Variation of sputum expectoration within day in bronchiectasis: Preliminary observational descriptive study

Background: Effective prescription of physical therapy airway clearance (ACT) is crucial for bronchiectasis patients, yet the optimal timing and frequency remain undefined. Understanding sputum expectoration patterns may determine the most suitable times for patients to undergo ACT. Objective: This study aimed to investigate the daily sputum expectoration patterns in patients with bronchiectasis. Materials and methods: Sputum was collected from ten bronchiectasis patients at home over three days, during morning (6 to 9 am), daytime (9 am to 6 pm), and evening (6 to 9 pm) periods. Collected sputum was centrifuged to remove saliva, weighed, and then converted to grams per hour for analysis. Results: A total of 90 sputum containers were collected over three days from 10 patients. Most patients (N=8) expectorated a median (IQR) of 14.34 (7.96, 23.67) gm, showing a higher trend in the morning (2.07 (1.16, 4.03) gm/hr), followed by evening (1.18 (1.86, 1.92) g/hr) with the least during daytime (0.41 (0.32, 0.82) gm/hr). A minority of patients (N=2) with massive sputum production (72 and 63.98 for participant 1 and participant 2 respectively) exhibited the highest rate of expectoration during daytime (5.71 /hr), followed by the evening (3.83 /hr) and morning (1.69 /hr) on average over three days. Conclusion: Most bronchiectasis patients exhibited higher rates of sputum expectoration in the morning and evening. Therefore, it is recommended to administer physical therapy for airway clearance twice daily, in the morning and evening, to prevent accumulation and enhance clearance.