Comparison of conventional chest physiotherapy and oscillatory positive expiratory pressure therapy in primary ciliary dyskinesia

Abstract

Background Chest physiotherapy (CP) is a recommended treatment modality in primary ciliary dyskinesia (PCD). Objective Primary aim was to compare the efficacy and safety of the conventional chest physiotherapy (CCP) and oscillatory positive expiratory pressure therapy (OPEPT). Secondary aims were to compare the exacerbation rate, time until the first exacerbation, patient compliance and comfort between the two CP methods. Methods This is a 6 month randomized, controlled crossover trial. Patients >6 years of age with PCD were randomized into two groups, first group was assigned to OPEPT (Acapella®) for 3 months while second group was assigned to CCP. Groups were crossed over to the other modality after a 15‐day washout period. Pulmonary function tests (PFTs) and compliance were monitored by monthly clinic visits. Results There was a significant increase in FEV1, FEF25–75, and PEF values (p = .018, p = .020, and p = .016, respectively) in the OPEPT group and in FVC values (p = .007) in CCP group compared to baseline. However PFT increase at 3rd month was not superior to each other with both physiotherapy methods. Median acute pulmonary exacerbation rate and time period until the first exacerbation were similar in both groups (p = .821, p = .092, respectively). Comfort and effectiveness of OPEPT was higher than CCP according to patients (p = .029 and p = .042, respectively). There were no adverse effects with either therapy. Conclusions OPEPT was as effective as CCP in PCD patients. OPEPT was more comfortable and effective than CCP according to patients. OPEPT might be an efficient alternative method for airway cleareance in PCD patients.

Pediatric pulmonology 2020 year in review: Rare and diffuse lung disease

“…[56][57][58] Oscillatory positive expiratory pressure therapy (OPEPT) uses an oscillating one-way valve that provides fluctuating positive airway pressure during exhalation, intended to induce vibrations within the airways and displace secretions. 59 Bingol et al 60 evaluated the efficacy and safety of OPEPT compared with CCP in 30 PCD patients, between 6 and 20 years of age, using a crossover design of two 3-month periods separated by a 15-day washout. No significant differences were found between two arms with respect to PFT results at 3 months, acute pulmonary exacerbation rate, or time until first exacerbation.…”

Recent Advances in Primary Ciliary Dyskinesia: From Diagnosis to Treatment

“…55 In another study comparing conventional chest physiotherapy and oscillatory positive expiratory pressure therapy, both methods were found to be effective techniques in terms of lung function measurement and patient comfort, with patient-reported comfort being higher with oscillatory positive expiratory pressure therapy. 56 It is therefore appropriate to choose the physiotherapy method according to patient age, compliance and available facilities, and to apply the technique twice daily. Patients should be encouraged to improve aerobic fitness and undertake regular exercise to assist mucus clearance.…”