STUDY PROTOCOL article
Front. Med.
Sec. Pulmonary Medicine
Nasal negative pressure oscillatory therapy versus oscillatory positive expiratory pressure for airway clearance in patients with acute exacerbations of bronchiectasis (NNPO-BE): a multicentre, randomised, crossover non-inferiority trial protocol
Siyuan Wang 1
Zhaobin zhou 2
Xiaobin Ma 3
Yang Yang 4
Jieping Lei 5,6
Shiwei Qumu 7,6,8,9
Beiyao Gao 10
Peijian Wang 10
Man Le 11
Shan Jiang 12
Ting Yang 7,13,8,9
1. Department of Rebilitation Medcine, China-Japan Friendship Hospital, Beijing, China
2. Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
3. Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
4. Department of Rehabilitation Medicine, The First People's Hospital of Yunnan Province, Kunming, China
5. Department of Clinical Research and Data management, China-Japan Friendship Hospital, Beijing, China
6. National Center of Respiratory Medicine, BeiJing, China
7. Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
8. China National Clinical Research Center for Respiratory Diseases, Beijing, China
9. Institute of Respiratory Medicine, China Academy of Chinese Medical Sciences, Beijing, China
10. Department of Rehabilitation Medicine, China-Japan Friendship Hospital, Beijing, China
11. Clinical Pharmacology Research, Peking Union Medical College Hospital, Beijing, China
12. Depantment of Rehabilitation Medcine, China-Japan Friendship Hospital, Beijing, China
13. National Center of Respiratory Medicine, Beijing, China
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Abstract
Background: Airway clearance techniques (ACTs) are a cornerstone of bronchiectasis management, particularly during acute exacerbations characterized by mucus retention and impaired mucociliary clearance. However, conventional ACTs are frequently limited by patient tolerance, reliance on skilled personnel and variable adherence in real-world settings. nasal negative pressure oscillatory airway clearance represents a novel, non-invasive strategy designed to enhance expiratory flow bias and promote mobilization of airway secretions. Objectives: To assess whether nasal negative pressure oscillatory (NNPO) airway clearance is non-inferior to standard airway clearance therapy, with oscillatory positive expiratory pressure (OPEP) used as the conventional comparator, in hospitalized patients with acute exacerbations of bronchiectasis. Methods: This is a prospective, multicenter, randomized crossover trial conducted across four tertiary hospitals in China. Eligible participants will receive NNPO and OPEP therapy in random order over four consecutive days. The primary outcome is sputum wet weight collected during and within 30 minutes after each treatment session. Secondary outcomes include lung function, peripheral oxygen saturation, patient-reported efficacy and comfort, and adverse events. Conclusion: This trial will evaluate the short-term efficacy and safety of nasal negative pressure oscillatory airway clearance compared with conventional airway clearance therapy in hospitalized patients with acute exacerbations of bronchiectasis, providing evidence to inform clinical decision-making in acute management.
Summary
Keywords
acute exacerbation of bronchiectasis, Airway clearance techniques, multicenter, Nasal negative pressure oscillatory therapy, non-inferiority, Randomized crossover trial
Received
15 January 2026
Accepted
09 February 2026
Copyright
© 2026 Wang, zhou, Ma, Yang, Lei, Qumu, Gao, Wang, Le, Jiang and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Shan Jiang; Ting Yang
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