***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The relative value of chest physiotherapy ( including cough ) and cough alone for the removal of excessive tracheobronchial secretions has been assessed in six patients with stable chronic obstructive lung disease . After labelling with inhaled radioactive tracer particles , clearance of secretions from selected central and peripheral lung regions was followed with a gamma camera linked to a computer . Cough alone and chest physiotherapy ( including cough ) were equally effective in the enhancement of central lung clearance .  Physiotherapy but not cough along accelerated peripheral lung clearance ( p less than 0.05 ) . Sputum yield was greater during physiotherapy than during cough ( p less than 0.05 ) . These findings confirm the value of chest physiotherapy and high-light the limitation of cough in patients with excessive tracheobronchial secretion and impaired mucociliary clearance BACKGROUND Bronchiectasis is a chronic suppurative lung disease characterised by irreversible dilation of the bronchi and persistent purulent sputum . The immunopathology of the disease was studied using a quantitative immunostaining technique with particular reference to T lymphocytes , macrophages , and granulocytes . METHODS Bronchial mucosal biopsy specimens were obtained by fibreoptic bronchoscopy from 12 patients with bronchiectasis ( six receiving inhaled steroids ) and 11 normal healthy controls .  Immunostaining ( APAAP method ) was performed on frozen cryostat sections with a panel of monoclonal antibodies to total leucocytes ( CD45 ) , T lymphocyte phenotypic markers ( CD3 , CD4 , CD8 ) , macrophages ( CD68 ) , eosinophils ( EG2 ) , and neutrophils ( elastase ) . RESULTS There was a mononuclear cell infiltrate in both patients with bronchiectasis and normal controls , but an overall increase in total leucocyte cell numbers ( CD45 + cells ) was identified in those with bronchiectasis ( median values 422 cells/mm2 versus 113 cells/mm2 in control tissue , p<0.001 ) . Intense infiltration of CD3 + T lymphocytes was observed compared with healthy controls ( 292 cells/mm2 and 40 cells/mm2 , respectively , p<0.001 ) . This comprised predominantly CD4 + T cells ( 118 cells/mm2 ) rather than CD8 + T cells ( 47 cells/mm2 ) . CD3 + cell counts were reduced in those subjects on inhaled steroids compared with those not receiving inhaled steroids ( 197 cells/mm2 versus 369 cells/mm2 , p<0.05 ) , as were CD4 + cell counts ( 82 cells/mm2 versus 190 cells/mm2 , p<0.05 ) . Neutrophil and macrophage cell numbers were also increased in patients with bronchiectasis ( 114 cells/mm2 and 213 cells/mm2 , respectively ) compared with controls ( 41 neutrophils/mm2 and 40 macrophages/mm2 ) . EG2 + ( activated ) eosinophil numbers were much lower than T cells , macrophages , and neutrophils in patients with bronchiectasis but were increased compared with controls ( 36 cells/mm2 versus 0 cells/mm2 , p<0.001 ) . In view of the markedly increased neutrophil counts in patients with bronchiectasis , biopsy specimens were immunostained for interleukin 8 ( IL-8 ) which was highly significantly increased compared with controls ( 47 cells/mm2 versus 15 cells/mm2 , p<0.01 ) . IL-8 + cells were less prominent in steroid treated patients than in patients not receiving treatment ( 30 cells/mm2 versus 60 cells/mm2 , p<0.05 ) . A further characteristic of bronchiectasis was mucous gl and hypertrophy . Gl and area comprised up to 40 % of the tissue in some bronchiectasis sections while no hypertrophy was noted in control biopsy specimens ( p<0.05 ) . CONCLUSION Airway inflammation in bronchiectasis is characterised by tissue neutrophilia , a mononuclear cell infiltrate composed mainly of CD4 + T cells and CD68 + macrophages , and increased IL-8 expression .  Inhaled corticosteroid treatment in patients with bronchiectasis is associated with a less marked infiltration by T cells and IL-8 + cells within the bronchial mucosa , although this finding requires confirmation in a prospect i ve placebo controlled trial Eight patients with Young 's syndrome were treated with four " mucoregulatory " agents for eight weeks in a r and omised , open crossover study . There was no improvement in tracheobronchial clearance , pulmonary function , or sperm count Background Non-cystic fibrosis bronchiectasis is characterised by sputum production , exercise limitation and recurrent infections . Although pulmonary rehabilitation is advocated for this patient group , its effects are unclear . The aims of this study are to determine the short and long term effects of pulmonary rehabilitation on exercise capacity , cough , quality of life and the incidence of acute pulmonary exacerbations . Methods / Design This r and omised controlled trial aims to recruit 64 patients with bronchiectasis from three tertiary institutions . Participants will be r and omly allocated to the intervention group ( supervised , twice weekly exercise training with regular review of airway clearance therapy ) or a control group ( twice weekly telephone support ) . Measurements will be taken at baseline , immediately following the intervention and at six and 12 months following the intervention period by a blinded assessor . Exercise capacity will be measured using the incremental shuttle walk test and the six-minute walk test . Quality of life and health status will be measured using the Chronic Respiratory Question naire , Leicester Cough Question naire , Assessment of Quality of Life Question naire and the Hospital Anxiety and Depression Scale . The rate of hospitalisation will be captured as well as the incidence of acute pulmonary exacerbations using a daily symptom diary . Discussion Results from this study will help to determine the efficacy of supervised twice-weekly pulmonary rehabilitation upon exercise capacity and quality of life in patients with bronchiectasis and will contribute to clinical practice guidelines for physiotherapists in the management of this population .Trial registration This study protocol is registered with Clinical Trials.gov ( NCT00885521 ) BACKGROUND AND PURPOSE Although the application of airway clearance techniques is considered an important component in the treatment of several obstructive pulmonary diseases , there is no scientific evidence supporting the use of Flutter Valve ™ in the management of patients with bronchiectasis . Moreover , the consequences of respiratory physiotherapy techniques on respiratory mechanics have not been fully studied . Therefore , we investigated the acute , short-term effects of Flutter Valve ™ on respiratory mechanics and sputum production in bronchiectatic patients . METHODS EIGHT patients were evaluated in a r and omized , blinded , cross-over trial . Impedance at 5 Hz ( R5 ) , resistance as a function of oscillation frequency ( dR/dF ) , reactance at 5 Hz ( X5 ) , resonant frequency ( f(0 ) ) and integral of reactance between 5 Hz and resonant frequency ( AX ) were recorded . RESULTS Flutter Valve ™ cleared 8.4 mL more secretions than the Sham Flutter intervention ( 95 % confidence interval [ 95 % CI ] , 3.4 - 13.4 ) . There was a higher percentage decrease in R5 ( -11.2 % ; 95 % CI , -4.4 to -18.2 ) , dR/dF ( -20.8 % ; 95 % CI , -32.4 to -9 ) and AX ( -7.8 % ; 95 % CI , -11.9 to -3.7 ) under Flutter Valve ™ . X5 and f(0 ) variation did not differ between interventions . CONCLUSIONS Flutter Valve ™ increases sputum removal during treatment and diminishes total and peripheral airway resistance in hypersecretive patients with bronchiectasis . Impulse oscillometry is a user-friendly tool to evaluate the effects of airway clearance techniques on respiratory mechanics BACKGROUND --In vitro studies have suggested that both the viscoelastic properties of lung secretions and the peak flow attained during simulated cough influence clearance . This study examines the possible association of the viscoelastic properties of sputum and maximum expiratory flow with measured effectiveness of mucus clearance induced by instructed cough and by forced expiration technique ( FET ) in patients with airways obstruction . METHODS --Nineteen patients ( 11 men and eight women ) of mean ( SE ) age , % predicted FEV1 , and daily sputum wet weight of 64 ( 2 ) years , 52 (6)% , and 37.5 ( 7.9 ) g respectively participated in the study . Mucus movement from proximal and peripheral lung regions was measured by an objective non-invasive radioaerosol technique . Each patient underwent three assessment s : control , cough , and FET . During cough and FET , maximum expiratory flow was measured at the mouth level . Apparent viscosity and elasticity of the expectorated sputum sample s were measured with a viscometer . RESULTS --Compared with the control run ( mean ( SE ) clearance : 16 (3)% ) there was an increase in clearance from the whole lung during cough ( 44 (5)% ) and FET ( 42 (5)% ) , and also an enhanced clearance of inhaled , deposited radioaerosol from the trachea , inner and intermediate regions of the lungs , but not from the outer region . There were , however , no differences in regional clearance between cough and FET . Neither regional nor total clearance correlated with maximum expiratory flow , apparent viscosity , elasticity , or daily sputum wet weight . CONCLUSIONS --These results confirm that cough and FET both promote effective clearance but suggest that , unlike in vitro studies , sputum production and viscoelasticity , as well as maximum expiratory flow , provide no guide to clearance efficacy in humans Background : Bronchiectasis is a chronic suppurative lung disease often characterised by airflow obstruction and hyperinflation , and leading to decreased exercise tolerance and reduced health status . The role of pulmonary rehabilitation ( PR ) and inspiratory muscle training ( IMT ) has not been investigated in this group of patients . Methods : Thirty two patients with idiopathic bronchiectasis were r and omly allocated to one of three groups : PR plus sham IMT ( PR-SHAM ) , PR plus targeted IMT ( PR-IMT ) , or control . All patients ( except the control group ) underwent an 8 week training programme of either PR or PR plus targeted IMT . Exercise training during PR was performed three times weekly at 80 % of the peak heart rate . IMT was performed at home for 15 minutes twice daily over the 8 week period . Results : PR-SHAM and PR-IMT result ed in significant increases in the incremental shuttle walking test of 96.7 metres ( 95 % confidence interval ( CI ) 59.6 to 133.7 ) and 124.5 metres ( 95 % CI 63.2 to 185.9 ) , respectively , and in endurance exercise capacity of 174.9 % ( 95 % CI 34.7 to 426.1 ) and 205.7 % ( 95 % CI 31.6 to 310.6 ) . There were no statistically significant differences in the improvements in exercise between the two groups . Significant improvements in inspiratory muscle strength were also observed both in the PR-IMT group ( 21.4 cm H2O increase , 95 % CI 9.3 to 33.4 ; p = 0.008 ) and the PR-SHAM group ( 12.0 cm H2O increase , 95 % CI 1.1 to 22.9 ; p = 0.04 ) , the magnitude of which were also similar ( p = 0.220 ) . Improvements in exercise capacity were maintained in the PR-IMT group 3 months after training , but not in the PR-SHAM group . Conclusion : PR is effective in improving exercise tolerance in bronchiectasis but there is no additional advantage of simultaneous IMT . IMT may , however , be important in the longevity of the training effects Educational aims To describe the specific current and potential future treatments for bronchiectasis . To describe a potential management plan for the treatment of bronchiectasis . Summary Non-cystic fibrosis ( non-CF ) bronchiectasis remains a common and difficult respiratory condition to manage . Patients with bronchiectasis generally tend to have persistent symptoms and require long-term medical treatment . There are a large number of treatment options available for the management of bronchiectasis . However only a limited number of trials to assess efficacy of treatment have been conducted . These studies have generally included fewer than 20 patients and very few of them have been r and omised or blinded . As such , the management of bronchiectasis is not clearly defined . This review will discuss the specific treatments available to treat patients with non-CF bronchiectasis and how they could be integrated into a specific management plan AUTHOR : e-mail address please Background : Airway clearance techniques are an important part of the routine care of patients with bronchiectasis . The use of the Flutter , a h and held pipe-like device causing oscillating positive expiratory pressure within the airways , has been proposed as an alternative to more conventional airway clearance techniques . Methods : A r and omised crossover study was performed in 17 stable patients with non-cystic fibrosis bronchiectasis at home , in which 4 weeks of daily active cycle of breathing technique ( ACBT ) were compared with 4 
    Output:
    
AUTHORS ' CONCLUSIONS ACTs appear to be safe for individuals ( adults and children ) with stable bronchiectasis , where there may be improvements in sputum expectoration , selected measures of lung function and health-related quality of life .
The role of these techniques in people with an acute exacerbation of bronchiectasis is unknown .