Abstract Rationale Airway clearance techniques (ACT) are a crucial supportive measure for non-tuberculosismycobacterium (NTM) patients with bronchiectasis.Randomized controlled trials specifically quantifying the independent contribution of ACTs tosputum conversion rates compared to no ACTs in patients on antibiotics are limited, butindirect evidence suggests that in patients with mild NTM lung disease who are not onantibiotics, ACTs alone may lead to a sputum culture conversion rate of 30-50%.Although patients traditionally received ACT instruction informally in outpatient pulmonaryclinic, a formal “Airway clearance education program (ACEP)” at Loma Linda University MedicalCenter, led by a respiratory care practitioner (RCP) was established in January 2024. The one-hour session focused on bronchodilator, mucolytic education and ACT training including huffcough, PEP, HFCWO, autogenic drainage, CPT etc. tailored to individual patient.MethodsWe conducted a quality improvement project to assess the impact of the ACEP on patients’respiratory status including exacerbations, sputum microbiology, LCQ score and spirometry.We compared the observed sputum-conversion rate following airway-clearance education to aprespecified null hypothesis of 30% conversion. The exact binomial test was used due to thesmall sample size and binary outcome. Statistical significance was assessed using a two-sided α = 0.05. The exact Clopper-Pearson method was used to calculate 95% confidence intervals(CIs).The effect of ACEP on pre and post hospitalization rate was assessed using McNemar’s exacttest for paired binary outcomes. Results Fifty patients underwent at least one session of ACEP between January 2024 to June 2025, 76%were female. Mean age was 67.8 years and average BMI was 22.9. Mean BSI was 6.6.Fifteen patients (30%) had NTM. Fourteen (28%) had pseudomonal infection. NTM pathogensincluded M. avium (n = 12), M. Gordonae (n = 2) and M. chelonae (n = 1). Three patients were oninhaled amikacin. Ten of fifteen patients (66.7%) achieved sputum conversion which was significantly higher fromthe hypothesized 30% rate, p = 0.0037 (95% CI, 0.384 - 0.882).After ACEP, the proportion of patients with ≥1 hospitalization decreased from 16 patients,32%(95% CI, 20-46%) to 5 patients, 10% (95% CI, 4-22%), indicating a clinically and statisticallysignificant reduction (p ≈ 0.0005). Conclusion A formal ACEP, led by a RCP is highly impactful in patients with non-CF bronchiectasis and NTM,in reducing hospitalizations related to respiratory exacerbations and can help achievemicrobiological clearance in conjunction with standard clinical care. This abstract is funded by: Loma Linda University
J Ramirez (2026) studied this question.