Physiotherapy Airway Clearance in the Education Setting (PACES)

Home-based airway clearance (Standard Care): Participants will complete daily airway clearance at home using a combination of airway clearance devices and breathing techniques to support sputum clearance while maintaining infection control. Sessions last 15–30 minutes, once per day, seven days per week, and are supervised by caregivers. Adherence is recorded in a daily diary and reviewed by the lead researcher at baseline, 6-month, and 12-month visits. School-based airway clearance (PACES intervention): Participants in the PACES programme complete daily supervised airway clearance sessions at school, using a combination of airway clearance devices and breathing techniques. Sessions last 10–15 minutes, once per school day, and are delivered one-to-one with a trained staff member. Adherence is recorded in a daily diary by staff and reviewed by the lead researcher during termly visits and email check-ins. Airway clearance techniques are tailored to each child’s clinical needs based on bronchiectasis best management recommendations. Devices may include positive expiratory pressure devices (e.g., TheraPEP, PariPEP, bubblePEP), oscillating devices (e.g., Aerobika, Acapella), or high-frequency chest wall oscillation where indicated. Breathing techniques may include diaphragmatic breathing, thoracic expansion exercises, huffing, and coughing. Initial staff training (PACES intervention): Prior to programme commencement, nominated school staff receive a single 60–90 minute face-to-face training session from the lead researcher. Training includes education on bronchiectasis, practical airway clearance instruction, infection control procedures, and symptom monitoring, with a competency check completed with the child participant. Staff are provided with equipment, action plans, and contact details for the lead researcher and clinic.