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Original research
Use of oscillatory positive expiratory pressure (OPEP) devices to augment sputum clearance in COPD: a systematic review and meta-analysis
  1. Saeed M Alghamdi1,2,
  2. Ruth Emily Barker1,3,
  3. Abdullah S S Alsulayyim1,4,
  4. Ali M Alasmari1,5,
  5. Winston A S Banya1,6,
  6. Michael I Polkey1,6,
  7. Surinder S Birring7,
  8. Nicholas S Hopkinson1
  1. 1 National Heart and Lung Institute, Imperial College London, London, UK
  2. 2 Respiratory Care Department, Umm Al-Qura University, Makkah, Saudi Arabia
  3. 3 Harefield Respiratory Research Group, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  4. 4 Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
  5. 5 College of Medical Rehabilitation, Taibah University, Madinah, Al Madinah, Saudi Arabia
  6. 6 Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  7. 7 Centre for Human& Applied Physiological Sciences, School of Basic & Medical Biosciences Faculty of Life Sciences & Medicine, King's College London, London, UK
  1. Correspondence to Dr Nicholas S Hopkinson, National Heart and Lung Institute, Imperial College London, London SW7 2BU, UK; n.hopkinson{at}


Introduction Oscillating positive expiratory pressure (OPEP) devices are intended to facilitate sputum clearance in chronic obstructive pulmonary disease (COPD), but there is uncertainty as to their place in treatment pathways. We aimed to review the existing literature to establish the evidence base for their use.

Methods A systematic search of records up to March 2020 was performed on PubMed, CINAHL, Medline (Ovid), Cochrane and Embase to retrieve clinical trials that evaluated the efficacy of OPEP devices in patients with COPD. Two independent reviewers retrieved the titles, abstracts and full texts, and completed the data extraction.

Results Following full-text review of 77 articles, eight (six randomised control trials and 2 cross-over studies) were eligible for inclusion. Pooled analysis showed low-grade evidence that the use of OPEP devices was associated with decreased COPD symptoms and exacerbations (OR 0.37, 95% CI 0.19 to 0.72), and enhanced exercise capacity; 6 min walk distance (mean difference (95% CI), 49.8 m (14.2 m to 85.5 m); p=0.009]). However, studies were mostly short term with the majority having a high risk of bias. The average acceptance, completion and drop-out rates were 82%, 91% and 8%, respectively.

Conclusion The use of OPEP devices can have a positive impact in COPD, but confidence in effect sizes is low and there is a need for further, higher quality studies to examine their long-term efficacy in COPD as well as to identify specific patient phenotypes that are more likely to respond.

PROSPERO registration number CRD 42016041835.

  • COPD exacerbations
  • exercise
  • pulmonary rehabilitation

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  • Contributors SMA, NSH, MIP, SSB and REB developed the idea and designed the study protocol. SMA, REB and NSH designed and wrote the search strategy and the first protocol draft. SMA, NSH, REB, ASSA and AMS planned the data extraction and statistical analysis. NSH, MIP, WASB and SSB provided critical insights. All authors have approved and contributed to the final written manuscript.

  • Funding The main author disclosed receipt of the following financial support for the research, authorship and/or publication of this article. This study was supported by a scholarship from Umm Al-Qura University in Saudi Arabia.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data generated or analysed during this study are included in this published article and its supplementary information files.

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