopulm
Rehabil Prev 2012; 32:278–283.
13 Zanini A, Aiello M, Adamo D, Cherubino F, Zampogna E, Sotgiu G, et al.
Effects of Pulmonary Rehabilitation in Patients with Non-Cystic Fibrosis
Bronchiectasis: A Retrospective Analysis of Clinical and Functional
Predictors of Efficacy. Respiration 2015; 89:525–533.
14 AbdelHalim HA, AboElNaga HH, Fathy KA. Comparison between active
cycles of breathing with postural drainage versus conventional chest
physiotherapy in subjects with bronchiectasis. Egypt J Chest Dis Tuberc
2016; 65:157–165.
15 Yang F, Gao L, Wang Q, Deng W, Gao W. Effect of exercise-based
pulmonary rehabilitation in patients with bronchiectasis: A meta-analysis.
Respir Med Res 2022; 81:100910.
16 Murray MP, Pentland JL, Hill AT. A randomised crossover trial of chest
physiotherapy in non-cystic fibrosis bronchiectasis. Eur Respir J 2009;
34:1086–1092.
17 Santamato A, Ranieri M, Panza F, Frisardi V, Marvulli R, Filoni S, et al.
Pulmonary rehabilitation for patients with bronchiectasis: case reports. Eur
J Phys Rehabil Med 2012; 48:293–298.
18 Swerts PM, Mostert R, Wouters EF. Comparison of corridor and treadmill
walking in patients with severe chronic obstructive pulmonary disease.
Phys Ther 1990; 70:439–442.