Open AccessComparison of effectiveness of temporary positive expiratory pressure versus oscillatory positive expiratory pressure in severe COPD patients
Author(s) -
Nicolini Antonello,
Mascardi Valentina,
Grecchi Bruna,
FerrariBravo Maura,
Banfi Paolo,
Barlascini Cornelius
Publication year - 2018
Publication title -
the clinical respiratory journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.789
H-Index - 33
eISSN - 1752-699X
pISSN - 1752-6981
DOI - 10.1111/crj.12661
Subject(s) - medicine , copd , randomized controlled trial , sputum , airway obstruction , pulmonary function testing , positive airway pressure , respiratory system , physical therapy , anesthesia , airway , tuberculosis , pathology , obstructive sleep apnea
In chronic obstructive pulmonary disease (COPD) patients few modalities of airway clearance have demonstrated effectiveness in reducing hypersecretion and bronchial obstruction. Positive expiratory pressure (PEP) is one of these. Objective Our goal was to compare the effectiveness of 2 devices Temporary PEP (T‐PEP) and Oscillatory PEP (O‐PEP) which use PEP applied at a low expiratory pressure of 1 cm H 2 O which creates oscillations that decrease bronchial obstruction in reducing COPD exacerbations and improving respiratory and health status assessment parameters. Each has different mechanism of action. Methods A 26 week randomized controlled study evaluated their efficacy in reducing exacerbations and improving health status assessment tests as well as respiratory function parameters in severe to very severe COPD patients. One hundred‐twenty patients were enrolled: 40 patients received T‐PEP therapy; 40 underwent treatment with O‐PEP; 40 constituted the control group. The primary outcome was the reduction of exacerbations after 1, 3 and 6 months; secondary outcomes were improvement of lung function and health status assessment tests [Modified Medical Research Council (MMRC) scale, Breathlessness, Cough, and Sputum Scale (BCSS) scale, and COPD Assessment Test (CAT) score]. Results Only T‐PEP statistically reduced the exacerbations after 1 and 3 months compared to the control group. Both the 2 devices improved dyspnea scale (MMRC), lung function parameters, and health status assessment (CAT) tests compared to the control group. Both interventions were well‐tolerated by our patients. Conclusions O‐PEP and T‐PEP are useful for COPD treatment but only T‐PEP reduces exacerbations. Adding tools for airway clearance to medical therapy can help the management of COPD.