Physical and Physiological Aspects of Airway Clearance Physiotherapeutic Techniques: Focused Review for their Efficacy

Introduction: This study represents a focused review of the physical and physiological aspects of Airway Clearance Physiotherapy Techniques (ACTs). Methods: The reviewed papers were categorically analyzed for study design, different ACTs, and their outcomes, to outline their efficacy. Two independent reviewers have searched for papers using keywords related to the above topic from 2017 onwards in databases like Google Scholar and PubMed. Randomized Controlled Trials (RCTs) and surveys of therapeutic interventions were included. Studies were selected based on therapeutic interventions and objective outcomes. Results: 20 studies were reviewed, and their aspects were analyzed; 15 were ultimately included. A total of N = 706 participants were included in these 15 studies (9 RCTs, 1 SR, and 5 other studies). Discussion: On Pedro';s scale, the studies are graded as 6 out of 10. The qualitative review highlighted that ACTs are as effective as the therapeutic synergy of their physiological and physical aspects in presenting pathology. Patient positioning, humidification, nebulization, correct sequence, and dosimetry determine efficacy. There are physical analogies like the Ketchup bottle to its antagonistic Sugar box, and applied anatomical aspects that determine the effectiveness of gravity-dependent posture and therapies like cough. These can be combined with the hyperinflation approach in ventilated cases. In spontaneous breathing patients, autogenic drainage, induced or directed cough reflex can be facilitated with different ACTs like CPT, PEP mask, and HFCWOs, etc. Conclusion: The combination of ACTs produces a balanced approach for the removal of secretions, and the dosage of the ACTs is also specific for these aspects.