Clinical researcher leads international review of airway techniques

19 March 2018

Dr Michelle Chatwin, consultant physiotherapist at Royal Brompton & Harefield NHS Foundation Trust, recently co-led an international workshop with researchers from across the world, to look at airway clearance techniques in neuromuscular disorders (NMD).

NMD is a very broad term which includes several diseases that impair the functioning of the muscles. There are a number of NMDs which affect lung muscles, which can result in patients not being able to properly cough and clear lung secretions on their own. This can lead to recurrent chest infections, acute secretion retention and decreased life expectancy. 

The workshop was the idea of Dr Michel Toussaint, a physiotherapist from the Inkendaal Rehabilitation Centre in Belgium. He and Dr Chatwin noticed great variation between different hospitals and centres - both in the UK and around the world - on how best to manage airway clearance techniques (ACTs) in patients with NMD. 

Their aim was to improve respiratory physiotherapy for people with NMD, by encouraging discussion and formulating some recommendations and consensus through a workshop. They submitted an application to the European Neuromuscular Centre, requesting to put together a panel of international experts. 

The workshop, held in Naarden, Netherlands, included clinicians, researchers, patients and patient advocacy groups, all from a range of socioeconomic and geographical backgrounds and disciplines. It was co-led by Dr Chatwin along with Dr Jesus Gonzalez-Bermejo from Pitié-Salpêtrière Hospital in Paris, France and Dr David Berlowitz from Austin Hospital in Melbourne, Australia. 

The result was a consensus guideline for standards of ACTs. This is an important part of caring for patients with NMDs, to help with clearance of lung secretions. 

It is hoped that improving ACT management will lead to improvements in the duration and quality of life. It is also hoped this will reduce the number of exacerbations requiring hospitalisation and reduce the need for invasive ventilation in people with NMDs. 

Dr Chatwin said: “This was a very exciting project. To get funding to have a meeting with 20 experts and patient representatives was amazing. The meeting was extremely productive and it was a privilege to work with everyone to produce these reference papers that should improve the management of individuals with NMD with regard to ACTs.” 

The full report was published in the journal Neuromuscular Disorders and provides practical recommendations that can be used by physicians, physiotherapists, patients and their carers.

Dr Chatwin also led a state-of-the-art review of ACT in patients with NMDs, published in the Respiratory Medicine Journal

This was intended as a go-to resource for all who need more information and recommendations for ACT management in patients with NMD. The review will be highlighted at the 15th International Conference on Home Mechanical Ventilation in Lyon, France, in March 2018.

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