Positive Expiratory Pressure via Mask Does Not Improve Ventilation Inhomogeneity More than Huffing and Coughing in Individuals with Stable Chronic Obstructive Pulmonary Disease and Chronic Sputum Expectoration

Abstract

Background: Positive expiratory pressure (PEP) has been used to promote airway clearance in individuals with chronic obstructive pulmonary disease (COPD) for many years; however, its mechanism of action and benefits are unclear. Previous authors have suggested that PEP improves collateral ventilation via changes in lung volumes. Objectives: It was the aim of this study to determine whether PEP improves ventilation inhomogeneity more than controlled huffing and coughing in individuals with stable COPD. Methods: Twelve participants with COPD (mean forced expiratory volume in 1 s 45% predicted) and chronic sputum expectoration performed PEP therapy (10-20 cm H₂O) or controlled huffing and coughing in random order on alternate study days with a 48-hour washout. Measures of acinar and conductive airway ventilation (S_acin, S_cond), lung volumes, spirometry and sputum wet weight were recorded before, immediately after and 90 min following treatment. Ease of expectoration [visual analogue scale (VAS)] and oxyhaemoglobin saturation were assessed immediately following treatment. Results: There were no significant differences between the effect of either test condition at any time point for any test parameter. Mean S_acin immediately following PEP and control conditions was 0.465 and 0.438 litre^-1, respectively (p = 0.45 for comparison between conditions) and mean S_cond was 0.042 and 0.039 litre^-1 (p = 0.55). PEP therapy did not significantly enhance total mean sputum expectoration compared to controlled huffing and coughing (7.06 vs. 6.15 g; p = 0.51) and did not improve ease of expectoration (VAS PEP 4.8 cm vs. control 4.1 cm; p = 0.53). Conclusion: Any therapeutic benefits of PEP in individuals with COPD and chronic sputum expectoration are unlikely to be mediated by improvements in ventilation or lung volumes.

Airway clearance techniques for patients with acute exacerbations of chronic obstructive pulmonary disease: Physical therapy practice in Sweden

“…These are all very well suited to the pathophysiological dysfunction that occurs in the lungs of people with COPD, however confirmatory evidence of these mechanisms occurring in this patient group has been somewhat elusive. 21,22 A previous systematic review of PEP therapy for patients with COPD showed inconsistent findings across a limited number of small studies and highlighted a need for further research to determine any likely clinical benefits. 23 A more recent Cochrane review reported a statistically significant pooled benefit for ACTs (compared to usual care) in reducing the need for or duration of assisted ventilation during AECOPD, with larger effects suggested for PEP-based versus non-PEP-based techniques.…”

Physiotherapetic Approach in Elderly With COPD: A Systematic Review

“…In the design of the present study, randomized and nonrandomized articles were analyzed, in which various types of physiotherapeutic interventions in the treatment of COPD in elderly patients were presented, from the analyzed trials, 6 studies obtained a positive outcome from the proposed analysis and 3 of the studies 14,15,18 did not obtain signi cant results.…”

“…According to the study by OSADNIK, et al 15 there are no signi cant differences between the use of Hu ng and PEP, because regardless of any bene t derived from therapy there appears to be no mediation for improvements in ventilation due to changes in lung volumes 30 .…”

Effects of positive expiratory pressure on pulmonary clearance of aerosolized technetium-99m-labeled diethylenetriaminepentaacetic acid in healthy individuals

“…Positive expiratory pressure (PEP) therapy involves breathing with slightly active expiration against mild expiratory resistance (typically 10-20 cmH 2 O) 9 . Its application via a PEP mask represents a reliable, safe, low-cost intervention that can increase lung volumes and intrathoracic pressure 10 …”