INTRODUCTION
Though cystic fibrosis (CF) is the commonest cause of bronchiectasis in
the western world, non-Cystic Fibrosis (non-CF) bronchiectasis remains
the major contributor to the burden of chronic respiratory morbidity in
both developed and developing countries due to late diagnosis, limited
resources to manage, and lack of research data.1-3
Diagnostic delay is highlighted as one reason for poor outcomes in
non-CF bronchiectasis patients.4,5 Therefore high
index of suspicion, early diagnosis and optimum airway clearance is the
way forward in improving the clinical outcome in
bronchiectasis.6
Bronchiectasis is characterized by irreversible abnormal dilatation and
anatomical distortion of the bronchial tree and represents a common end
stage of many nonspecific and unrelated antecedent
conditions.7A complex interplay between infection and
inflammation creates a pro-inflammatory vicious cycle that progressively
destructs pulmonary architecture leading to chronic bronchial dilatation
which is the hallmark of bronchiectasis.8 With this
pathophysiological background, management is directed at breaking this
vicious cycle and facilitating the muco-ciliary clearance of secretions
which will hinder the on-going bronchial
damage..Therefore treatment of underlying cause and
providing optimum supportive care should happen
parallelly.9,10To date, most of the treatment
recommendations for non-CF bronchiectasis are extrapolated from studies
done on paediatric patients with CF or adults with
bronchiectasis.11-13Multiple airway clearance
techniques have been introduced without their value been well
established.14
HS has many mucolytic mechanisms that improve the in vitro
transportability of the mucus. It disrupts the structure of the mucus
gel, thereby reducing its viscosity and elasticity. It also increases
the osmotic activity of the surface liquid layer of the airway to
facilitate drawing water into the airway lumen. In addition it helps to
dissociate DNA from the mucoprotein and allows natural proteolytic
enzymes to digest it. HS reaches a peak effect within about 10 minutes
of administration.15
Pre medication of HS nebulizations before commencement of airway
clearance technique is a well-established method in managing
bronchiectasis due to CF.16,17Based on the
effectiveness and safety demonstrated in CF patients, most of the
international guidelines recommend the use of HS in the management of
bronchiectasis irrespective of the
aetiology.18-20However it should be appreciated that
the properties of mucus produced in CF patients are different from that
of patients with non-CF bronchiectasis.
Apart from the absence of high quality scientific evidence on the use of
HS in the management of non-CF bronchiectasis some of the available
trials on adults give contradicting results.21, 22 Yet
some centres use this technique in the management of children with
non-CF bronchiectasis.
The primary objective of this study was to establish whether use of HS
nebulization prior to chest physiotherapy would improve the pulmonary
functions reflected by FEV1, FVC and FEV1/FVC ratio as well as morbidity
over a period of time.