<p>Positive Expiratory Pressure Therapy With And Without Oscillation And Hospital Length Of Stay For Acute Exacerbation Of Chronic Obstructive Pulmonary Disease</p>

Abstract

Introduction: Pharmacologic management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is well-established. Our aim in the current study is to determine if therapy with a positive expiratory pressure (PEP) device with or without an oscillatory mechanism (OM) in addition to standard care results in a reduction in hospital length of stay (LOS) among patients hospitalized for AECOPD. Methods: Two studies were performed and are reported here. Study 1: Patients admitted with AECOPD and sputum production were enrolled in a prospective trial comparing PEP therapy versus Oscillatory PEP (OPEP) therapy. Study 2: A retrospective historical cohort, matched in a 2 to 1 manner by age, gender, and season of admission, was compared with the prospectively collected data to determine the effect of PEP ± OM versus standard care on hospital LOS. Results: In the prospective trial (Study 1; 91 subjects), median hospital LOS was 3.2 (95% CI 3.0-4.3) days in the OPEP group and 4.8 (95% CI 3.9-6.1) days in the PEP group (p=0.16). In fully adjusted models comparing the prospective trial data with the retrospective cohort (Study 2; 182 subjects), cases had a median hospital LOS of 4.2 days (95% CI 3.8-5.1) versus 5.2 days (95% CI 4.4-6.0) in controls, consistent with a shorter hospital LOS with adjunctive PEP±OM therapy versus standard care (p=0.04). Conclusion: Adjunctive therapy with a PEP device versus standard care may reduce hospital LOS in patients admitted for AECOPD. Although the addition of an OM component to PEP therapy suggests a further reduction in hospital LOS, comprehensive multicenter randomized controlled trials are needed to confirm these findings. Clinical trial registration number: NCT03094806.

<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^® and Acapella^® Devices</p>

“…To our knowledge, the only study of Acapella effectiveness in treating acute COPD exacerbations was a clinical trial comparing patients who received an adjunct Acapella device (PEP or OPEP) to matched retrospective controls who received standard of care alone; this study found that patients who used Acapella had a 1-day reduction in the hospital length of stay. 23 Although OPEP devices share the general objective of opening airways and using airway oscillations to loosen mucus, the device mechanisms and consequently the pressure pulse waveforms that they generate differ, and several studies have reported better performance characteristics related to airway clearance for the Aerobika device compared to Acapella. [24][25][26] Therefore, the present study provides new evidence on how functional differences between the devices may translate to differences in preventing severe disease exacerbations, illustrated by the lower rate of subsequent inpatient admissions due to severe disease exacerbation in Aerobika device users compared to Acapella users in the PS-matched comparative analyses and further confirmed in adjusted analyses, as well as preventing moderate exacerbations and allcause hospitalizations that may be due to worsening of overall quality of life 4,5 and worsening comorbid conditions (eg, hospitalizations due to cardiac events 34 ).…”

“…To our knowledge, the only study of Acapella effectiveness in treating acute COPD exacerbations was a clinical trial comparing patients who received an adjunct Acapella device (PEP or OPEP) to matched retrospective controls who received standard of care alone; this study found that patients who used Acapella had a 1-day reduction in the hospital length of stay. 23 …”

“…One database study reported that the Aerobika OPEP device reduces 30-day exacerbations by nearly 30% compared to no positive expiratory pressure (PEP) or OPEP device use following a hospital visit, 22 and a clinical trial reported that patients who used an adjunct Acapella device had a 1-day reduction of hospital length of stay for acute exacerbation compared to those who received physician’s choice of standard COPD management. 23 Moreover, there are functional differences among a few existing OPEP devices, as revealed by several laboratory studies using simulated lung models, which may impact clinical efficacy. In particular, the Aerobika OPEP device has been shown to have the most consistent pressure amplitude, highest mean pressure amplitude at higher resistance settings, 24 , 25 and highest total pressure pulse impact 26 compared to Acapella and other OPEP devices.…”

Physiotherapy for large airway collapse: an ABC approach

“…Studies in bronchiectasis suggest the Acapella™ may improve quality of life in comparison to no ACT [ 41 ] and is also safe to use in exacerbations [ 42 ]. A recent review in COPD also showed modest evidence that the use of OPEP devices was associated with decreased symptoms of COPD and exacerbations (OR 0.37, 95% CI 0.19–0.72) [ 43 ] and may have a superior effect on length of stay during exacerbations of COPD compared to PEP alone [ 44 ]. Additionally evidence in cystic fibrosis suggests that OPEP is not more or less effective than other forms of ACT [ 45 ] and may be chosen if a patient prefers this device and resources allow.…”

Non-Pharmaceutical Techniques for Obstructive Airway Clearance Focusing on the Role of Oscillating Positive Expiratory Pressure (OPEP): A Narrative Review

“…In 2019, Milan et al [84] reported a prospective single-center trial with hospitalized COPD patients with significant mucus production receiving OPEP therapy with the primary endpoint being hospital length-of-stay as a health care resource utilization metric. The investigation study compared PEP therapy (n = 47) with OPEP treatment (n = 44).…”