This narrative review evaluates the evidence for physiotherapy—especially airway clearance therapy (ACT)—in managing Primary Ciliary Dyskinesia (PCD), covering techniques, mucolytic agents, exercise, and age-specific considerations across the lifespan.
No ACT technique (PEP, ACBT, autogenic drainage, IPV, HFCWO, etc.) has shown clear superiority over others; evidence for mucolytics such as hypertonic saline or rhDNase is weak or controversial; exercise may improve ventilatory capacity and quality of life, but data are scarce.
Current recommendations rely heavily on expert opinion and extrapolation from cystic fibrosis and non-CF bronchiectasis, rather than PCD-specific RCT data; randomized trials are ethically difficult when ACT is already considered standard care; practice varies widely with no standardized international guidelines.
Start ACT early in PCD, adapt the technique to the patient's developmental stage, and prioritize adherence strategies—but recognize that the choice of specific ACT method should be individualized, as no single approach is proven superior. Mucolytics should be used cautiously given limited supporting evidence in PCD.
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