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Changing practice by changing pressures: a role for oscillating positive expiratory pressure in chronic obstructive pulmonary disease
  1. Adam Lewis1,
  2. Christian Robert Osadnik2
  1. 1 Department of Health Sciences, Brunel University London, Uxbridge, UK
  2. 2 Department of Physiotherapy, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
  1. Correspondence to Dr Adam Lewis, Brunel University London, Uxbridge, UNITED KINGDOM UB8 3PH, UK; adam.lewis{at}

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Positive expiratory pressure (PEP) is an airway clearance technique involving a series of exhalation manoeuvres against a positive pressure that seeks to promote sputum clearance. It is often prescribed for people with chronic obstructive pulmonary disease (COPD) who experience sputum production, and clinical interest regarding its importance has existed for many years. Most randomised controlled trials (RCTs) in this field pertain to non-oscillatory PEP, however, high-quality RCTs of oscillatory PEP (a variation of the technique involving rapid pressure fluctuations within the airways) are emerging. One such example is published in this issue of Thorax, by Alghamdi et al.1

Alghamdi et al 1 provide important data on the efficacy of the ‘Acapella’ oscillating PEP (OPEP) device to reduce cough burden for patients with COPD who regularly produce sputum. The intervention group in this study were encouraged to use an Acapella alongside their active cycle of breathing techniques (ACBT) while the control group performed ACBT only. Participants were encouraged to perform interventions three times per day for 3 months. The strengths of this study are the methodology, particularly the recruitment of patients with a chronic bronchitic phenotype who are most likely to benefit from ACBT and OPEP. The authors also collected triangulated cough and sleep data involving both questionnaire-based and objectively quantified data, which enhances the rigour of conclusions relating to improved cough frequency, quality of life and fatigue. The authors also observed reduced odds of exacerbations in the OPEP group. This is significant considering the high numbers of individuals who had not exacerbated in the previous year at baseline. However, longer-term follow-up data in future studies will be required to confirm this. The results from Alghamdi et al 1 are clinically relevant and relate well to current provision restrictions during COVID-19.

Current National Institute for Health and Care Excellence …

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  • Twitter @apl104, @cosadnik

  • Contributors Both authors contributed equally to the writing, reviewing and revision of this editorial.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AL declares working on lung volume reduction, remote vital sign monitoring, and singing for lung health clinical studies with Professor Nicholas Hopkinson, Dr Keir Philip, Dr Winston Banya, Mrs Sara Buttery and Professor Michael Polkey. CRO declares no conflict of interest.

  • Provenance and peer review Commissioned; externally peer reviewed.

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