The Efficacy of Oscillating Positive Expiratory Pressure (OPEP) Therapy in Patients with Bronchiectasis - A Prospective Study
Authors/Creators
- 1. Senior Resident, Department of Pulmonary Medicine, Government Medical College, Kozhikode, Kerala
- 2. Associate Professor, Department of Pulmonary Medicine, Government Medical College, Kozhikode, Kerala
- 3. Associate Professor, Department of Pharmacology, Government Medical College, Kozhikode, Kerala
- 4. Professor, Department of Pulmonary Medicine, Government Medical College, Manjeri, Kerala
Description
Background: A characteristic feature in bronchiectasis is the impairment in clearance of secretions leading to frequent colonization and recurrent infection with various pathogenic organisms. This results in a vicious cycle of purulent secretions, bronchial damage, bronchial dilation, and further impairment. Chest physiotherapy (CPT) with postural drainage is the standard treatment for mobilization and removal of airway secretions. Airway clearance can be augmented by use of devices such as oscillating positive expiratory pressure (OPEP) devices which combines positive expiratory pressure therapy with high frequency oscillations within the airways. Objectives: To study the efficacy of Oscillating Positive Expiratory Pressure (OPEP) Therapy compared with Conventional Chest Physiotherapy (CCPT) in patients with bronchiectasis in reducing exacerbations, improving lung functions, quality of daily life activity and healthy status. Methods: A Prospective cohort clinical study conducted in patients with bronchiectasis in a tertiary care setting for a period between February 2018 and July 2019.A total of 130 patients were randomized into two groups to receive either Oscillating Positive Expiratory Pressure (OPEP) therapy using Acapella device or conventional chest physiotherapy in addition to regular pharmacotherapy. All patients were reassessed every 2 months. FEV1 was measured at the beginning of study, 4th month and at the end. Comfort, well-being and adherence were assessed in the two study groups using a 5-point Likert scale at the end of the study. The Statistical software SPSS 22.0, and R environment ver.3.2.2 were used for the analysis of the data. Results: The number of exacerbations was significantly less in OPEP group compared to CCPT group and the onset of exacerbations was later in the former group. Health related quality of life, comfort and wellbeing showed improvement in OPEP group. Conclusion: The relatively lower exacerbation rates and their later onset, improvement in health-related quality of life, comfort and wellbeing in patients performing OPEP therapy compared with CCPT supports the use of OPEP therapy for airway clearance than other conventional airway clearance techniques in patients with Bronchiectasis.
Abstract (English)
Background: A characteristic feature in bronchiectasis is the impairment in clearance of secretions leading to frequent colonization and recurrent infection with various pathogenic organisms. This results in a vicious cycle of purulent secretions, bronchial damage, bronchial dilation, and further impairment. Chest physiotherapy (CPT) with postural drainage is the standard treatment for mobilization and removal of airway secretions. Airway clearance can be augmented by use of devices such as oscillating positive expiratory pressure (OPEP) devices which combines positive expiratory pressure therapy with high frequency oscillations within the airways. Objectives: To study the efficacy of Oscillating Positive Expiratory Pressure (OPEP) Therapy compared with Conventional Chest Physiotherapy (CCPT) in patients with bronchiectasis in reducing exacerbations, improving lung functions, quality of daily life activity and healthy status. Methods: A Prospective cohort clinical study conducted in patients with bronchiectasis in a tertiary care setting for a period between February 2018 and July 2019.A total of 130 patients were randomized into two groups to receive either Oscillating Positive Expiratory Pressure (OPEP) therapy using Acapella device or conventional chest physiotherapy in addition to regular pharmacotherapy. All patients were reassessed every 2 months. FEV1 was measured at the beginning of study, 4th month and at the end. Comfort, well-being and adherence were assessed in the two study groups using a 5-point Likert scale at the end of the study. The Statistical software SPSS 22.0, and R environment ver.3.2.2 were used for the analysis of the data. Results: The number of exacerbations was significantly less in OPEP group compared to CCPT group and the onset of exacerbations was later in the former group. Health related quality of life, comfort and wellbeing showed improvement in OPEP group. Conclusion: The relatively lower exacerbation rates and their later onset, improvement in health-related quality of life, comfort and wellbeing in patients performing OPEP therapy compared with CCPT supports the use of OPEP therapy for airway clearance than other conventional airway clearance techniques in patients with Bronchiectasis.
Files
IJPCR,Vol14,Issue5,Article28.pdf
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Additional details
Dates
- Accepted
-
2022-05-05
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/14/IJPCR,Vol14,Issue5,Article28.pdf
- Development Status
- Active
References
- 1. King PT, Holdsworth SR, Freezer NJ, Villanueva E, Holmes PW. Characterization of the onset and presenting clinical features of adult bronchiectasis. Respir Med. 2006;100(12):2183–9. 2. Fishman AP, Elias JA, Grippi MA, et al, eds. Fishman's pulmonary disease and disorders, 5th ed. New York, NY: McGraw Hill, 2015; pp. 1759–1773 3. Goeminne PC, Hernandez F, Diel R, Filonenko A, Hughes R, Juelich F, et al. The economic burden of bronchiectasis - known and unknown: a systematic review. BMC Pulm Med. 2019;19(1):54 4. Hardy KA. A review of airway clearance: new techniques indications and recommendations. Resp Care. 1994; 39:440. 5. Mcllwaine PM, Wong LT, Peacock D, Davidson AG. Long-term comparative trial of positive expiratory pressure versus oscillating positive expiratory pressure (flutter) physiotherapy in the treatment of cystic fibrosis. J Pediatr. 2001; 138:845–849. 6. Volsko TA, DiFiore J, Chatburn RL. Performance comparison of two oscillating positive expiratory pressure devices: Acapella versus Flutter. Respir Care. 2003;48(2):124–30. 7. Finklea JD, Khan G, Thomas S, Song J, Myers D, Arroliga AC. Predictors of mortality in hospitalized patients with acute exacerbation of bronchiectasis. Respir Med. 2010;104(6):816–21 8. Martínez-García MA, Soler-Cataluña J-J, Perpiñá-Tordera M, RománSánchez P, Soriano J. Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. Chest. 2007;132(5):1565–72 9. Patterson J, Bradley J, Hewitt O, et al. Airway clearance in bronchiectasis: a randomised crossover trial of active cycle of breathing techniques versus Acapella. Respiration 2005; 72: 239– 242. 10. Thompson C, Harrison S, Ashley J, et al. Randomised crossover study of the Flutter device and the active cycle of breathing technique in non-cystic fibrosis bronchiectasis. Thorax 2002; 57: 446–448. 11. Eaton T, Young P, Zeng I, Kolbe J. A randomized evaluation of the acute efficacy, acceptability and tolerability of flutter and active cycle of breathing with and without postural drainage in non-cystic fibrosis bronchiectasis. Chron Respir Dis. 2007;4(1):23–30. 12. Chalmers JD, Goeminne P, Aliberti S, et al. The bronchiectasis severity index: an international derivation and validation study. Am J RespirCrit Care Med 2014; 189: 576–585. 13. Lee AL, Burge AT, Holland AE. Airway clearance techniques for bronchiectasis. Cochrane Database Syst Rev. 2015;(11):CD008351 14. Erazo, E. W. V., Walles, J. G., Bejarano, H. A., Ustariz, R. J. M., Mejía, A. O., Escobar, P. L. J. Cabra, O. P., & Rodriguez, A. C. E. Reconstruction through the Use of the Posterior Peroneum for Coverage of Defects of the Distal Third of the Leg. Journal of Medical Research and Health Sciences, 2022:5(4), 1967– 1972. 15. McCool FD, Rosen MJ. Nonpharmacologic airway clearance therapies: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):250S-259S.16. Murray M, Pentland J and Hill A. A Randomised crossover trial of chest physiotherapy in non-cystic fibrosis bronchiectasis. Eur Respir J 2009; 34: 1086–1092