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Airway clearance techniques for bronchiectasis

  1. Annemarie L Lee1,2,3,*,
  2. Angela Burge4,
  3. Anne E Holland2,3,5

Editorial Group: Cochrane Airways Group

Published Online: 31 MAY 2013

Assessed as up-to-date: 19 OCT 2012

DOI: 10.1002/14651858.CD008351.pub2


How to Cite

Lee AL, Burge A, Holland AE. Airway clearance techniques for bronchiectasis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD008351. DOI: 10.1002/14651858.CD008351.pub2.

Author Information

  1. 1

    The University of Melbourne, School of Physiotherapy, Carlton, Victoria, Australia

  2. 2

    Alfred Health, Department of Physiotherapy, Prahan, Australia

  3. 3

    Institute for Breathing and Sleep, Heidelberg, Australia

  4. 4

    The Alfred Hospital, Department of Physiotherapy, Melbourne, Victoria, Australia

  5. 5

    La Trobe University, Department of Physiotherapy, Bundoora, Victoria, Australia

*Annemarie L Lee, annlee@unimelb.edu.au. Annemarie.Lee@alfred.org.au.

Publication History

  1. Publication Status: New
  2. Published Online: 31 MAY 2013

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References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
Figueiredo 2010 {published data only}
  • Figueiredo PHS, Zin WA, Guimaraes FS. Flutter valve improves respiratory mechanics and sputum production in patients with bronchiectasis. Physiotherapy Research International 2010;17:12-20.
Guimaraes 2012 {published data only}
  • Guimaraes FS, Moco VJR, Menezes SLS, Dias CM, Salles REB, Lopes AJ. Effects of ELTGOL and Flutter VRP1 on the dynamic and static pulmonary volumes and on the secretion clearance of patients with bronchiectasis [Efeitos da ELTGOL e do Flutter nos volumes pulmonares dinamicos e estaticos e na remocao de secrecao de pacientes com bronquiectasia]. Revista Brasileira de Fisioterapia 2012;16(2):108-13.
Kurz 1997 {published data only}
  • Kurz M, Ahrens P, Zielen S, Hofmann D. Physiotherapy with the VRP-1 device. Objective and subjective results of a comparative study in children with chronic lung diseases [Physiotherapie mit dem VRP1-Gerat: Objektive und subjektive Ergebnisse einer vergleichenden Studie bei Kindern mit chronischen Lungenerkrankungen]. Pravention und Rehabilitation 1997;9(3):105-9.
Murray 2009 {published data only (unpublished sought but not used)}
  • Murray MP, Pentland JL, Hill AT. A randomised crossover trial of chest physiotherapy in non-cystic fibrosis bronchiectasis. European Respiratory Journal 2009;34(5):1086-92.
Sutton 1988 {published data only (unpublished sought but not used)}

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
Ambrosino 1995 {published data only (unpublished sought but not used)}
  • Ambrosino N, Callegari G, Galloni C, Brega S, Pinna G. Clinical evaluation of oscillating positive expiratory pressure for enhancing expectoration in diseases other than cystic fibrosis. Monaldi Archives for Chest Disease 1995;50(4):269-75.
Antunes 2001 {published data only}
  • Antunes LC, de Carvalho SMF, Borges FD, de Assis VL, de Godoy I. A study of the conventional chest physiotherapy versus Flutter VRP1 in the treatment of patients carrying bronchiectasis. Salusvita 2001;20(1):23-30.
Bradley 2006 {published data only}
  • Bradley J, Moran F. Pulmonary rehabilitation improves exercise tolerance in patients with bronchiectasis. Australian Journal of Physiotherapy 2006;52(1):65.
Briffa 2011 {published data only}
Cecins 1999 {published data only}
Cegla 1993 {published data only}
  • Cegla UH, Retzow A. Physiotherapy in chronic obstructive lung diseases - experiences with the VRP1 Desitin in a multicentre comparative study [Physiotherapie mit dem VRP1 bei chronisch obstruktiven Atemwegserkrankungen - Ergebnisse einer multizentrischen vergleichsstudie]. Pneumologie 1993;47:636-9.
Clinkscale 2012 {published data only}
  • Clinkscale D, Spihlman K, Watts P, Rosenbluth D, Kollef MH. A randomised trial of conventional chest physical therapy versus high frequency chest wall compressions in intubated and non-intubated adults. Respiratory Care 2012;57(8):221-8.
Conway 1992 {published data only}
  • Conway JH, Fleming JS, Perring S, Holgate ST. Humidification as an adjunct to chest physiotherapy in aiding tracheo-bronchial clearance in patients with bronchiectasis. Respiratory Medicine 1992;86(2):109-14.
Crisafulli 2007 {published data only}
  • Crisafulli E, Coletti O, Costi S, Zanasi E, lorenzi C, Lucic S, et al. Effectiveness of erdosteine in elderly patients with bronchiectasis and hypersecretion: a 15 days prospective, parallel, open-label, pilot study. Clinical Therapeutics 2007;29(9):2001-9.
Currie 1988 {published data only}
Daviskas 2008 {published data only}
Eaton 2007 {published data only}
  • Eaton T, Young P, Zeng I, Kolbe J. A randomised evaluation of the acute efficacy, acceptability and tolerability of Flutter and active cycle of breathing with and without postural drainage in non-cystic fibrosis bronchiectasis. Chronic Respiratory Disease 2007;4(1):23-30.
Gallon 1991 {published data only}
Gokdemir 2011 {published data only}
  • Gokdemir Y, Ersu R, Karadag B, Karakoc F. Comparison of conventional chest physiotherapy and high-frequency chest wall oscillation in primary ciliary dyskinesia. European Respiratory Society Annual Congress, Amsterdam 2011;38(2):836S (P4575).
Hartsell 1987 {published data only}
  • Hartsell MB. Chest physiotherapy and mechanical vibration. Journal of Paediatric Nursing 1987;2(2):135-7.
Hasani 1994 {published data only}
Hasani 1995 {published data only}
  • Hasani A, Toms N, Agnew JE, Pavia D, Clarke SW. Regional mucus clearance following cough and forced expiration technique in patients with asthma, chronic bronchitis and bronchiectasis. European Respiratory Journal Supplement 1995;8:19297.
Herrero 2011 {published data only}
  • Herrero B, Polverino E, Romeu DM, Vilaro J. Efficacy of airway clearance therapy with different autonomy degrees in nonCF-bronchiectasis: randomised cross-over trial. European Respiratory Society Annual Congress, Amsterdam 2011;38(3):540s (2977).
Indinnimeo 2007 {published data only}
  • Indinnimeo L, Tancredi G, Barreto M, De Castro G, Zicari AM, Monaco F, et al. Effects of a program of hospital-supervised chest physical therapy on lung function tests in children with chronic respiratory disease: 1-year follow-up. International Journal of Immunopathology and Pharmacology 2007;20(4):841-5.
Joshi 2004 {published data only}
  • Joshi JM, Sundaram P. Role of inhaled steroids in stable bronchiectasis. Indian Practitioner 2004;57(4):243-5.
Kaminska 1988 {published data only}
  • Kaminska TM, Pearson SB. A comparison of postural drainage and positive expiratory pressure in the domiciliary management of patients with chronic bronchial sepsis. Physiotherapy 1988;74(5):251-4.
Kellett 2001 {published data only}
  • Kellett F, Niven R, Redfern J. Double blind trial of hyperosmolar saline as an adjunct to physiotherapy in patients with bronchiectasis. European Respiratory Journal 2001;18 Suppl 33:484s.
Kellett 2005 {published data only}
Kellett 2005a {published data only}
  • Kellet F, Niven RM. A single blind study to compared nebulised hypertonic saline (7%) and normal saline (0.9%) as an adjunct to physiotherapy airway clearance in patients with bronchiectasis. European Respiratory Journal 2005;26 Suppl 49:2012.
Kellett 2011 {published data only}
  • Kellett F, Robert NM. Nebulised 7% hypertonic saline improves lung function and quality of life in bronchiectasis. Respiratory Medicine 2011;105(4):1831-5.
Larroquet 1997 {published data only}
  • Larroquet M, Balquet P, Gruner M. Video-assisted thorascopic surgery for bronchiectasis. Pediatric Pulmonology 1997;24 Suppl 16:180.
Lee 2010 {published data only}
  • Lee AL, Cecins N, Hill CJ, Holland AE, Rautela L, Stirling RG, et al. The effect of pulmonary rehabilitation in patients with non-cystic fibrosis bronchiectasis: protocol for a randomised controlled trial. BMC Pulmonary Medicine 2010;10:5.
Long 2001 {published data only}
  • Long C. The Effects of Manual Chest Percussion in Patients with Chronic Obstructive Pulmonary Disease and Bronchiectasis. East Sussex Hospitals NHS Trust 2001.
Maa 2007 {published data only}
Mazzocco 1985 {published data only}
Moran 2007 {published data only}
  • Moran FM, Elborn SE, Bradbury I, Piper A, Hewitt O, Bradley JM. Airway clearance in bronchiectasis: is non-invasive ventilation a useful adjunct in moderate to severe disease?. Thorax 2007;62 Suppl III:A87.
Morgan 1999 {published data only}
  • Morgan LC, Maxwell L, de Longhi R, Peters MJ, Rutland J. Comparison of Flutter device (FD) with postural drainage (PD) in adult patients with non-CF bronchiectasis. Proceedings of the Thoracic Society of Australia and New Zealand 1999;52:P93.
Mutalithas 2008 {published data only}
  • Mutalithas K, Watkin G, Willig B, Wardlaw A, Pavord ID, Birring SS. Improvement in health status following bronchopulmonary hygiene physical therapy in patients with bronchiectasis. Respiratory Medicine 2008;102(8):1140-4.
Nakamura 2003 {published data only}
Naraparaju 2010 {published data only}
  • Naraparaju S, Vaishali K, Venkatesan P, Acharya V. A comparison of the Acapella and a threshold inspiratory muscle trainer for sputum clearance in bronchiectasis - a pilot study. Physiotherapy Theory and Practice 2010;26(6):353-7.
Newall 2005 {published data only}
Newton 1979 {published data only}
  • Newton DA. Chest physiotherapy under scrutiny. Lancet 1979;1(8106):49-50.
Noone 1999 {published data only}
  • Noone PG, Bennett WD, Regnis JA, Zeman KL, Carson JL, King M, et al. Effect of aerosolized uridine-5'-triphosphate on airway clearance with cough in patients with primary ciliary dyskinesia. American Journal of Respiratory and Critical Care Medicine 1999;160(1):144-9.
Paneroni 2011 {published data only}
  • Paneroni M, Clini E, SImonelli C, Bianchi L, Degli Antoni F, Vitacca M. Safety and efficacy of short-term intrapulmonary percussive ventilation in patients with bronchiectasis. Respiratory Care 2011;56(7):984-8.
Patterson 2003 {published data only}
  • Patterson JE, Bradley JM, Elborn JS. Airway clearance in bronchiectasis: a randomised crossover trial of ACBT versus TIRE. European Respiratory Journal 2003;22 Suppl 45:P1585.
Patterson 2004 {published data only}
  • Patterson JE, Bradley JM, Elborn JS. Airway clearance in bronchiectasis: a randomized crossover trial of active cycle of breathing techniques (incorporating postural drainage and vibration) versus test of incremental respiratory endurance. Chronic Respiratory Disease 2004;1(3):127-30.
Patterson 2005 {published data only (unpublished sought but not used)}
  • Patterson JE, Bradley JM, Hewitt O, Bradbury I, Elborn JS. Airway clearance in bronchiectasis: a randomised crossover trial of active cycle of breathing techniques versus acapella. Respiration 2005;72(3):239-42.
Patterson 2005a {published data only}
  • Patterson JE, Bradley JM, Hewitt O, Bradbury I, Elborn JS. Airway clearance during oral antibiotic therapy in bronchiectasis: a randomised trial of acapella versus usual airway clearance therapy. American Thoracic Society Conference Proceedings; 2005 May 20-25; San Diego (CA). 2005:P917.
Patterson 2007 {published data only (unpublished sought but not used)}
  • Patterson JE, Hewitt O, Kent L, Bradbury I, Elborn JS, Bradley JM. Acapella versus 'usual airway clearance' during acute exacerbation in bronchiectasis: a randomised crossover trial. Chronic Respiratory Disease 2007;4(2):67-74.
Polverino 2012 {published data only}
  • Polverino E, Herrero B, Vilaro J, Marti D. Efficacy of airway clearance therapy with different autonomy degress in non-CF bronchiectasis: a randomised cross-over trial. American Journal of Respiratory and Critical Care Medicine 2012;185(1):A4876.
Santamaria 1998 {published data only}
  • Santamaria F, Celentano L, Buonpensiero P, Sarnelli P, Caterino M, Raia V. Positive expiratory pressure treatment: efficacy in pulmonary diseases. Journal of Pediatrics 1998;133(5):717-18.
Savci 1998 {published data only}
  • Savci S, Inal D, Arikan H. A comparison of the active cycle of breathing technique with and without manual techniques in patients with bronchiectasis. European Respiratory Journal 1998;1 Suppl 12:28212S.
Su 2012 {published data only}
  • Su CL, Chang CC, Lin YK, Lee KT, Lee CN, Chiang LL. Randomised crossover study of lung expansion therapy using negative pressure and positive pressure in bronchiectasis. Journal of Experimental and Clinical Medicine 2012;4(7):149-53.
Sutton 1983 {published data only (unpublished sought but not used)}
  • Sutton PP, Parker RA, Webber BA, Newman SP, Garland N, Lopez Vidriero MT, et al. Assessment of the forced expiration technique, postural drainage and directed coughing in chest physiotherapy. European Journal of Respiratory Diseases 1983;64(1):62-8.
Syed 2009 {published data only}
  • Syed N, Maiya AG, Siva Kumar T. Active cycles of breathing technique (ACBT) versus conventional chest physical therapy on airway clearance in bronchiectasis - crossover trial. Advances in Physiotherapy 2009;11(4):193-8.
Tambascio 2011 {published data only}
  • Tambascio J, de Souza LT, Lisboa RMh, Passarelli RDCV, de Souza HCD, Gastaldi AC. The influence of Flutter VRP1 components of mucus transport of patients with bronchiectasis. Respiratory Medicine 2011;105(9):1316-21.
Thompson 2000 {published data only}
  • Thompson CS, Harrison S, Ashley J, Day K, Smith DL. Flutter valve or conventional physiotherapy in productive non-cystic fibrosis bronchiectasis? A randomised crossover study. Thorax 2000;55 Suppl 3:A71.
Thompson 2002 {published data only}
  • Thompson CS, Harrison S, Ashley J, Day K, Smith DL. Randomised crossover study of the Flutter device and the active cycle of breathing technique in non-cystic fibrosis bronchiectasis. Thorax 2002;57(5):446-8.
Tsang 1994 {published data only}
  • Tsang KWT, Roberts P, Read RC, Kees R, Wilson R, Cole PJ. The concentrations of clarithromycin and its 14-hydroxy metabolite in sputum of patients with bronchiectasis following single dose administration. Journal of Antimicrobial Chemotherapy 1994;33(2):289-97.
Tsang 2003 {published data only (unpublished sought but not used)}
  • Tsang SMH, Jones AYM. Postural drainage or flutter device in conjunction with breathing and coughing compared to breathing and coughing alone in improving secretion removal and lung function in patients with acute exacerbation of bronchiectasis. A pilot study. Hong Kong Physiotherapy Journal 2003;21:29-36.
Valente 2004 {published data only}
  • Valente AM, Gastaldi AC, Cravo SL, Afonso JL, Sologuren MJJ, Guimaraes RC. The effect of two techniques on the characteristics and transport of sputum in patients with bronchiectasis. A pilot study. Physiotherapy 2004;90(3):158-64.
Venturelli 2013 {published data only}
  • Venturelli E, Crisafulli E, deBiase A, Righi D, Berrighi D, Cavicchioli PP, et al. Efficacy of temporary positive expiratory pressure (TPEP) in patients with lung diseases and chronic mucus hypersecretion. The UNIKO(R) project: a multicentre randomized controlled trial. Clinical Rehabilitation 2013;27(4):336-46.
Volker 1972 {published data only}
  • Volker C. Objectivation of treatment effects in children with respiratory tract diseases using spirometric examinations in the people's saline bath resort, Kosen. Zeitschrift Fur Physiotherapie 1972;24(5):383-90.
Wilson 1995 {published data only}
  • Wilson GE, Baldwin AL, Walshaw MJ. A comparison of traditional chest physiotherapy with the active cycle of breathing in patients with chronic suppurative lung disease. European Respiratory Journal 1995;8 Suppl 19:171S.

References to ongoing studies

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
Hill 2000 {published data only}
  • Hill S. An investigation of the impact of inspiratory muscle training and/or exercise training on pulmonary function, exercise tolerance, quality of life and sputum clearance in patients with idiopathic bronchiectasis. Thorax 2000;1:28212S.
Murray 2007 {published data only}
  • Murray M. Is regular chest physiotherapy effective in severe non cystic fibrosis bronchiectasis?. clinicaltrials.gov/ct2/show/NCT00816309 (accessed 16 April 2013).

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
AIHW 2005
  • Australian Institute of Health and Welfare. Chronic Respiratory Diseases in Australia: Their Prevalence, Consequences and Prevention. Australian Institute of Health and Welfare 2005.
Arens 1994
  • Arens RA, Gozal D, Omlin KJ, Vega J, Boyd KP, Keens TG, et al. Comparison of high frequency chest compression and conventional chest physiotherapy in hospitalised patients with cystic fibrosis. American Journal of Respiratory and Critical Care Medicine 1994;114:171-7.
Barker 2002
Bateman 1981
Bott 2009
  • Bott J, Blumenthal S, Buxton M, Ellum S, Falconer C, Garrod R, et al. Guidelines for the physiotherapy management of the adult medical, spontaneously breathing patient. Thorax 2009;64 Suppl 1:i1-i51.
Boucher 2010
  • Boucher RC. Bronchiectasis: a continuum of ion transport dysfunction or multiple hits?. American Journal of Respiratory and Critical Care Medicine 2010;181:1017-9.
Chang 2008
Chang 2008a
  • Chang AB, Grimwood K, Maguire G, King PT, Morris PS, Torzillo PT. Management of bronchiectasis and chronic suppurative lung disease in Indigenous children and adults from rural and remote Australian communities. Medical Journal of Australia 2008;189(7):386-393.
Cochrane 1977
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Cole 1986
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Flude 2012
Gaga 1998
  • Gaga M, Bentley AM, Humbert M, Barkans J, O'Brien F, Wathens CG, et al. Increases in CD4+ T lymphocytes, macrophages, neutrophils and interleukin 8 positive cells in the airways of patients with bronchiectasis. Thorax 1998;53(8):685-91.
Garrard 1978
Higgins 2011
  • Higgins J, Altman D (editors). Chapter 8: Assessing risk of bias in included studies. In: HigginsJPT, Green S (editors). Cochrane Handbook of Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Hill 2011
  • Hill AT, Pasteur M, Cornford C, Welham S, Bilton D. Primary care summary of the British Thoracic Society guideline on the management of non-cystic fibrosis bronchiectasis. Primary Care Respiratory Journal 2011;20(2):135-140.
Jones 2005
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Kim 1986
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Kim 1987
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  • King P, Holdsworth SR, Freezer NJ, Villanueva E, Gallagher M, Holmes PW. Outcome in adult bronchiectasis. Journal of Chronic Obstructive Pulmonary Disease 2005;2:27-34.
King 2006a
King 2006b
  • King P, Holdsworth SR, Freezer NJ, Villanueva E, Holmes PW. Characterisation of the onset and presenting clinical features of adult bronchiectasis. Respiratory Medicine 2006;100(12):2183-9.
King 2010
Koulouris 2003
  • Koulouris NG, Retsou S, Kosmas E, Dimakou K, Malagari K, Mantzikopoulos G, et al. Tidal expiratory flow limitation, dyspnoea and exercise capacity in patients with bilateral bronchiectasis. European Respiratory Journal 2003;21:743-8.
Loebinger 2009
  • Loebinger M, Wells A, Hansell D, Chinyanganya N, Devaraj A, Meister M, et al. Mortality in bronchiectasis: a long-term study assessing the factors influencing survival. European Respiratory Journal 2009;34:843-9.
Martinez-Garcia 2005
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Martinez-Garcia 2007
  • Martinez-Garcia MA, Soler-Cataluna JJ, Perpina-Tordera M, Roman-Sanchez P, Soriano J. Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. Chest 2007;132:1565-72.
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  • Martinez-Garcia MA, Perpina-Tordera M, Soler-Cataluna JJ, Roman-Sanchez P, Lloris-Bayo A, Gonzalez-Molina A. Dissociation of lung function, dyspnoea ratings and pulmonary extension in bronchiectasis. Respiratory Medicine 2007;101:2248-53.
McCool 2006
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O'Donnell 1998
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Oberwaldner 1986
Pasteur 2010
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Raj 2009
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Regnis 1994
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RevMan 2011
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Sutton 1985
  • Sutton P, Lopez-Vidriero M, Pavia D, Newman S, Clay M, Webber B, et al. Assessment of percussion, vibratory-shaking and breathing exercises in chest physiotherapy. European Journal of Respiratory Disease 1985;66(2):147-52.
Tsang 2004
Tsang 2009
van der Schans 2000
  • van der Schans CP, Prasad A, Main E. Chest physiotherapy compared to no chest physiotherapy for cystic fibrosis. Cochrane Database of Systematic Reviews 2000, Issue 2. [DOI: 10.1002/14651858.CD001401]
van der Schans 2002
  • van der Schans CP. Airway clearance: assessment of techniques. Paediatric Respiratory Reviews 2002;3:110-4.
van Henstrum 1988
  • van Henstrum M, Festen J, Beurskens C, Hankel M, Beekman F, Corstens F. Conventional physiotherapy and forced expiration manoeuvres have similar effects on tracheobronchial clearance. European Respiratory Journal 1988;1:758-61.
Weycker 2005
  • Weycker D, Edelsberg J, Oster G, Tino G. Prevalence and economic burden of bronchiectasis. Clinical Pulmonary Medicine 2005;12(4):205-9.
Williams 1994
Wilson 1997
  • Wilson C, Jones P, O'Leary CJ, Cole P, Wilson R. Validation of the St George's Respiratory Questionnaire in bronchiectasis. American Journal of Respiratory and Critical Care Medicine 1997;156:536-41.

References to other published versions of this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
Jones 1998
  • Jones AP, Rowe BH. Bronchopulmonary hygiene physical therapy for chronic obstructive pulmonary disease and bronchiectasis. Cochrane Database of Systematic Reviews 1998, Issue 4. [DOI: 10.1002/14651858.CD000045]