Evaluation of Treatment Efficacy and Safety of ACBT in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a preventable and treatable condition that affects many people due to poor management. Our systematic review and meta-analysis aims to investigate the safety and efficacy of active cycle of breathing techniques (ACBT) among COPD patients, as there are still many unresolved issues regarding its use. The primary objective of this study is to evaluate the efficacy and safety of ACBT as a treatment for COPD patients. Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and searched for randomized controlled trials (RCTs) from electronic databases such as EMBASE, Web of Science, PubMed, and CINAHL. The Cochrane Collaboration tool was used to assess the risk of bias in each study. The inclusion criteria comprised COPD patients, including those with acute exacerbation, interventions related to ACBT technology, and those reporting sputum production. Only RCTs were considered, even if the intervention was combined with other treatments. Conversely, non-RCTs, systematic reviews, meta-analyses, case studies, editorials, and journals were excluded. The Review Manager software (version 5.4.1) was used for statistical analysis, which included calculating the 95% confidence intervals (CI) and the odds ratio (OR) and measuring heterogeneity. Results: Eight randomized controlled trials with 390 participants were included in this meta-analysis. Each study had control and intervention groups comprising elderly and middle-aged individuals. The results showed that ACBT did not statistically significantly improve forced vital capacity (FVC) and forced expiratory volume in one second (FEV₁) compared to standard care, with low heterogeneity [df = 1, 95% CI: 0.66 to 1.53, I² = 0]. The use of ACBT technology in combination with postural drainage did not improve SpO₂ among COPD patients, and there was no effect on sputum production with low heterogeneity [df = 2, 95% CI: 0.74 to 1.35, I² = 0%, p > 0.05]. Conclusions: The ACBT intervention did not improve cough efficiency and sputum production among COPD patients. This study was limited by incomplete data, inconsistencies in the control group, underrepresentation of the global population, analysis of short-term effects of COPD, and a high risk of publication bias in the included studies. Therefore, the findings on the effects of ACBT on COPD were inconclusive and found no significant improvements in the condition of patients. Future studies should thoroughly analyze the effects of ACBT across multi-ethnic populations and its effects on musculoskeletal muscles.