OBJECTIVE: To compare the efficacy of three slow expiratory airway clearance techniques (ACTs). DESIGN: Randomised crossover trial. SETTING: Tertiary hospital. PARTICIPANTS: Thirty-one outpatients with bronchiectasis and chronic sputum expectoration. INTERVENTIONS: Autogenic drainage (AD), slow expiration with glottis opened in lateral posture (ELTGOL), and temporary positive expiratory pressure (TPEP). MAIN OUTCOMES: Sputum expectoration during each session (primary endpoint) and in the 24-hour period after each session. Leicester Cough Questionnaire (LCQ) score and spirometry results were recorded at the beginning and after each week of treatment. Data were summarised as median difference (95% confidence interval (CI)). RESULTS: Median (interquartile range) daily expectoration at baseline was 21.1 (15.3 to 35.6) g. During physiotherapy sessions, AD and ELTGOL expectorated more sputum than TPEP (AD versus TPEP 3.1 g (95% CI 1.5 to 4.8); ELTGOL versus TPEP 3.6 g (95% CI 2.8 to 7.1)), while overall expectoration in the 24-hour period after each session was similar for all techniques (p = 0.8). Sputum clearance at 24 hours post-intervention was lower than baseline assessment for all techniques (AD versus baseline -10.0 g (95% CI -15.0 to -6.8); ELTGOL versus baseline -9.2 g (95% CI -14.2 to -7.9); TPEP versus baseline -6.0 g (95% CI -12.0 to -6.1)). The LCQ score increased with all techniques (AD 0.5, 95% CI 0.1 to 0.5; ELTGOL 0.9, 95% CI 0.5 to 2.1; TPEP 0.4, 95% CI 0.1 to 1.2), being similar for all ACTs (p = 0.6). No changes in lung function were observed. CONCLUSIONS: Slow expiratory ACTs enhance mucus clearance during treatment sessions, and reduce expectoration for the rest of the day in patients with bronchiectasis. CLINICAL TRIAL REGISTRATION NUMBER: NCT01854788.

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