Comparison of Lung Flute and threshold positive expiratory pressure devices for airway clearance in patients with chronic obstructive pulmonary disease: a randomised clinical trial

Background/Aims Mucus hypersecretion and altered lung functions leads to adverse clinical outcomes in chronic obstructive pulmonary disease. The aim of this study was to compare the effects of the Lung Flute and threshold positive expiratory pressure devices on sputum quantity and pulmonary functions in chronic obstructive pulmonary disease patients. Methods A total of 50 patients with chronic obstructive pulmonary disease were randomly divided into two groups. Group 1 used the Lung Flute device and group 2 used a threshold positive expiratory pressure device. Sputum quantity was measured post-intervention on a daily basis. Forced expiratory volume in the first second, forced vital capacity, and peak expiratory flow rate were evaluated on day 1 and day 6. Results The mean sputum quantity in group 1 was 11.40 ml and it was 11.04 ml in group 2. Between-group comparison demonstrated a significant improvement in forced expiratory volume in the first second for group 1 compared to group 2 (P<0.005). Conclusions The Lung Flute was found to be slightly more effective than the threshold positive expiratory pressure device for airway clearance and also had a positive effect on pulmonary functions in patients with chronic obstructive pulmonary disease.

An initial evaluation of the safety of a disposable oscillating positive expiratory pressure device in patients with chronic obstructive pulmonary disease: a sort-term pilot study

Background Handheld oscillating positive expiratory pressure (OPEP) devices have been a mainstay of treatment for patients with hypersecretory conditions such as cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) since the 1970s. Current devices are reusable and require regular cleaning and disinfection to prevent harbouring potentially pathogenic organisms. Adherence to cleaning regimens for respiratory devices is often poor and in response to this, a prototype disposable OPEP device—the ‘UL-OPEP’ (University of Limerick—Oscillating Positive Expiratory Pressure device)—was developed to mitigate the risk of contamination by pathogens. The device was previously evaluated successfully in a group of paediatric CF patients. The aim of the current study was to initially evaluate the safety of the prototype in patients with COPD over a period of 1 month to ensure no adverse events, negative impacts on lung function, exercise tolerance, or quality of life. Data on user experience of the device were also collected during post-study follow-up. Methods A sample of 50 volunteer participants were recruited from pulmonary rehabilitation clinics within the local hospital network. The patients were clinically stable, productive, and not current or previous users of OPEP devices. Participants were invited to use a prototype disposable OPEP device daily for a period of 1 month. Pre- and post-study lung function was assessed with standard spirometry, and exercise tolerance with the 6-min-walk-test (6MWT). Quality of life was assessed using the St. George’s Respiratory Questionnaire (SGRQ), and user experience of the prototype device evaluated using a post-study questionnaire. Results 24 Participants completed the study: 9 were female. Overall median age was 67.5 years, range 53–85 years. Lung function, 6-min walk test, and SGRQ scores showed no significant change post-study. User feedback was positive overall. Conclusions The results indicate that the UL-OPEP is safe to use in patients with COPD. No adverse events were recorded during the study or in the follow-up period of 2 weeks. The device did not negatively impact patients’ lung function, exercise tolerance, or quality of life during short term use (1 month), and usability feedback received was generally positive. Larger, longer duration studies will be required to evaluate efficacy. Registration The study was approved as a Clinical Investigation by the Irish Health Products Regulatory Authority (CRN-2209025-CI0085).

Positive Expiratory Pressure: A Potential Therapy to Mitigate Acute Bronchoconstriction in the Asthma of Obesity

Late-onset non-allergic (LONA) asthma in obesity is characterized by increased peripheral airway closure secondary to abnormally collapsible airways. We hypothesized that positive expiratory pressure (PEP) would mitigate the tendency to airway closure during bronchoconstriction, potentially serving as rescue therapy for LONA asthma of obesity. The PC20 dose of methacholine was determined in 18 obese participants with LONA asthma. At each of 4 subsequent visits, we used oscillometry to measure input respiratory impedance (Zrs) over 8 minutes; participants received their PC20 concentration of methacholine aerosol during the first 4.5 minutes. PEP combinations of either 0 or 10 cmH2O either during and/or after the methacholine delivery were applied, randomized between visits. Parameters characterizing respiratory system mechanics were extracted from the Zrs spectra. In 18 LONA asthma patients (14 females, BMI: 39.6±3.4 kg/m2), 10 cmH2O PEP during methacholine reduced elevations in the central airway resistance, peripheral airway resistance and elastance, and breathing frequency was also reduced. During the 3.5 min following methacholine delivery, PEP of 10 cmH2O reduced Ax and peripheral elastance compared to no PEP. PEP mitigates the onset of airway narrowing brought on by methacholine challenge, and airway closure once it is established. PEP thus might serve as a non-pharmacologic therapy to manage acute airway narrowing for obese LONA asthma.

MEDEX 2015: Prophylactic Effects of Positive Expiratory Pressure in Trekkers at Very High Altitude

Purpose: Positive expiratory pressure (PEP) breathing has been shown to increase arterial oxygenation during acute hypoxic exposure but the underlying mechanisms and consequences on symptoms during prolonged high-altitude exposure remain to be elucidated.Methods: Twenty-four males (41 ± 16 years) were investigated, at sea level and at 5,085 m after 18 days of trekking from 570 m. Participants breathed through a face-mask with PEP = 0 cmH2O (PEP0, 0–45th min) and with PEP = 10 cmH2O (PEP10, 46–90th min). Arterial (SpO2), quadriceps and prefrontal (near infrared spectroscopy) oxygenation was measured continuously. Middle cerebral artery blood velocity (MCAv, transcranial Doppler), cardiac function (2D-echocardiography), extravascular lung water accumulation (UsLC, thoracic ultrasound lung comets) and acute mountain sickness (Lake Louise score, LLS) were assessed during PEP0 and PEP10.Results: At 5,085 m with PEP0, SpO2 was 78 ± 4%, UsLC was 8 ± 5 (a.u.) and the LLS was 2.3 ± 1.7 (all P &lt; 0.05 versus sea level). At 5,085 m, PEP10 increased significantly SpO2 (+9 ± 5%), quadriceps (+2 ± 2%) and prefrontal cortex (+2 ± 2%) oxygenation (P &lt; 0.05), and decreased significantly MCAv (−16 ± 14 cm.s–1) and cardiac output (−0.7 ± 1.2 L.min–1) together with a reduced stroke volume (−9 ± 15 mL, all P &lt; 0.05) and no systemic hypotension. PEP10 decreased slightly the number of UsLC (−1.4 ± 2.7, P = 0.04) while the incidence of acute mountain sickness (LLS ≥ 3) fell from 42% with PEP0 to 25% after PEP10 (P = 0.043).Conclusion: PEP10 breathing improved arterial and tissue oxygenation and symptoms of acute mountain sickness after trekking to very high altitude, despite reduced cerebral perfusion and cardiac output. Further studies are required to establish whether PEP-breathing prophylactic mechanisms also occur in participants with more severe acute mountain sickness.

The Influence of Respiratory Component on Satisfaction with Physical Therapy after Cardiosurgical Interventions

The purpose of the study was to investigate the effect of additional respiratory physical therapy on the level of satisfaction with physical therapy among patients after cardiac surgery. Materials and methods. The study involved 150 patients. The patients were randomly divided into three groups: control (respiratory physical therapy was limited to cough), group of incentive spirometry (in classes with a physical therapist patients performed additional 3 approaches of 10 breaths through the simulator; they received recommendations for hourly performance of a similar number of cycles of exercise), a group of patients who received additional respiratory physical therapy with positive expiratory pressure in the form of exhalation into a bottle of water through a tube (number of repetitions and recommendations are similar to those received by the previous group). All groups underwent the same protocol of mobilization and use of therapeutic physical exercises in the procedure of therapeutic gymnastics. Performing exercises with breathing simulators began on the first postoperative day. Results and discussion. A questionnaire (17 questions) was used to assess the satisfaction with physical therapy. The survey was conducted on the seventh postoperative day. The answers were distributed on a 5-point Likert scale from 1 point to 5 points. The key preoperative indicators and time indicators of surgical interventions of the examined groups did not differ significantly. Analysis of satisfaction with physical therapy revealed a high level in all items of the questionnaire. Statistical differences between the groups were found in only three items of the questionnaire, but they were not related to either the use of equipment or diligence in treatment or the content of physical therapy. The overall score of the questionnaire did not differ in groups according to the Kraskel-Wallis criterion, and Me indicators (25%; 75%) were in the control group – 81 (77; 85) points, in the group of stimulating spirometry – 81 (72; 85) points in the group with positive expiratory pressure – 79 (73; 84) points (χ2 = 4.560; p = 0.102). Conclusion. Additional respiratory physical therapy did not affect the overall satisfaction rate and results of most items of the questionnaire. The differences found in the three items did not indicate any effect of the use of respiratory physical therapy on the level of satisfaction, as higher scores in these items were in the control group. All items in the questionnaire received high scores