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.