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Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 3

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Forest plot of comparison: 1 Acute COPD: ACTs vs no ACTs (control), outcome: 1.5 Need for increased ventilatory assistance (invasive or non‐invasive).
Figuras y tablas -
Figure 4

Forest plot of comparison: 1 Acute COPD: ACTs vs no ACTs (control), outcome: 1.5 Need for increased ventilatory assistance (invasive or non‐invasive).

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Forest plot of comparison: 1 Acute COPD: ACTs vs no ACTs (control), outcome: 1.6 Duration of ventilatory assistance (days).
Figuras y tablas -
Figure 5

Forest plot of comparison: 1 Acute COPD: ACTs vs no ACTs (control), outcome: 1.6 Duration of ventilatory assistance (days).

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Forest plot of comparison: 1 Acute COPD: ACTs vs no ACTs (control), outcome: 1.8 Length of hospital stay (days).
Figuras y tablas -
Figure 6

Forest plot of comparison: 1 Acute COPD: ACTs vs no ACTs (control), outcome: 1.8 Length of hospital stay (days).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 1 Number of AECOPDs (long‐term).
Figuras y tablas -
Analysis 1.1

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 1 Number of AECOPDs (long‐term).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 2 Number of AECOPDs (long‐term).
Figuras y tablas -
Analysis 1.2

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 2 Number of AECOPDs (long‐term).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 3 Need for respiratory hospital admission (long‐term).
Figuras y tablas -
Analysis 1.3

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 3 Need for respiratory hospital admission (long‐term).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 4 Need for respiratory hospital admission (long‐term).
Figuras y tablas -
Analysis 1.4

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 4 Need for respiratory hospital admission (long‐term).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 5 Need for increased ventilatory assistance (invasive or non‐invasive).
Figuras y tablas -
Analysis 1.5

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 5 Need for increased ventilatory assistance (invasive or non‐invasive).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 6 Duration of ventilatory assistance (days).
Figuras y tablas -
Analysis 1.6

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 6 Duration of ventilatory assistance (days).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 7 Length of ICU stay (days).
Figuras y tablas -
Analysis 1.7

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 7 Length of ICU stay (days).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 8 Length of hospital stay (days).
Figuras y tablas -
Analysis 1.8

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 8 Length of hospital stay (days).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 9 QOL ‐ SGRQ total (short‐term).
Figuras y tablas -
Analysis 1.9

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 9 QOL ‐ SGRQ total (short‐term).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 10 FEV1 (L) (short‐term).
Figuras y tablas -
Analysis 1.10

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 10 FEV1 (L) (short‐term).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 11 VC (L) (short‐term).
Figuras y tablas -
Analysis 1.11

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 11 VC (L) (short‐term).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 12 FEV1/FVC (%) (short‐term).
Figuras y tablas -
Analysis 1.12

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 12 FEV1/FVC (%) (short‐term).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 13 Gas exchange: pH (short‐term).
Figuras y tablas -
Analysis 1.13

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 13 Gas exchange: pH (short‐term).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 14 Gas exchange: PaO2 (mmHg) (short‐term).
Figuras y tablas -
Analysis 1.14

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 14 Gas exchange: PaO2 (mmHg) (short‐term).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 15 Gas exchange: PaCO2 (mmHg) (short‐term).
Figuras y tablas -
Analysis 1.15

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 15 Gas exchange: PaCO2 (mmHg) (short‐term).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 16 Gas exchange: SpO2 (%) (short‐term).
Figuras y tablas -
Analysis 1.16

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 16 Gas exchange: SpO2 (%) (short‐term).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 17 Breathlessness ‐ Borg scale (short‐term).
Figuras y tablas -
Analysis 1.17

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 17 Breathlessness ‐ Borg scale (short‐term).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 18 Sputum weight, g (immediate).
Figuras y tablas -
Analysis 1.18

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 18 Sputum weight, g (immediate).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 19 Sputum volume, ml (immediate).
Figuras y tablas -
Analysis 1.19

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 19 Sputum volume, ml (immediate).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 20 Sputum volume, ml (24/24) (short‐term).
Figuras y tablas -
Analysis 1.20

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 20 Sputum volume, ml (24/24) (short‐term).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 21 Mortality (short‐term).
Figuras y tablas -
Analysis 1.21

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 21 Mortality (short‐term).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 22 Mortality (long‐term).
Figuras y tablas -
Analysis 1.22

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 22 Mortality (long‐term).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 23 Participant withdrawal (immediate).
Figuras y tablas -
Analysis 1.23

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 23 Participant withdrawal (immediate).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 24 Participant withdrawal (short‐term).
Figuras y tablas -
Analysis 1.24

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 24 Participant withdrawal (short‐term).

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Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 25 Participant withdrawal (long‐term).
Figuras y tablas -
Analysis 1.25

Comparison 1 Acute COPD: ACTs vs no ACTs (control), Outcome 25 Participant withdrawal (long‐term).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 1 Number of AECOPDs (short‐term).
Figuras y tablas -
Analysis 2.1

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 1 Number of AECOPDs (short‐term).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 2 Need for respiratory hospital admission (long‐term).
Figuras y tablas -
Analysis 2.2

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 2 Need for respiratory hospital admission (long‐term).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 3 Total number of days hospitalised (long‐term).
Figuras y tablas -
Analysis 2.3

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 3 Total number of days hospitalised (long‐term).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 4 QOL ‐ SGRQ total (short‐term).
Figuras y tablas -
Analysis 2.4

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 4 QOL ‐ SGRQ total (short‐term).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 5 FEV1 (L) (immediate).
Figuras y tablas -
Analysis 2.5

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 5 FEV1 (L) (immediate).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 6 FEV1 (L) (short‐term).
Figuras y tablas -
Analysis 2.6

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 6 FEV1 (L) (short‐term).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 7 VC (L) (immediate).
Figuras y tablas -
Analysis 2.7

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 7 VC (L) (immediate).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 8 VC (L) (short‐term).
Figuras y tablas -
Analysis 2.8

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 8 VC (L) (short‐term).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 9 Gas exchange: PaO2 (mmHg) (short‐term).
Figuras y tablas -
Analysis 2.9

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 9 Gas exchange: PaO2 (mmHg) (short‐term).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 10 Gas exchange: PaCO2 (mmHg) (short‐term).
Figuras y tablas -
Analysis 2.10

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 10 Gas exchange: PaCO2 (mmHg) (short‐term).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 11 Gas exchange: SpO2 (%) (immediate).
Figuras y tablas -
Analysis 2.11

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 11 Gas exchange: SpO2 (%) (immediate).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 12 Breathlessness, Borg scale (immediate).
Figuras y tablas -
Analysis 2.12

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 12 Breathlessness, Borg scale (immediate).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 13 Sputum weight, g (immediate).
Figuras y tablas -
Analysis 2.13

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 13 Sputum weight, g (immediate).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 14 Sputum volume, ml (immediate).
Figuras y tablas -
Analysis 2.14

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 14 Sputum volume, ml (immediate).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 15 Mucociliary clearance, scintigraphy (% retention).
Figuras y tablas -
Analysis 2.15

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 15 Mucociliary clearance, scintigraphy (% retention).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 16 Exercise tolerance, 6MWD (m) (short‐term).
Figuras y tablas -
Analysis 2.16

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 16 Exercise tolerance, 6MWD (m) (short‐term).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 17 Exercise tolerance, 12MWD (m) (long‐term).
Figuras y tablas -
Analysis 2.17

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 17 Exercise tolerance, 12MWD (m) (long‐term).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 18 Need for antibiotics (short‐term).
Figuras y tablas -
Analysis 2.18

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 18 Need for antibiotics (short‐term).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 19 Need for antibiotics (long‐term).
Figuras y tablas -
Analysis 2.19

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 19 Need for antibiotics (long‐term).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 20 Participant withdrawal (short‐term).
Figuras y tablas -
Analysis 2.20

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 20 Participant withdrawal (short‐term).

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Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 21 Participant withdrawal (long‐term).
Figuras y tablas -
Analysis 2.21

Comparison 2 Stable COPD: ACTs vs no ACTs (control), Outcome 21 Participant withdrawal (long‐term).

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Summary of findings for the main comparison. Airway clearance techniques for individuals with an exacerbation of COPD

ACTs for individuals with an AECOPD

Patient or population: individuals with an exacerbation of COPD
Settings: hospital (inpatient ward or emergency department)
Intervention: airway clearance techniques (ACTs)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

ACTs

Need for increased ventilatory assistance (invasive or non‐invasive)

Study population

OR 0.21
(0.05 to 0.85)

171
(4 studies)

⊕⊕⊝⊝
low1,2

112 per 1000

26 per 1000
(6 to 97)

Medium‐risk population

67 per 1000

15 per 1000
(4 to 58)

Duration of ventilatory assistance
days

7 days3

The mean duration of ventilatory assistance in the intervention groups was
2.05 lower
(2.6 to 1.51 lower)

54
(2 studies)

⊕⊕⊝⊝
low1,2

Length of hospital stay
days

9 days3

The mean length of hospital stay in the intervention groups was
0.75 lower
(1.38 to 0.11 lower)

171
(3 studies)

⊕⊕⊝⊝
low1,2

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
ACT: airway clearance technique; AECOPD: acute exacerbation of chronic obstructive pulmonary disease; CI: Confidence interval; OR: Odds ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 (‐1 limitations) Some significant risks of bias across included studies.
2 (‐1 imprecision) Small sample sizes across included studies +/‐ wide confidence intervals.

3 Mean duration in control arm of trials.

Figuras y tablas -
Summary of findings for the main comparison. Airway clearance techniques for individuals with an exacerbation of COPD
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Table 1. Comparison of interventions (AECOPD)

Study

Design

Intervention

Intensity

Session duration, frequency

Total therapy duration

Max. follow‐up

Anthonisen 1964

RCT

Non‐PEP (CCPT)

Unclear

Unclear, od

10 days

D/C from hospital

Bellone 2002

RCT

PEP (mask)

10 to 15 cm H2O

30 to 40 minutes, tds

3 days

D/C from RICU

Brown 1987

RXT

Non‐PEP (CCPT)

'Firm pressure'

15 minutes/affected segment

Single session

24/24

Haidl 2002

RCT

PEP (Cornet)

Position 1

5 breaths

Single session

Immediate

Inal‐Ince 2004

RCT

Non‐PEP (breathing exs)

N/A

15 to 30 minutes, od

Until D/C from ICU

D/C from ICU

Kodric 2009

RCT

Non‐PEP (breathing exs)

N/A

30 to 40 minutes, bd

7 days

6 months

Newton 1978

RCT

Non‐PEP (CCPT + IPPV)

Unclear

10 to 15 minutes, tds +

15 minutes IPPV, tds

Unclear

3 months

Newton 1978a

RXT

Non‐PEP (breathing exs + CCPT)

Unclear

15 minutes

Single session

Immediate

Vargas 2005

RCT

PEP (IPV via mask)

Peak pressure 20 +/‐ 5 cm H2O, percussion frequency 250 +/‐ 50/min, I:E 1:2.5

30 minutes, bd

Until spontaneous RR < 25/min and pH > 7.38 for 24/24 (mean 3 +/‐ 1 days)

D/C from hospital

RCT: randomised controlled trial; RXT: randomised cross‐over trial; od: once/day; bd: twice/day; tds: three times/day; exs: exercises; RR: respiratory rate; D/C: discharge; CCPT: conventional chest physiotherapy (postural drainage, percussion, vibration); IPV: intrapulmonary percussive ventilation; PEP: positive expiratory pressure.

Figuras y tablas -
Table 1. Comparison of interventions (AECOPD)
Ir a la tabla de la revisión
Table 2. Comparison of interventions (stable COPD)

Study

Design

Intervention

Intensity

Session duration, frequency

Total therapy duration

Max. follow‐up

Cegla 1997

RCT

PEP (Cornet, Flutter)

Unclear

5 minutes, qid

7 days

Short‐term (end of 7 days)

Cegla 2001

RXT

PEP (Cornet)

Position 1 (estimated pressure 20 +/‐ 5 cm H2O)

Duration of nebulisation

Single session

Immediate (25 minutes)

Cegla 2002

RCT

PEP (Cornet)

Start position

≥ 5 minutes, tds + prn (if mucus or dyspnoea)

2 years

Long‐term (end of 2 years)

Christensen 1990

RCT

PEP (mask with PEEP valve)

10 cm H2O

≥ 15 minutes, tds

6 months

Long‐term (end of 6 months)

Christensen 1991

RCT

PEP (mask)

10 to 20 cm H2O

10 breaths, bd

4 weeks

Short‐term (end of 4 weeks)

Christensen 1991a

RXT

PEP (mask)

10 to 15 cm H2O

8 to 10 minutes, tds

2 weeks

Short‐term (end of 2 weeks)

Hasani 1995

RXT

Non‐PEP (FET)

N/A

9 minutes

Single session

Immediate

Martins 2006

RXT

Non‐PEP (ELTGOL)

N/A

20 minutes

Single session

Immediate (20 minutes)

Martins 2007

RXT

Non‐PEP (ELTGOL)

N/A

20 minutes

Single session

Immediate (120 minutes)

May 1979

RXT

Non‐PEP (CCPT)

Unclear

Unclear

Single session

Immediate (120 minutes)

Morsch 2008

RCT

PEP (Flutter +/‐ FET)

Horizontal position, 0.8 to 25 cm H2O

5 minutes

Single session

Immediate

Oldenburg 1979

RXT

Non‐PEP (CCPT);
Non‐PEP (physical exercise)

N/A (CCPT);
70% to 75% predicted HRmax (physical exercise)

30 minutes (CCPT);
20 minutes (physical exercise)

Single session (CCPT);
Single session (physical exercise)

Immediate (2.5 hours)

Pavia 1976

RXT

Non‐PEP (mechanical vibration)

Onset of tremulous speech; amp 2 mm; frequency 41Hz

60 minutes

Single session

Immediate (5 hours)

Rasmussen 2001

RXT

PEP (valve)

5 to 20 cm H2O

Unclear, bd

4 days

Immediate (1 hour)

Rivington‐Law 1984

RXT

Non‐PEP (breathing exs);
Non‐PEP (breathing exs + CCPT)

N/A (breathing exs);
'Moderate'  (≤ 20 mmHg) intensity (breathing exs + CCPT)

15 minutes

Single session

Immediate (15 minutes)

van Hengstum 1988

RXT

PEP (mask);
Non‐PEP (breathing exs + CCPT)

10 to 15 cm H2O (PEP);
N/A (breathing exs + CCPT)

20 minutes (PEP);
30 minutes (breathing exs + CCPT)

Single session

Short‐term (24/24)

Weiner 1996

RCT

PEP (Flutter)

Unclear

10 minutes, od

3 months

Long‐term (end of 3 months)

Wolkove 2002

RXT

PEP (Flutter)

Position which generated the best chest 'flutter' sensation

10 minutes

Single session

Immediate (120 minutes)

Wolkove 2004

RXT

PEP (Flutter)

Position which generated the best chest 'flutter' sensation

10 minutes, qid

1 week

Short‐term (end of 1 week)

RCT: randomised controlled trial; RXT: randomised cross‐over trial; od: once/day; bd: two times/day; tds: three times/day; qid: four times/day; prn: as needed; exs: exercises; CCPT: conventional chest physiotherapy (postural drainage, percussion, vibration); ELTGOL: expiration with the glottis open in the lateral posture; PEP: positive expiratory pressure.

Figuras y tablas -
Table 2. Comparison of interventions (stable COPD)
Ir a la tabla de la revisión
Table 3. Studies which met sensitivity analysis requirements

Adequate allocation concealment

Adequate assessor blinding

Complete data or evidence of ITT analysis

Haidl 2002

Christensen 1990

Cegla 1997

Kodric 2009

Newton 1978a

Cegla 2001

Newton 1978

Weiner 1996

Cegla 2002

Newton 1978a

Christensen 1991a

Vargas 2005

May 1979

Wolkove 2004

Morsch 2008

Oldenburg 1979

Vargas 2005

Weiner 1996

Study must have been rated as 'low risk of bias' for relevant item to be included in sensitivity analysis. ITT: intention‐to‐treat.

Figuras y tablas -
Table 3. Studies which met sensitivity analysis requirements
Ir a la tabla de la revisión
Comparison 1. Acute COPD: ACTs vs no ACTs (control)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of AECOPDs (long‐term) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 Non‐PEP techniques

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number of AECOPDs (long‐term) Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Non‐PEP techniques

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Need for respiratory hospital admission (long‐term) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 Non‐PEP techniques

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Need for respiratory hospital admission (long‐term) Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.1 Non‐PEP techniques

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Need for increased ventilatory assistance (invasive or non‐invasive) Show forest plot

4

171

Odds Ratio (M‐H, Fixed, 95% CI)

0.21 [0.05, 0.85]

5.1 PEP techniques

2

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.11 [0.01, 0.87]

5.2 Non‐PEP techniques

2

111

Odds Ratio (M‐H, Fixed, 95% CI)

0.47 [0.07, 3.36]

6 Duration of ventilatory assistance (days) Show forest plot

2

54

Mean Difference (IV, Fixed, 95% CI)

‐2.05 [‐2.60, ‐1.51]

6.1 PEP techniques

1

27

Mean Difference (IV, Fixed, 95% CI)

‐2.10 [‐2.67, ‐1.53]

6.2 Non‐PEP techniques

1

27

Mean Difference (IV, Fixed, 95% CI)

‐1.49 [‐3.49, 0.51]

7 Length of ICU stay (days) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

7.1 Non‐PEP techniques

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Length of hospital stay (days) Show forest plot

3

171

Mean Difference (IV, Fixed, 95% CI)

‐0.75 [‐1.38, ‐0.11]

8.1 PEP techniques

1

33

Mean Difference (IV, Fixed, 95% CI)

‐1.10 [‐1.89, ‐0.31]

8.2 Non‐PEP techniques

2

138

Mean Difference (IV, Fixed, 95% CI)

‐0.09 [‐1.17, 0.99]

9 QOL ‐ SGRQ total (short‐term) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

9.1 Non‐PEP techniques

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

10 FEV1 (L) (short‐term) Show forest plot

2

106

Mean Difference (IV, Fixed, 95% CI)

0.02 [‐0.16, 0.20]

10.1 PEP techniques

1

27

Mean Difference (IV, Fixed, 95% CI)

0.08 [‐0.17, 0.32]

10.2 Non‐PEP techniques

1

79

Mean Difference (IV, Fixed, 95% CI)

‐0.05 [‐0.32, 0.22]

11 VC (L) (short‐term) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

11.1 Non‐PEP techniques

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

12 FEV1/FVC (%) (short‐term) Show forest plot

2

86

Mean Difference (IV, Fixed, 95% CI)

4.33 [‐1.99, 10.64]

12.1 PEP techniques

1

27

Mean Difference (IV, Fixed, 95% CI)

1.0 [‐11.37, 13.37]

12.2 Non‐PEP techniques

1

59

Mean Difference (IV, Fixed, 95% CI)

5.5 [‐1.85, 12.85]

13 Gas exchange: pH (short‐term) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

13.1 PEP techniques

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

14 Gas exchange: PaO2 (mmHg) (short‐term) Show forest plot

2

106

Mean Difference (IV, Fixed, 95% CI)

‐0.66 [‐5.02, 3.71]

14.1 PEP techniques

1

27

Mean Difference (IV, Fixed, 95% CI)

0.80 [‐6.86, 8.46]

14.2 Non‐PEP techniques

1

79

Mean Difference (IV, Fixed, 95% CI)

‐1.36 [‐6.67, 3.95]

15 Gas exchange: PaCO2 (mmHg) (short‐term) Show forest plot

2

105

Mean Difference (IV, Fixed, 95% CI)

‐1.10 [‐5.56, 3.37]

15.1 PEP techniques

1

26

Mean Difference (IV, Fixed, 95% CI)

‐3.80 [‐17.83, 10.23]

15.2 Non‐PEP techniques

1

79

Mean Difference (IV, Fixed, 95% CI)

‐0.79 [‐5.50, 3.92]

16 Gas exchange: SpO2 (%) (short‐term) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

16.1 Non‐PEP techniques

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17 Breathlessness ‐ Borg scale (short‐term) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

17.1 Non‐PEP techniques

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

18 Sputum weight, g (immediate) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

18.1 PEP techniques

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

19 Sputum volume, ml (immediate) Show forest plot

1

Mean Difference (Fixed, 95% CI)

Totals not selected

19.1 Non‐PEP techniques

1

Mean Difference (Fixed, 95% CI)

0.0 [0.0, 0.0]

20 Sputum volume, ml (24/24) (short‐term) Show forest plot

2

138

Mean Difference (IV, Fixed, 95% CI)

0.04 [‐3.73, 3.80]

20.1 Non‐PEP techniques

2

138

Mean Difference (IV, Fixed, 95% CI)

0.04 [‐3.73, 3.80]

21 Mortality (short‐term) Show forest plot

4

171

Odds Ratio (M‐H, Fixed, 95% CI)

0.72 [0.14, 3.80]

21.1 PEP techniques

2

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.93]

21.2 Non‐PEP techniques

2

111

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.13, 7.45]

22 Mortality (long‐term) Show forest plot

2

107

Odds Ratio (M‐H, Fixed, 95% CI)

0.82 [0.26, 2.63]

22.1 Non‐PEP techniques

2

107

Odds Ratio (M‐H, Fixed, 95% CI)

0.82 [0.26, 2.63]

23 Participant withdrawal (immediate) Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

23.1 PEP techniques

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

24 Participant withdrawal (short‐term) Show forest plot

4

203

Odds Ratio (M‐H, Fixed, 95% CI)

0.55 [0.11, 2.69]

24.1 PEP techniques

2

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.93]

24.2 Non‐PEP techniques

2

143

Odds Ratio (M‐H, Fixed, 95% CI)

0.65 [0.10, 4.10]

25 Participant withdrawal (long‐term) Show forest plot

2

143

Odds Ratio (M‐H, Fixed, 95% CI)

0.87 [0.39, 1.94]

25.1 Non‐PEP techniques

2

143

Odds Ratio (M‐H, Fixed, 95% CI)

0.87 [0.39, 1.94]
Figuras y tablas -
Comparison 1. Acute COPD: ACTs vs no ACTs (control)
Ir a la tabla de la revisión
Comparison 2. Stable COPD: ACTs vs no ACTs (control)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number of AECOPDs (short‐term) Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 PEP techniques

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Need for respiratory hospital admission (long‐term) Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 PEP techniques

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Total number of days hospitalised (long‐term) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 PEP techniques

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 QOL ‐ SGRQ total (short‐term) Show forest plot

1

Mean Difference (Fixed, 95% CI)

Totals not selected

4.1 PEP techniques

1

Mean Difference (Fixed, 95% CI)

0.0 [0.0, 0.0]

5 FEV1 (L) (immediate) Show forest plot

1

Mean Difference (Fixed, 95% CI)

Totals not selected

5.1 PEP techniques

1

Mean Difference (Fixed, 95% CI)

0.0 [0.0, 0.0]

6 FEV1 (L) (short‐term) Show forest plot

2

118

Mean Difference (IV, Fixed, 95% CI)

‐0.04 [‐0.35, 0.28]

6.1 PEP techniques

2

118

Mean Difference (IV, Fixed, 95% CI)

‐0.04 [‐0.35, 0.28]

7 VC (L) (immediate) Show forest plot

1

Mean Difference (Fixed, 95% CI)

Totals not selected

7.1 PEP techniques

1

Mean Difference (Fixed, 95% CI)

0.0 [0.0, 0.0]

8 VC (L) (short‐term) Show forest plot

2

118

Mean Difference (IV, Fixed, 95% CI)

‐0.05 [‐0.43, 0.33]

8.1 PEP techniques

2

118

Mean Difference (IV, Fixed, 95% CI)

‐0.05 [‐0.43, 0.33]

9 Gas exchange: PaO2 (mmHg) (short‐term) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

9.1 PEP techniques

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

10 Gas exchange: PaCO2 (mmHg) (short‐term) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

10.1 PEP techniques

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

11 Gas exchange: SpO2 (%) (immediate) Show forest plot

1

Mean Difference (Fixed, 95% CI)

Totals not selected

11.1 PEP techniques

1

Mean Difference (Fixed, 95% CI)

0.0 [0.0, 0.0]

12 Breathlessness, Borg scale (immediate) Show forest plot

1

Mean Difference (Fixed, 95% CI)

Totals not selected

12.1 PEP techniques

1

Mean Difference (Fixed, 95% CI)

0.0 [0.0, 0.0]

13 Sputum weight, g (immediate) Show forest plot

1

Mean Difference (Fixed, 95% CI)

Totals not selected

13.1 PEP techniques

1

Mean Difference (Fixed, 95% CI)

0.0 [0.0, 0.0]

14 Sputum volume, ml (immediate) Show forest plot

1

Mean Difference (Fixed, 95% CI)

Totals not selected

14.1 Non‐PEP techniques

1

Mean Difference (Fixed, 95% CI)

0.0 [0.0, 0.0]

15 Mucociliary clearance, scintigraphy (% retention) Show forest plot

2

Mean Difference (Fixed, 95% CI)

1.20 [‐2.79, 5.19]

15.1 Non‐PEP techniques

2

Mean Difference (Fixed, 95% CI)

1.20 [‐2.79, 5.19]

16 Exercise tolerance, 6MWD (m) (short‐term) Show forest plot

2

Mean Difference (Fixed, 95% CI)

12.93 [5.98, 19.89]

16.1 PEP techniques

2

Mean Difference (Fixed, 95% CI)

12.93 [5.98, 19.89]

17 Exercise tolerance, 12MWD (m) (long‐term) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

17.1 PEP techniques

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

18 Need for antibiotics (short‐term) Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

18.1 PEP techniques

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

19 Need for antibiotics (long‐term) Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

19.1 PEP techniques

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

20 Participant withdrawal (short‐term) Show forest plot

2

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

20.1 PEP techniques

2

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

21 Participant withdrawal (long‐term) Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

21.1 PEP techniques

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]
Figuras y tablas -
Comparison 2. Stable COPD: ACTs vs no ACTs (control)
Ir a la tabla de la revisión