CPAP and EPAP elicit similar lung deflation in a non‐equivalent mode in GOLD 3‐4 COPD patients

Müller, Paulo de Tarso; Christofoletti, Gustavo; Koch, Rodrigo; Nogueira, João Henrique Zardetti; Patusco, Luiz Armando Pereira; Chiappa, Gaspar R.

doi:10.1111/crj.12716

Cited by 3 publications

(3 citation statements)

References 30 publications

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“…The effects of EPAP on HRV complexity during rest in COPD patients are unprecedented and cannot be compared to other scientific studies. One of the main findings of our study with 5 cmH 2 O EPAP was the increase of SpO 2 , different from Müller et al ( 12 ) study, in which they applied 10 cmH 2 O EPAP and found no improvement in SpO 2 . The main effect of the EPAP device consists in increasing expiratory flow and decreasing pulmonary hyperinflation ( 11 ).…”

Section: Discussioncontrasting

confidence: 99%

“…The main effect of the EPAP device consists in increasing expiratory flow and decreasing pulmonary hyperinflation ( 11 ). EPAP demonstrated equivalent effects to CPAP on static hyperinflation, improvements in inspiratory muscle strength, and inspiratory capacity ( 12 ). The device has been used in COPD patients to assist elimination of pulmonary secretions and induce a reduction in minute ventilation, respiratory rate, and physiological dead space ( 25 , 26 ).…”

Section: Discussionmentioning

confidence: 99%

“…Nicolini et al ( 11 ) evaluated the effect of expiratory positive airway pressure (EPAP) on the 6-min walk test (6MWT) in COPD patients and found a beneficial effect of EPAP on their functional capacity. Müller et al ( 12 ) highlighted that CPAP and EPAP reduce static hyperinflation in COPD patients, and that EPAP demonstrates equivalent effects to CPAP on static hyperinflation indirectly measured by inspiratory capacity and maximal inspiratory pressure (MIP). EPAP application relieves dynamic airway compression during expiration, reducing expiratory airflow limitation and thereby increasing inspiratory capacity in COPD patients ( 13 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

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Influence of expiratory positive airway pressure on cardiac autonomic modulation at rest and in submaximal exercise in COPD patients

Goulart

Martin

Mansour

et al. 2018

Braz J Med Biol Res

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The aim of this study was to evaluate the effect of expiratory positive airway pressure (EPAP) on heart rate variability (HRV) indices at rest and during 6-min walk test (6MWT) in chronic obstructive pulmonary disease (COPD) patients. Fifteen moderate to severe COPD patients were randomized and evaluated with and without (Non-EPAP) a 5 cmH2O EPAP device. Respiratory rate (RR) was collected at rest (5 min), during the 6MWT (5 min), and at recovery (5 min). Indices of HRV were computed in the time domain, in the frequency domain, and nonlinear analysis. For EPAP and Non-EPAP during the 6MWT, we found an increased mean heart rate (HR) (P=0.001; P=0.001) while mean RR (P=0.001; P=0.015) and RR tri index decreased (P=0.006; P=0.028). Peripheral oxygen saturation (P=0.019) increased at rest only in the EPAP group. In EPAP, correlations were found between forced expiratory volume in 1 s (FEV1) and low frequency (LF) sympathetic tonus (P=0.05; r=-0.49), FEV1 and high frequency (HF) parasympathetic tonus at rest (P=0.05; r=0.49), lactate at rest and LF during the 6MWT (P=0.02; r=-0.57), and lactate at rest and HF during 6MWT (P=0.02; r=0.56). Through a linear regression model, we found that lactate at rest explained 27% of the alterations of LF during 6MWT. The use of 5 cmH2O EPAP improved autonomic cardiac modulation and its complexity at rest in COPD patients. Although it did not influence the performance of the 6MWT, the EPAP device caused alterations in resting lactate concentration with an effect on sympatho-vagal control during the test.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of expiratory positive airway pressure on cardiac autonomic modulation at rest and in submaximal exercise in COPD patients

Goulart

Martin

Mansour

et al. 2018

Braz J Med Biol Res

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Inspiratory Muscle Training Potentiates the Beneficial Effects of Proportional Assisted Ventilation on Exertional Dyspnea and Exercise Tolerance in COPD: A Proof-of-Concept Randomized and Controlled Trial

Koch

Augusto

Ramos

et al. 2020

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Acute effects of expiratory positive pressure on autonomic cardiac modulation during spontaneous and slow deep breathing in COPD patients

Silva

Goulart

Mansour³

et al. 2020

An. Acad. Bras. Ciênc.

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Aim: to evaluate the acute effects of expiratory positive airway pressure on cardiac autonomic modulation in chronic obstructive pulmonary disease patients during spontaneous breathing and slow deep breathing. Methods: 17 patients were evaluated. The R-R intervals were collected (Polar ® S810i) during spontaneous breathing (10 minutes) and slow deep breathing (4 minutes), with and without 5 cmH 2 O expiratory positive airway pressure. Stable signals were analyzed by Kubios ®. Heart rate variability indices were computed in time domain and in frequency domain. Results: Expiratory positive airway pressure application affected low frequency (spontaneous breathing: 62.5±4.1 vs slow deep breathing: 28.2±4.2, p<0.001) and high frequency (spontaneous breathing: 37.4±17.3 vs slow deep breathing: 58.9±18.1, p<0.001). Interactions were observed between expiratory positive airway pressure effect and slow deep breathing effect for low frequency (p<0.001), high frequency (p<0.001) and low frequency/high frequency ratio (p<0.001). When patients were stratifi ed by disease's severity, we identifi ed a signifi cant low frequency reduction (p<0.001) and high frequency increase (p<0.001) for all stages when slow deep breathing was associated with expiratory positive airway pressure. Conclusion: A 5 cmH 2 O expiratory positive airway pressure during spontaneous and slow deep breathing can elicit an acute response, resulting in a cardiac autonomic control improvement in moderate-to-very severe patients.

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CPAP and EPAP elicit similar lung deflation in a non‐equivalent mode in GOLD 3‐4 COPD patients

Cited by 3 publications

References 30 publications

Influence of expiratory positive airway pressure on cardiac autonomic modulation at rest and in submaximal exercise in COPD patients

Influence of expiratory positive airway pressure on cardiac autonomic modulation at rest and in submaximal exercise in COPD patients

Inspiratory Muscle Training Potentiates the Beneficial Effects of Proportional Assisted Ventilation on Exertional Dyspnea and Exercise Tolerance in COPD: A Proof-of-Concept Randomized and Controlled Trial

Acute effects of expiratory positive pressure on autonomic cardiac modulation during spontaneous and slow deep breathing in COPD patients

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