Airway clearance techniques (ACTs) are part of the main management strategy for patients with bronchiectasis. Despite being a priority for patients, accessibility, implementation and reporting of ACTs are variable in clinical settings and research studies. This European Respiratory Society statement summarises current knowledge about ACTs in adults with bronchiectasis and makes recommendations to improve the future evidence base. A task force of 14 experts and two patient representatives (10 countries) determined the scope of this statement through consensus and defined six questions. The questions were answered based on systematic searches of the literature. The statement provides a comprehensive review of the physiological rationale for ACTs in adults with bronchiectasis, and the mechanisms of action along with the advantages and disadvantages of each ACT. Evidence on ACTs in clinical practice indicates that the most frequently used techniques are active cycle of breathing techniques, positive expiratory pressure devices and gravity-assisted drainage, although there is limited evidence on the type of ACTs used in specific countries. A review of 30 randomised trials for the effectiveness of ACTs shows that these interventions increase sputum clearance during or after treatment, reduce the impact of cough and the risk of exacerbations, and improve health-related quality of life. Furthermore, strategies for reducing the risk of bias in future studies are proposed. Finally, an exploration of patients’ perceptions, barriers and enablers related to this treatment is also included to facilitate implementation and adherence to ACTs.

Background The Berg Balance Scale (BBS), Balance Evaluation Systems Test (BESTest), Mini-BESTest and the Brief-BESTest are useful to assess balance, however their psychometric properties have not been tested in patients with chronic obstructive pulmonary disease (COPD). Objective This study aimed to compare the validity, reliability and ability to identify fall status of the BBS, BESTest, Mini-BESTest and the Brief-BESTest in patients with COPD. Design A cross-sectional study was conducted. Methods Forty-six patients (24 males; 75.9±7.1years) were included. Participants were asked to report their falls during the previous 12 months and to fill in the Activity-specific Balance Confidence (ABC) Scale. The BBS and the BESTest were administered. Mini-BESTest and Brief-BESTest scores were computed based on the BESTest performance. Validity was assessed by correlating balance tests with each other and with the ABC Scale. Interrater reliability (2 raters), intrarater reliability (48-72 hours) and minimal detectable changes (MDCs) were established. Receiver operating characteristics assessed the ability of each balance test to differentiate between patients with and without a history of falls. Results Balance test scores were significantly correlated with each other (spearman's correlation [rho]=0.73-0.90) and with the ABC Scale (rho=0.53-0.75). Balance tests presented high interrater (Intraclass Correlation Coefficients[ICCs]=0.85-0.97) and intrarater reliability (ICCs=0.52-0.88), and acceptable MDCs (MDCs=3.3-6.3 points). Although all balance tests were able to identify fall status (area under the curve [AUC]=0.74-0.84), the BBS (sensitivity=73%, specificity=77%) and the Brief-BESTest (sensitivity=81%, specificity=73%) had the higher ability. Limitations Findings are generalizable mainly to older patients with moderate COPD. Conclusions: The four balance tests are valid, reliable and valuable to identify fall status in patients with COPD. The Brief-BESTest presented slightly higher interrater reliability and ability to differentiate patients' falls status.