Oscillating Positive Expiratory Pressure on Respiratory Resistance in Chronic Obstructive Pulmonary Disease With a Small Amount of Secretion

Gastaldi, Ada Clarice; Paredi, Paolo; Talwar, Anjana; Meah, Sally; Barnes, Peter J.; Usmani, Omar

doi:10.1097/md.0000000000001845

Cited by 21 publications

(35 citation statements)

References 42 publications

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“…Another study found that short-term use of a Flutter device can reduce airways resistance even in patients with COPD with minimal sputum production. 14 …”

Section: Resultsmentioning

confidence: 99%

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

Barker

Hopkinson

2017

BMJ Open Resp Res

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IntroductionOscillatory positive pressure devices (OPEP) can be used as adjuncts to improve sputum clearance in chronic obstructive pulmonary disease (COPD), though the evidence base is incomplete. The attitudes of physiotherapists towards these devices in the care of patients with COPD is unknown. In addition, actual use compared with the prescription of medications has not been studied.MethodsWe analysed English prescribing data, obtained from OpenPrescribing.net, for a 3-year period from 2013. In addition, we conducted an online survey of members of the Association of Chartered Physiotherapists in Respiratory Care regarding awareness of devices, thresholds for treatment and device preference.ResultsOut of a potential 3.2 million COPD patient-years of treatment between 2013 and 2015, 422 744 patient-years of treatment with carbocisteine, at a cost of £73 million, were prescribed, as well as 1.1 million years treatment with tiotropium. In the same period, only 4989 OPEP devices were prescribed. There were 116 responses to the survey (12% response rate), 72% in hospital practice, 28% based in the community. There were variations in respondents’ threshold for treatment with sputum adjuncts in COPD, and when asked to select either the Acapella, Flutter or positive expiratory pressure mask, preferences were 69%, 24% or 6%, respectively.ConclusionsThere is a 100-fold difference between use of carbocisteine and OPEP devices in COPD, with far fewer devices prescribed than are included in the phenotypes clinicians believe them to be effective in. Variation in physiotherapist attitudes to treatment thresholds highlights the need for research into the effectiveness of OPEP devices in specific patient phenotypes.

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“…Another study found that short-term use of a Flutter device can reduce airways resistance even in patients with COPD with minimal sputum production. 14 …”

Section: Resultsmentioning

confidence: 99%

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

Barker

Hopkinson

2017

BMJ Open Resp Res

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“…There are several reports that alternative types of vibration and oscillation can facilitate air removal and improve lung function in various clinical settings [6][7][8][9][10]. So far, no clinical studies have evaluated the effect of positive vasodilator pressure with Acapella (Smiths Medical Inc, Carlsbad, California) in patients undergoing coronary artery bypass grafting.…”

Section: Introductionmentioning

confidence: 99%

Comparing the Effect of Incentive Spirometry with Acapella on Blood Gases in Physiotherapy After Coronary Artery Bypass Graft

Alam

Hussain

Shehzad

et al. 2020

Cureus

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To compare the effect of incentive spirometry with Acapella (Smiths Medical Inc, Carlsbad, California) in physiotherapy after coronary artery bypass surgery. Methods A randomized controlled trial comparing incentive spirometry with Acapella was conducted in the intensive care unit of Chaudhary Pervaiz Elahi Institute of Cardiology (CPEIC) Multan. The study began from December 2017 to August 2019 after getting approval from the ethical committee of the hospital. Informed written consent was taken from all 270 patients who were included in the study. Patients who underwent coronary artery bypass graft (CABG) were divided into two groups by the lottery method. The primary end-point of the study was to check the blood gases on Day 3 after the procedure at room air and compare it with the baseline and with blood gases immediately after the procedure. SPSS 23 (IBM Corp., Armonk, NY) was used to analyze the data of this study. For qualitative variables in data such as gender, place of living, patients with any comorbidities, and education status were statistically analyzed in percentage and frequencies. For numerical variables, such as age, body mass index, blood gases values, distance covered in a six-minute walk test, and spirometry values were analyzed and statistically measured as mean and standard deviation. A P-value of less than .05 was considered significant.

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“…The study was powered at 90% to detect a 0.1 kPa L-1 s difference in the primary outcome of trough R5, assuming a within subject standard deviation of 0.13 kPa L-1 s, and an alpha error of 0.05 (two-tailed) [ 19 ]. Students t-tests were used to compare treatment effects at baseline and after chronic dosing.…”

Section: Methodsmentioning

confidence: 99%

Effects of combination therapy indacaterol/glycopyrronium versus tiotropium on moderate to severe COPD: evaluation of impulse oscillometry and exacerbation rate

Molino

Simioli

Stanziola

et al. 2017

Multidiscip Respir Med

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BackgroundSmall airways are considered the major site of airflow limitation in COPD. Impulse oscillometry (IOS) is a forced oscillation technique, which provides passive measurement of lung mechanics. It can differentiate small airway from large airway obstruction and is more sensitive than spirometry for peripheral airway disease. In this study the efficacy of the combination of Indacaterol/Glycopirronium (IND/GLY) versus Tiotropium on airway resistance (R5, R20, R5–20), lung reactance (X) and resonant frequency in moderate to severe COPD patients has been evaluated. We also evaluated inspiratory capacity (IC), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), exacerbation rate and quality of life.MethodsForty patients were monitored with forced oscillation technique and spirometry. Patients were randomized in 2 groups: 20 received fixed dose once daily Indacaterol/Glycopyrronium (Group A) and 20 received single Tiotropium (Group B).The oscillometry parameters were the measure of resistance in the airways at 5 Hz (R5), at 20 Hz (R20) and the lung reactance (X).ResultsThere was a statistically significant difference between pre-dosing at V1 and at follow up visits in R5, R20 and X values in patients receiving dual bronchodilation but not in control group. Pre-dosing IC value at follow up visits in patients receiving dual bronchodilation had a statistical significant variation.ConclusionsThe “new” bronchodilator combination LABA/LAMA significantly reduces bronchial obstruction in small airways too. The oscillometry demonstrated greater sensitivity compared with spirometry for monitoring outcome measures of airway obstruction and the effect of long-term therapy.

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Oscillating Positive Expiratory Pressure on Respiratory Resistance in Chronic Obstructive Pulmonary Disease With a Small Amount of Secretion

Cited by 21 publications

References 42 publications

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

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

Comparing the Effect of Incentive Spirometry with Acapella on Blood Gases in Physiotherapy After Coronary Artery Bypass Graft

Effects of combination therapy indacaterol/glycopyrronium versus tiotropium on moderate to severe COPD: evaluation of impulse oscillometry and exacerbation rate

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