Adjuncts for sputum clearance in COPD: clinical consensus versus actual use

Barker, Ruth E; Hopkinson, Nicholas S

doi:10.1136/bmjresp-2017-000226

Cited by 9 publications

(17 citation statements)

References 11 publications

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“…Interventions to improve cough in COPD include smoking cessation and inhaled pharmacotherapy as well as physiotherapy techniques to aid sputum clearance. It is notable that although mucolytic therapies are widely prescribed, adjuncts to assist sputum clearance such as oscillatory positive expiratory pressure (OPEP) are much less commonly prescribed 52 . The evidence base to support the latter remains strikingly limited, given how common productive cough is in COPD 53 …”

Section: Addressing the Burden Of Copdmentioning

confidence: 99%

Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity

et al. 2021

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An individual's experience of COPD is determined by many factors in addition to the pathological features of chronic bronchitis and emphysema and the symptoms that derive directly from them. Multimorbidity is the norm rather than the exception, so most people with COPD are living with a range of other medical problems which can decrease overall quality of life. COPD is caused by the inhalation of noxious particles or gases, in particular tobacco smoke, but also by early life disadvantage impairing lung development and by occupations where inhaled exposures are common (e.g. industrial, farming and cleaning work). Wealthy people are therefore relatively protected from developing COPD and people who do develop the condition may have reduced resources to cope. COPD is also no longer a condition that predominantly affects men. The prevalence of COPD among women has equalled that of men since 2008 in many high‐income countries, due to increased exposure to tobacco, and in low‐income countries due to biomass fuels. COPD is one of the leading causes of death in women in the USA, and death rates attributed to COPD in women in some countries are predicted to overtake those of men in the next decade. Many factors contribute to this phenomenon, but in addition to socioeconomic and occupational factors, there is increasing evidence of a higher susceptibility of females to smoking and pollutants. Quality of life is also more significantly impaired in women. Although most medications (bronchodilators and inhaled corticosteroids) used to treat COPD demonstrate similar trends for exacerbation prevention and lung function improvement in men and women, this is an understudied area and clinical trials frequently have a preponderance of males. A better understanding of gender‐based predictors of efficacy of all therapeutic interventions is crucial for comprehensive patient care. There is an urgent need to recognize the increasing burden of COPD in women and to facilitate global improvements in disease prevention and management in this specific population. Many individuals with COPD follow a trajectory of both lung function decline and also multimorbidity. Unfavourable lung function trajectories throughout life have implications for later development of other chronic diseases. An enhanced understanding of the temporal associations underlying the development of coexisting diseases is a crucial first step in unravelling potential common disease pathways. Lessons can be learned from exploring disease trajectories of other NCD as well as multimorbidity development. Further research will be essential to explain how early life risk factors commonly influence trajectories of COPD and other diseases, how different diseases develop in relation to each other in a temporal way and how this ultimately leads to different multimorbidity patterns in COPD. This review integrates new knowledge and ideas pertaining to three broad themes (i) the overall burden of disease in COPD, (ii) an unappreciated high burden in women and (iii) the contrast...

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Section: Addressing the Burden Of Copdmentioning

confidence: 99%

Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity

et al. 2021

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“…The absence of clear data, and the relative neglect of sputum clearance techniques in guidelines, have meant that their use is much less common than the prescription of mucolytic drugs 11 25. We previously explored respiratory physiotherapist opinion regarding the use of OPEP devices in COPD, finding a range of attitudes 11.…”

Section: Discussionmentioning

confidence: 99%

“…Oscillatory positive expiratory pressure (OPEP) devices are intended to be used to augment sputum clearance; the positive pressure helps to splint airways open while the vibration mobilises and breaks down mucus, making it easier to expectorate 10 11. Many patients with COPD demonstrate vocal cord narrowing in expiration,12 so PEP may also attenuate this facilitating sputum expectoration.…”

Section: Introductionmentioning

confidence: 99%

“…Many patients with COPD demonstrate vocal cord narrowing in expiration,12 so PEP may also attenuate this facilitating sputum expectoration. Prescribing data suggest that the provision of OPEP devices to reduce the symptom burden from sputum production in patients with COPD is much less common than mucolytic drugs, and they are relatively neglected in clinical guidelines 11…”

Section: Introductionmentioning

confidence: 99%

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Oscillatory positive expiratory pressure therapy in COPD (O-COPD): a randomised controlled trial

Alghamdi

Alsulayyim

Alasmari

et al. 2022

Thorax

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BackgroundOscillatory positive expiratory pressure (OPEP) devices are intended to facilitate sputum clearance and reduce cough, but there is limited evidence for their effectiveness in COPD, or to guide patient selection. We aimed to assess the impact of OPEP therapy on quality of life and objective measures of cough and sleep disturbance in patients with COPD with regular sputum production.MethodsWe enrolled stable patients with COPD, who reported sputum production every day or most days, into an assessor-blind, parallel-group, randomised controlled trial comparing 3 months of using an Acapella device against usual care (including use of the active cycle of breathing technique). The primary outcome was cough-related quality of life measured using the Leicester Cough Questionnaire (LCQ). Secondary outcomes included fatigue (Functional Assessment of Chronic Illness Therapy, FACIT score) and generic quality of life (EuroQol-5 Dimensions, EQ-5D). In a substudy (n=45), objective monitoring of cough and disturbance/movement during sleep were also available.Results122 participants (61/61 OPEP/control) were recruited, 40% female, 17% smokers, FEV1 38 (25–56)% predicted, and age 62±10 years. 103 completed the study (55/48 OPEP/control). Use of OPEP was associated with an improvement in LCQ compared with controls; MD (95% CI) 1.03 (0.71 to 2.10); (p=0.03), FACIT score 4.68 (1.34 to 8.02); (p<0.001) and EQ-5D 4.00 (0.49 to 19.75); (p=0.04). There was also an improvement in cough frequency −60 (−43 to −95) coughs/24 hours (p<0.001), but no statistically significant effect on sleep disturbance was identified.ConclusionsRegular use of an Acapella device improves symptoms and quality of life in people with COPD who produce sputum daily or most days.Trial registration numberISRCTN44651852.

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“…Second, data on disease severity were not available, which would provide context on the generalizability of the study population. For example, some physicians may selectively prescribe OPEP devices to patients with a history of frequent severe exacerbations, 38 but severe patients at risk of post-discharge mortality may be underrepresented, given our study requirement of 12 months of follow-up data. Thirdly, it is not known from the claims data who administered the OPEP device, whether patients used the OPEP devices with the proper techniques or with the appropriate frequency, if the devices were used with nebulizers, or what other physiotherapy treatments (eg, breathing programs) may have been administered, which could impact device efficacy and outcomes.…”

Section: Discussionmentioning

confidence: 99%

Impact of Oscillating Positive Expiratory Pressure Device Use on Post-Discharge Hospitalizations: A Retrospective Cohort Study Comparing Patients with COPD or Chronic Bronchitis Using the Aerobika® and Acapella® Devices

Tse¹,

Wada²,

Wang³

et al. 2020

COPD

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Purpose: Managing and preventing disease exacerbations are key goals of COPD care. Oscillating positive expiratory pressure (OPEP) devices have been shown to improve clinical outcomes when added to COPD standard of care. This retrospective database study compared real-world resource use and disease exacerbation among patients with COPD or chronic bronchitis prescribed either of two commonly used OPEP devices.

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Adjuncts for sputum clearance in COPD: clinical consensus versus actual use

Cited by 9 publications

References 11 publications

Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity

Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity

Oscillatory positive expiratory pressure therapy in COPD (O-COPD): a randomised controlled trial

<p>Impact of Oscillating Positive Expiratory Pressure Device Use on Post-Discharge Hospitalizations: A Retrospective Cohort Study Comparing Patients with COPD or Chronic Bronchitis Using the Aerobika<sup>®</sup> and Acapella<sup>®</sup> Devices</p>

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