The effect of positive expiratory pressure (PEP) therapy on symptoms, quality of life and incidence of re-exacerbation in patients with acute exacerbations of chronic obstructive pulmonary disease: a multicentre, randomised controlled trial
- Christian R Osadnik1,2,
- Christine F McDonald2,3,
- Belinda R Miller4,
- Catherine J Hill2,5,
- Ben Tarrant6,
- Ranjana Steward6,
- Caroline Chao5,
- Nicole Stodden5,
- Cristino C Oliveira1,
- Nadia Gagliardi3,
- Anne E Holland1,2,6
- 1School of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia
- 2Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
- 3Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- 4Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
- 5Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia
- 6Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Correspondence to Christian Robert Osadnik, La Trobe University, Alfred Clinical School, Level 4, The Alfred Centre, Commercial Road, Prahran, Melbourne, VIC 3181, Australia;
- Received 13 February 2013
- Revised 13 August 2013
- Accepted 15 August 2013
- Published Online First 4 September 2013
Background Positive expiratory pressure (PEP) is a technique used to enhance sputum clearance during acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The impact of PEP therapy during acute exacerbations on clinically important outcomes is not clear. This study sought to determine the effect of PEP therapy on symptoms, quality of life and future exacerbations in patients with AECOPD.
Methods 90 inpatients (58 men; mean age 68.6 years, FEV1 40.8% predicted) with AECOPD and sputum expectoration were randomised to receive usual care (including physical exercise)±PEP therapy. The Breathlessness, Cough and Sputum Scale (BCSS), St George's Respiratory Questionnaire (SGRQ) and BODE index (Body mass index, airflow Obstruction, Dyspnoea, Exercise tolerance) were measured at discharge, 8 weeks and 6 months following discharge, and analysed via linear mixed models. Exacerbations and hospitalisations were recorded using home diaries.
Results There were no significant between-group differences over time for BCSS score [mean (SE) at discharge 5.2 (0.4) vs 5.0 (0.4) for PEP and control group, respectively; p=0.978] or SGRQ total score [41.6 (2.6) vs 40.8 (2.8) at 8 weeks, p=0.872]. Dyspnoea improved more rapidly in the PEP group over the first 8 weeks (p=0.006), however these benefits were not observed at 6 months. Exacerbations (p=0.986) and hospitalisations (p=0.359) did not differ between groups.
Conclusions We found no evidence that PEP therapy during AECOPD improves important short-term or long-term outcomes. There does not appear to be a routine role for PEP therapy in the management of such individuals.