Active Cycle of Breathing Technique for Airway Clearance in COPD: A Systematic Review

I Made Satya Surya Diputra; Laila Nurindah Sari; Anak Agung Sagung Ratih Dwi Yanthi Putri; I Komang Alit Manacika; Luh Putu Ayu Vitalisyawati; I Gusti Putu Martha Kusuma

doi:10.24843/

Penulis

I Made Satya Surya Diputra Physiotherapy Professional Study Program, Faculty of Medicine, Universitas Dhyana Pura, Bali, Indonesia Penulis
Laila Nurindah Sari Physiotherapy Professional Study Program, Faculty of Medicine, Universitas Dhyana Pura, Bali, Indonesia Penulis
Anak Agung Sagung Ratih Dwi Yanthi Putri Universitas Dhyana Pura Penulis
I Komang Alit Manacika Physiotherapy Professional Study Program, Faculty of Medicine, Universitas Dhyana Pura, Bali, Indonesia Penulis
Luh Putu Ayu Vitalisyawati Physiotherapy Professional Study Program, Faculty of Medicine, Universitas Dhyana Pura, Bali, Indonesia Penulis
I Gusti Putu Martha Kusuma Physiotherapy Professional Study Program, Faculty of Medicine, Universitas Dhyana Pura, Bali, Indonesia Penulis

DOI:

https://doi.org/10.24843/

Kata Kunci:

Chronic Obstructive Pulmonary Disease, Pulmonary Rehabilitation, Physical Therapy Modalities, Respiration, Airway Management

Abstrak

Background: Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent airflow limitation accompanied by impaired mucociliary clearance and sputum retention, contributing to dyspnea, reduced pulmonary function, and decreased quality of life. Active Cycle of Breathing Technique (ACBT) is widely used in pulmonary rehabilitation to facilitate airway clearance; however, evidence regarding its effectiveness in COPD remains inconsistent.
Objective: To synthesize evidence from randomized controlled trials (RCTs) regarding the effectiveness of ACBT in improving airway clearance among adults with COPD.
Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline. PubMed, ScienceDirect, Cochrane Library, and Google Scholar were searched for RCTs published between 2020 and 2025. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) Scale, and risk of bias was evaluated using the Cochrane Risk of Bias 2 tool.
Results: Four RCTs involving 189 participants were included. Compared with usual care, ACBT significantly increased 24-hour sputum production (p=0.025), improved FEV₁/FVC (p<0.0001), and increased oxygen saturation (p=0.003). Combined interventions demonstrated greater improvements in FEV₁ (p=0.004) and FVC (p=0.023) than ACBT alone. Both ACBT and Buteyko Breathing Technique improved dyspnea and quality of life, although the latter showed greater post-treatment improvement.
Conclusion: Evidence from four RCTs suggests that ACBT provides potential benefits for improving airway clearance and selected respiratory outcomes in adults with COPD. Nevertheless, the certainty of evidence remains limited because of the small number of studies, methodological heterogeneity, and combination interventions that preclude isolation of the independent effect of ACBT.