Upright Positive Expiratory Pressure Therapy and Exercise: Effects on Gastroesophageal Reflux in COPD and Bronchiectasis

Abstract

. RESULTS: Fifty-seven participants (30 with bronchiectasis, 27 with COPD, mean ؎ SD age 61 ؎ 13 y, FEV 1 61.2 ؎ 24.6% predicted) completed the study. Episodes of isolated distal esophageal reflux occurred in 30% of participants during PEP therapy, 22% during the 6MWT, and 20% during the GST. However, there was no significant difference in distal RI during 6MWT or PEP therapy, compared to BGT (all P > .05). The number of reflux episodes was decreased, compared to BGT during the GST (P ‫؍‬ .001) and 6MWT (P ‫؍‬ .001), but not during PEP therapy (P ‫؍‬ .71). CONCLUSIONS: Episodes of gastroesophageal reflux may occur during physiotherapy tasks, including airway clearance therapy using mouthpiece PEP, the 6MWT, and a measure of upper limb movement. However, as these activities did not increase the frequency of these events, no modifications to these tasks to minimize the occurrence of gastroesophageal reflux are necessary.

Influence of intrapulmonary percussive ventilation in upright position on gastro‐oesophageal reflux in infants

“…27 It is well known that posture has an impact on the frequency of LOS relaxations, one of the physiological mechanisms to increase GOR episodes. 28 In infants with symptoms attributed to GOR, prone and left lateral position produced a significant reduction in total GOR, compared to supine and right lateral position. 29 Prone posture has been associated with sudden infant death and is not recommended.…”

“…More prudence seems justified while treating very young children suffering from pathological GOR or a chronic disease (e.g., infants with CF), especially when combining with gravity‐assisted positions . It is well known that posture has an impact on the frequency of LOS relaxations, one of the physiological mechanisms to increase GOR episodes . In infants with symptoms attributed to GOR, prone and left lateral position produced a significant reduction in total GOR, compared to supine and right lateral position .…”

“…Lee investigated the effect of positive expiratory pressure (PEP) in adult patients with COPD and bronchiectasis. She found no significant difference in the number of RE in the distal oesophagus, compared to baseline, but a significant lower number of RE in the proximal oesophagus . Previous studies showed a beneficial effect of continuous positive airway pressure (CPAP) on the reduction of GOR.…”

“…She found no significant difference in the number of RE in the distal oesophagus, compared to baseline, but a significant lower number of RE in the proximal oesophagus. 28 Previous studies showed a beneficial effect of continuous positive airway pressure (CPAP) on the reduction of GOR. Green et al found that patients with higher CPAP pressure demonstrated greater reduction in their GOR score.…”

British Thoracic Society Guideline for bronchiectasis in adults

“…A study evaluated the effect of a single session of PEP therapy in the sitting position on gastro-oesophageal reflux. 140 A session of PEP therapy in sitting was not associated with a significant increase in reflux by pH monitoring.…”