Effects of Expiratory Positive Airway Pressure on Exercise Tolerance, Dynamic Hyperinflation, and Dyspnea in COPD

Gass, Ricardo; Merola, Pietro Krauspenhar; Monteiro, Mariane Borba; Cardoso, Dannuey Machado; Paiva, Dulciane Nunes; Teixeira, Paulo José Zimermann; Knorst, Marli Maria; Berton, Danilo Cortozi

doi:10.4187/respcare.05556

Cited by 9 publications

(16 citation statements)

References 42 publications

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“…Five studies 18 , 23 , 24 , 26 , 27 applied EPAP through a resistor face mask. Three studies used the 6MWT as a protocol 17 , 25 , 26 for the evaluation of the effect of EPAP, and two used CEPT in cycle ergometer for lower limbs 23 , 24 . All studies used constant work rate tests, except one that used an incremental test 23 .…”

Section: Resultsmentioning

confidence: 99%

“…Five of the included studies evaluated dynamic hyperinflation 17 , 18 , 24 , 26 , 27 . IC was compared during exercise of the lower limbs without EPAP and EPAP 10 cmH 2 O, with no significant effect on reducing the onset of DH (0.04 L; 95% CI − 0.1 to 0.2; I 2 = 0%; p = 0.70).…”

Section: Resultsmentioning

confidence: 99%

“…Several studies have evaluated the effects of EPAP during exercise on individuals with COPD 17 , 18 , 23 – 27 . However, controversy persists in the literature about the effects of EPAP on DH 17 , 18 , 24 , 26 , 27 and exercise tolerance in individuals with COPD 17 , 24 – 27 . Therefore, we conducted this systematic review and meta-analysis of available studies that assessed the effects of EPAP during exercise on the onset of DH, exercise tolerance, and symptom intensity in subjects with COPD.…”

Section: Introductionmentioning

confidence: 99%

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Effect of the expiratory positive airway pressure on dynamic hyperinflation and exercise capacity in patients with COPD: a meta-analysis

Cardoso

Gass

Sbruzzi

et al. 2020

Sci Rep

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Expiratory positive airway pressure (EPAP) is widely applicable, either as a strategy for pulmonary reexpansion, elimination of pulmonary secretion or to reduce hyperinflation. However, there is no consensus in the literature about the real benefits of EPAP in reducing dynamic hyperinflation (DH) and increasing exercise tolerance in subjects with chronic obstructive pulmonary disease (COPD). To systematically review the effects of EPAP application during the submaximal stress test on DH and exercise capacity in patients with COPD. This meta-analysis was performed from a systematic search in the PubMed, EMBASE, PeDRO, and Cochrane databases, as well as a manual search. Studies that evaluated the effect of positive expiratory pressure on DH, exercise capacity, sensation of dyspnea, respiratory rate, peripheral oxygen saturation, sense of effort in lower limbs, and heart rate were included. GRADE was used to determine the quality of evidence for each outcome. Of the 2,227 localized studies, seven studies were included. The results show that EPAP did not change DH and reduced exercise tolerance in the constant load test. EPAP caused a reduction in respiratory rate after exercise (− 2.33 bpm; 95% CI: − 4.56 to − 0.10) (very low evidence) when using a pressure level of 5 cmH 2 O. The other outcomes analyzed were not significantly altered by the use of EPAP. Our study demonstrates that the use of EPAP does not prevent the onset of DH and may reduce lower limb exercise capacity in patients with COPD. However, larger and higher-quality studies are needed to clarify the potential benefit of EPAP in this population.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of the expiratory positive airway pressure on dynamic hyperinflation and exercise capacity in patients with COPD: a meta-analysis

Cardoso

Gass

Sbruzzi

et al. 2020

Sci Rep

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“…Acompanhada do caráter multissistêmico, estão associados à doença outras comorbidades como a disfunção muscular periférica e a diminuição da capacidade oxidativa, resultando em uma redução da tolerância ao exercício, inatividade e falta de condicionamento que interferem amplamente no prognóstico da doença e na qualidade de vida (CORLATEANU et al, 2016, COOPER;DRAPSFIELD, 2008;CHATILA et al, 2008, MALTAIS et al, 2014GOLD, 2017;O'DONNELL et al, 2017;O'DONNELL et al, 2014;BOREL et al, 2013). Estudos recentes apresentam que em sujeitos com DPOC a hiperinsuflação pulmonar está relacionada a dispneia percebida, redução da complacência pulmonar e limitação do exercício (LANGER et al, 2014;GASS et al, 2017).…”

Section: Fundamentaçãounclassified

“…Há ainda muitas controvérsias na literatura contemporânea com relação ao uso do EPAP e o nível pressórico utilizado. Gass et al (2017) estudaram EPAP com 5 e 10 cmH2O e observaram que quanto maior o nível de pressão expiratória do EPAP, menor é a tolerância ao exercício físico. Russo et al (2016) ao comparar a EPAP de 1cmH2O e 10cmH2O, observou que não houve diferença significativa entre ambas as pressões quando relacionado a tolerância ao exercício físico no TC6m.…”

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Efeitos da Pressão Positiva Expiratória sobre a capacidade de exercício em sujeitos acometidos por Doença Pulmonar Obstrutiva Crônica

Ferreira

Schneiders

Mansour

et al. 2018

RJP

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A Doença Pulmonar Obstrutiva Crônica (DPOC) leva a repercussões cardíacas e intolerância ao exercício. A pressão positiva expiratória nas vias aéreas (EPAP) aumenta a saturação de oxigênio (SpO2) e reduz o trabalho respiratório. O objetivo foi avaliar o EPAP na tolerância ao exercício em pacientes com DPOC. Estudo cruzado randomizado, avaliou-se 19 pacientes com DPOC através do teste de caminhada de seis minutos (TC6m): sem EPAP (G1) e com EPAP (G2). Variáveis analisadas no repouso, durante o TC6m e recuperação pós teste: SpO2, frequência respiratória (FR), frequência cardíaca (FC), BORG-esforço (BORG-e), BORG-dispneia (BORG-d), pressão arterial sistólica e diastólica e duplo produto (DP). Utilizou-se análise de variância para estimar a diferença dentro dos grupos e teste t de Student para a diferença entre os grupos. Dentro e em ambos os grupos: durante o TC6m verificou-se aumento da FC, do BORG-d, do DP e redução da SpO2 que se recuperou pós teste. Somente G2 recuperou a FC pós teste. Diferenças significativas foram observadas entre os grupos: no repouso para a SpO2 e FR; na recuperação pós TC6m para a FR. O EPAP de 5cmH2O, causa efeito positivo na SpO2 e FR de repouso e proporciona atenuada melhora na recuperação da FC e SpO2 pós TC6m.

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Fisioterapia e sindrome ventilatoria ostruttiva, in fase stabile

Bonnevie

Prieur

Gravier

et al. 2019

EMC - Medicina Riabilitativa

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Effects of Expiratory Positive Airway Pressure on Exercise Tolerance, Dynamic Hyperinflation, and Dyspnea in COPD

Abstract: The application of EPAP5 or EPAP10 during exercise tended to cause a progressive reduction in exercise tolerance in subjects with COPD without improvement in dyspnea or dynamic hyperinflation at equivalent exercise duration.

Cited by 9 publications

References 42 publications

Effect of the expiratory positive airway pressure on dynamic hyperinflation and exercise capacity in patients with COPD: a meta-analysis

Effect of the expiratory positive airway pressure on dynamic hyperinflation and exercise capacity in patients with COPD: a meta-analysis

Efeitos da Pressão Positiva Expiratória sobre a capacidade de exercício em sujeitos acometidos por Doença Pulmonar Obstrutiva Crônica

Fisioterapia e sindrome ventilatoria ostruttiva, in fase stabile

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