Airway clearance techniques for chronic obstructive pulmonary disease

Osadnik, Christian; McDonald, Christine F; Jones, Arthur; Holland, Anne E

doi:10.1002/14651858.cd008328.pub2

Cited by 59 publications

(40 citation statements)

References 86 publications

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“…Whether the MBNW findings have implications for individuals with acute exacerbations of COPD, where ACTs appear to differ in their effects compared to stable disease [4] and are more frequently prescribed [2,3], remains unclear. Replicating this study in an acute environment would be challenging as the washout duration is likely to coincide with significant clinical improvement, and tolerance to repeated lung function tests may be low.…”

Section: Discussionmentioning

confidence: 99%

“…They are frequently prescribed for patients with chronic obstructive pulmonary disease (COPD) [2,3]. However, convincing evidence of significant clinical benefits is limited [4]. Factors such as disease severity [5], the degree of elastic lung recoil [6] or the presence of other co-existing respiratory conditions such as bronchiectasis [1] (reported in 29-50% of patients with COPD) [7,8] may influence the response to ACTs.…”

Section: Introductionmentioning

confidence: 99%

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Positive Expiratory Pressure via Mask Does Not Improve Ventilation Inhomogeneity More than Huffing and Coughing in Individuals with Stable Chronic Obstructive Pulmonary Disease and Chronic Sputum Expectoration

et al. 2013

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Background: Positive expiratory pressure (PEP) has been used to promote airway clearance in individuals with chronic obstructive pulmonary disease (COPD) for many years; however, its mechanism of action and benefits are unclear. Previous authors have suggested that PEP improves collateral ventilation via changes in lung volumes. Objectives: It was the aim of this study to determine whether PEP improves ventilation inhomogeneity more than controlled huffing and coughing in individuals with stable COPD. Methods: Twelve participants with COPD (mean forced expiratory volume in 1 s 45% predicted) and chronic sputum expectoration performed PEP therapy (10-20 cm H₂O) or controlled huffing and coughing in random order on alternate study days with a 48-hour washout. Measures of acinar and conductive airway ventilation (S_acin, S_cond), lung volumes, spirometry and sputum wet weight were recorded before, immediately after and 90 min following treatment. Ease of expectoration [visual analogue scale (VAS)] and oxyhaemoglobin saturation were assessed immediately following treatment. Results: There were no significant differences between the effect of either test condition at any time point for any test parameter. Mean S_acin immediately following PEP and control conditions was 0.465 and 0.438 litre^-1, respectively (p = 0.45 for comparison between conditions) and mean S_cond was 0.042 and 0.039 litre^-1 (p = 0.55). PEP therapy did not significantly enhance total mean sputum expectoration compared to controlled huffing and coughing (7.06 vs. 6.15 g; p = 0.51) and did not improve ease of expectoration (VAS PEP 4.8 cm vs. control 4.1 cm; p = 0.53). Conclusion: Any therapeutic benefits of PEP in individuals with COPD and chronic sputum expectoration are unlikely to be mediated by improvements in ventilation or lung volumes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Positive Expiratory Pressure via Mask Does Not Improve Ventilation Inhomogeneity More than Huffing and Coughing in Individuals with Stable Chronic Obstructive Pulmonary Disease and Chronic Sputum Expectoration

et al. 2013

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“…Reduced secretion clearance is associated with increased frequency of COPD exacerbations, which are a major cause of hospital admissions and may result in premature death (MacIntyre and Huang 2008). There is limited goodquality evidence for the effectiveness of airway clearance treatments in an acute exacerbation of COPD (AECOPD) (Osadnik et al 2012).…”

Section: Introductionmentioning

confidence: 99%

“…Recruitment problems are common in clinical trials (McDonald et al 2006, Osadnik et al 2012, Seemungal et al 1998, Su et al 2007. It is estimated that less than a third of randomised controlled trials successfully achieve their recruitment target in the given time, and 50% of trials extend recruitment time in order to achieve their target (McDonald et al 2006, Osadnik et al 2012.…”

Section: Introductionmentioning

confidence: 99%

“…It is estimated that less than a third of randomised controlled trials successfully achieve their recruitment target in the given time, and 50% of trials extend recruitment time in order to achieve their target (McDonald et al 2006, Osadnik et al 2012. Clinician-led research brings its own challenges, adding to the complexity of conducting research in the clinical setting.…”

Section: Introductionmentioning

confidence: 99%

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Challenges of undertaking a clinical trial using bubble-PEP in an acute exacerbation of chronic obstructive pulmonary disease: A feasibility study

Eastwood¹,

Jepsen²,

Coulter³

et al. 2016

NZJP

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The aims of this study were to compare the effect of bubble-positive expiratory pressure with a commercial positive expiratory pressure device and standardised physiotherapy in patients with an acute exacerbation of chronic obstructive pulmonary disease, and to assess the feasibility of inpatient research methods. Patients admitted to a medical ward at Middlemore Hospital, Auckland, New Zealand, with an acute exacerbation of chronic obstructive pulmonary disease were randomly assigned to a treatment group. Participants undertook one supervised treatment, then independently completed two further sessions. Participants' symptoms and ease of sputum expectoration were measured using the Breathlessness, Cough and Sputum Scale. Health-related quality of life and length of hospital stay were also recorded. Only eleven participants were recruited, over ten months. The study was, therefore, underpowered to show differences in end points. Useful findings were uncovered relating to the feasibility of the protocol. Limitations to the recruitment process were identified, including staffing issues and the assessment schedule. Findings from this study will enable revision of the study protocol to allow a modified trial to be performed in the future. B, Jepsen N, Coulter K, Wong C, Zeng I (2016) Challenges of undertaking a clinical trial using bubble-PEP in an acute exacerbation of chronic obstructive pulmonary disease: A feasibility study. Eastwood

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