A short-term evaluation of a prototype disposable Oscillating Positive Expiratory Pressure (OPEP) device in a cohort of children with cystic fibrosis

Abstract Background Oscillating Positive Expiratory Pressure (OPEP) devices are important adjuncts to airway clearance therapy in patients with cystic fibrosis (CF). Current devices are typically reusable and require daily, or often more frequent, cleaning to prevent risk of infection by acting as reservoirs of potentially pathogenic organisms. In response, a daily disposable OPEP device, the UL-OPEP, was developed to mitigate the risk of contamination and eliminate the burdensome need for cleaning devices. Methods A convenience sample of 36 participants, all current OPEP device users, was recruited from a paediatric CF service. For one month, participants replaced their current OPEP device with a novel daily disposable device. Assessment included pre- and post-intervention lung function by spirometry, as well as Lung Clearance Index. Quality of life was assessed using the Cystic Fibrosis Questionnaire – Revised, while user experience was evaluated with a post-study survey. Results 31 participants completed the study: 18 males; median age 10 years, range 4–16 years. Lung function (mean difference ± SD, %FEV1 = 1.69 ± 11.93; %FVC = 0.58 ± 10.04; FEV1: FVC = 0.01 ± 0.09), LCI (mean difference ± SD, 0.08 ± 1.13), six-minute walk test, and CFQ-R were unchanged post-intervention. Participant-reported experiences of the device were predominantly positive. Conclusions The disposable OPEP device maintained patients’ lung function during short term use (≤ 1 month), and was the subject of positive feedback regarding functionality while reducing the risk of airway contamination associated with ineffective cleaning. Registration The study was approved as a Clinical Investigation by the Irish Health Products Regulatory Authority (CRN-2209025-CI0085).

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Effects of exercise and airway clearance (positive expiratory pressure) on mucus clearance in cystic fibrosis: a randomised crossover trial

European Respiratory Journal ◽

10.1183/13993003.01793-2018 ◽

2019 ◽

Vol 53 (4) ◽

pp. 1801793 ◽

Cited By ~ 6

Author(s):

Tiffany J. Dwyer ◽

Evangelia Daviskas ◽

Rahizan Zainuldin ◽

Jordan Verschuer ◽

Stefan Eberl ◽

...

Keyword(s):

Cystic Fibrosis ◽

Lung Disease ◽

Crossover Trial ◽

Treadmill Exercise ◽

Forced Expiratory Volume ◽

Mean Difference ◽

Peak Oxygen Consumption ◽

Mucus Clearance ◽

Airway Clearance ◽

Positive Expiratory Pressure

Exercise improves mucus clearance in people without lung disease and those with chronic bronchitis. No study has investigated exercise alone for mucus clearance in cystic fibrosis (CF). The aim of this study was to compare the effects of treadmill exercise to resting breathing and airway clearance with positive expiratory pressure (PEP) therapy on mucus clearance in adults with CF.This 3-day randomised, controlled, crossover trial included 14 adults with mild to severe CF lung disease (forced expiratory volume in 1 s % predicted 31–113%). Interventions were 20 min of resting breathing (control), treadmill exercise at 60% of the participant's peak oxygen consumption or PEP therapy (including huffing and coughing). Mucus clearance was measured using the radioaerosol technique and gamma camera imaging.Treadmill exercise improved whole lung mucus clearance compared to resting breathing (mean difference 3%, 95% CI 2–4); however, exercise alone was less effective than PEP therapy (mean difference −7%, 95% CI −6– −8). When comparing treadmill exercise to PEP therapy, there were no significant differences in mucus clearance from the intermediate and peripheral lung regions, but significantly less clearance from the central lung region (likely reflecting the huffing and coughing that was only in PEP therapy).It is recommended that huffing and coughing are included to maximise mucus clearance with exercise.

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Short-Term Effect of Different Physical Exercises and Physiotherapy Combinations on Sputum Expectoration, Oxygen Saturation, and Lung Function in Young Patients with Cystic Fibrosis

Lung ◽

10.1007/s00408-016-9888-x ◽

2016 ◽

Vol 194 (4) ◽

pp. 659-664 ◽

Cited By ~ 4

Author(s):

Susi Kriemler ◽

Thomas Radtke ◽

Gregor Christen ◽

Marta Kerstan-Huber ◽

Helge Hebestreit

Keyword(s):

Cystic Fibrosis ◽

Lung Function ◽

Oxygen Saturation ◽

Young Patients ◽

Term Effect ◽

Short Term ◽

Short Term Effect ◽

Physical Exercises

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Short-term effect of elexacaftor-tezacaftor-ivacaftor on lung function and transplant planning in cystic fibrosis patients with advanced lung disease

Journal of Cystic Fibrosis ◽

10.1016/j.jcf.2021.05.009 ◽

2021 ◽

Author(s):

Bermingham B ◽

Rueschhoff A ◽

Ratti G ◽

Nesmith A ◽

Goodwin D ◽

...

Keyword(s):

Cystic Fibrosis ◽

Lung Function ◽

Lung Disease ◽

Term Effect ◽

Short Term ◽

Short Term Effect

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Physiologic Evidence for High-Frequency Chest Wall Oscillation and Positive Expiratory Pressure Breathing in Hospitalized Subjects With Cystic Fibrosis

Physical Therapy ◽

10.1093/ptj/85.12.1278 ◽

2005 ◽

Vol 85 (12) ◽

pp. 1278-1289 ◽

Cited By ~ 31

Author(s):

Joan C Darbee ◽

Jamshed F Kanga ◽

Patricia J Ohtake

Keyword(s):

Cystic Fibrosis ◽

Lung Function ◽

Chest Wall ◽

High Frequency ◽

Gas Mixing ◽

Ventilation Distribution ◽

Oxyhemoglobin Saturation ◽

Arterial Blood ◽

Wall Oscillation ◽

Positive Expiratory Pressure

Abstract Background and Purpose. This investigation identified ventilation distribution, gas mixing, lung function, and arterial blood oxyhemoglobin saturation (Spo2) physiologic responses to 2 independent airway clearance treatments, high-frequency chest wall oscillation (HFCWO) and low positive expiratory pressure (PEP) breathing, for subjects who had cystic fibrosis (CF) and who were hospitalized during acute and subacute phases of a pulmonary exacerbation. Subjects. Fifteen subjects with moderate to severe CF were included in this study. Methods. Subjects performed single-breath inert gas tests and spirometry before and immediately after HFCWO and PEP breathing at admission and discharge. Arterial blood oxyhemoglobin saturation was monitored throughout each treatment. Results. At admission and discharge, PEP breathing increased Spo2 during treatment, whereas HFCWO decreased Spo2 during treatment. Ventilation distribution, gas mixing, and lung function improved after HFCWO or PEP breathing. Discussion and Conclusion. High-frequency chest wall oscillation and PEP breathing are similarly efficacious in improving ventilation distribution, gas mixing, and pulmonary function in hospitalized people with CF. Because Spo2 decreases during HFCWO, people who have moderate to severe CF and who use HFCWO should have Spo2 monitored during an acute exacerbation.

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Physiologic Evidence for the Efficacy of Positive Expiratory Pressure as an Airway Clearance Technique in Patients With Cystic Fibrosis

Physical Therapy ◽

10.1093/ptj/84.6.524 ◽

2004 ◽

Vol 84 (6) ◽

pp. 524-537 ◽

Cited By ~ 18

Author(s):

Joan C Darbee ◽

Patricia J Ohtake ◽

Brydon JB Grant ◽

Frank J Cerny

Keyword(s):

Cystic Fibrosis ◽

Lung Function ◽

Vital Capacity ◽

Preliminary Investigation ◽

Therapeutic Modality ◽

Gas Mixing ◽

Ventilation Distribution ◽

Single Breath ◽

Arterial Blood ◽

Positive Expiratory Pressure

Abstract Background and Purpose. Individuals with cystic fibrosis (CF) have large amounts of infected mucus in their lungs, which causes irreversible lung tissue damage. Although patient-administered positive expiratory pressure (PEP) breathing has been promoted as an effective therapeutic modality for removing mucus and improving ventilation distribution in these patients, the effects of PEP on ventilation distribution and gas mixing have not been documented. Therefore, this preliminary investigation described responses in distribution of ventilation and gas mixing to PEP breathing for patients with moderate to severe CF lung disease. Subjects and Methods. The effects of PEP breathing on ventilation distribution, gas mixing, lung volumes, expiratory airflow, percentage of arterial blood oxyhemoglobin saturation (Spo2), and sputum volume were studied in 5 patients with CF (mean age=18 years, SD=4, range=13–22) after no-PEP, low-PEP (10–20 cm H2O), and high-PEP (>20 cm H2O) breathing conditions. Single-breath inert gas studies and lung function tests were performed before, immediately after, and 45 minutes after intervention. Single-breath tests assess ventilation distribution homogeneity and gas mixing by observing the extent to which an inspired test gas mixes with gas already residing in the lung. Results. Improvements in gas mixing were observed in all PEP conditions. By 45 minutes after intervention, the no-PEP group improved by 5%, the low-PEP group improved by 15%, and the high-PEP group improved by 23%. Slow vital capacity increased by 1% for no PEP, by 9% for low PEP, and by 13% for high PEP 45 minutes after intervention. Residual volume decreased by 13% after no PEP, by 20% after low PEP, and by 30% after high PEP. Immediate improvements in forced expiratory flow during the middle half of the forced vital capacity maneuver (FEF25%–75%) were sustained following high PEP but not following low PEP. Discussion and Conclusion. This study demonstrated the physiologic basis for the efficacy of PEP therapy. The results confirm that low PEP and high PEP improve gas mixing in individuals with CF, and these improvements were associated with increased lung function, sputum expectoration, and SpO2. The authors propose that improvements in gas mixing may lead to increases in oxygenation and thus functional exercise capacity.

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