Conical-PEP is safe, reduces lung hyperinflation and contributes to improved exercise endurance in patients with COPD: a randomised cross-over trial

Padkao, Tadsawiya; Boonsawat, Watchara; Jones, Chulee

doi:10.1016/s1836-9553(10)70052-7

Cited by 19 publications

(30 citation statements)

References 21 publications

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“…In fact, a recent study demonstrated a significant increment in IC and marginally prolonged exercise time using a similar EPAP device. 23 This study used an exercise protocol in order to evaluate duration of exercise until fatigue (using 30% of 1 maximal repetition alternate knee extension exercise at 70% age-predicted maximal heart rate). Our data, on the other hand, were obtained from a whole body, subjectively determined moderate to intense exercise, in more severe COPD patients (mean FEV 1 38% vs 61% predicted).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, their primary objective was not the evaluation of the effect on physiological variables that may detect DH, 11,13-15 except one study on which we previously commented. 23 Nevertheless, 2 studies reported the effects of CPAP on operational lung volumes during exercise in COPD, and there was no change in end-expiratory lung volume with the addition of CPAP. 13,14 The physiological rationale for EPAP utilization in COPD patients is explained by potential improvement in ventilation-perfusion ratio, 27 change in breathing pattern, 28,29 reduction of expiratory flow limitation, 30 and improved length/tension relation of the respiratory muscles.…”

Section: Effects Of Epap On Copdmentioning

confidence: 99%

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Effects of Expiratory Positive Airway Pressure on Dynamic Hyperinflation During Exercise in Patients With COPD

et al. 2012

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Section: Discussionmentioning

confidence: 99%

Section: Effects Of Epap On Copdmentioning

confidence: 99%

Effects of Expiratory Positive Airway Pressure on Dynamic Hyperinflation During Exercise in Patients With COPD

et al. 2012

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“…Oxygen saturation, heart rate, respiratory rate, dyspnea (using the Borg scale), and distance walked (meters) were recorded at the beginning and the end of every test as previously indicated [13]. A lightweight bluetooth wireless oxymeterNonin Avant 4000 was used for continuous oxygen saturation and heart rate measurements.…”

Section: Methodsmentioning

confidence: 99%

“…Several studies have demonstrated a relationship between decreased dyspnea and reduced work of breathing [7,10-12]. Only few evidences exist concerning the use of positive expiratory devices: these devices should permit a reduction in lung hyperinflation and an increasing in exercise duration (endurance) [13]. On this regard we decided to investigate if the use of a positive expiratory pressure device could improve the distance walked by patients with moderate to severe COPD.…”

Section: Introductionmentioning

confidence: 99%

Use of positive expiratory pressure during six minute walk test: results in patients with moderate to severe chronic obstructive pulmonary disease

Nicolini¹,

Merliak²,

Barlascini³

2013

Multidiscip Respir Med

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BackgroundThe six-minute walk test (6MWT) is widely used because it is both simple and reliable as a measure of exercise capacity. Individuals with chronic obstructive pulmonary disease (COPD) usually show a limited capacity to perform exercise.MethodsOur study is a prospective, randomized controlled trial which uses the 6MWT in one hundred consecutive in and out- patients with moderate to severe COPD to assess the benefit of a simple positive expiratory pressure (PEP) device. PEP device consisted of a PEP valve 5 cmH2O connected to 1-meter tube and a mouthpiece. All the enrolled patients performed a 6MWT before randomization. The following day PEP group patients performed the 6MWT using PEP device. Control group patients performed the 6MWT without this device. The primary outcome was the difference in distance (meters) walked.ResultsFunctional capacity assessed by the distance covered during 6MWT improved in the PEP group more than in the control group. The difference was statistically significant (p < 0.001).Oxygen saturation improved to a statistically significant level during 6MWT (p < 0.01). Heart rate was also reduced (p < 0.03).ConclusionsThere are few studies demonstrating that PEP devices enhance exercise capacity in COPD patients. Our results has been obtained using only a low positive expiratory pressure (5 cmH2O). In our opinion the strength of this study is the simplicity and the lower cost when compared to other devices and approaches. The study was registered as Chi CTR-ORC-12002173 at http://www.chictr.org.

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“…Another recent study has shown that a similar EPAP device increased inspiratory capacity and marginally prolonged exercise duration. 2 Furthermore, evidence has emerged that noninvasive ventilation is a new tool in pulmonary rehabilitation, since it reduces symptoms during exercise in those patients with more severe disease and, consequently, improves exercise tolerance. 3 Considering the high cost of using other noninvasive ventilation modalities in addition to pulmonary rehabilitation, it is relevant to investigate the applicability of cost-effective devices such as EPAP delivered by a spring load resistor, in order to increase the availability of this strategy in the highest possible number of clinical settings when treating patients with COPD.…”

Section: See the Original Study On Page 1405mentioning

confidence: 99%

Use of Expiratory Positive Airway Pressure Delivered by a Spring Load Resistor During Exercise: A New Tool to Optimize Exercise Training in Patients With COPD?

Hernandes

Pitta

2012

Respir Care

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In this issue of the RESPIRATORY CARE, Monteiro and colleagues 1 contribute to the scientific literature of COPD by applying in these patients a modality of noninvasive ventilation that has not yet been studied in depth during exercise: expiratory positive airway pressure (EPAP). The authors evaluated the effects of EPAP delivered by a spring load resistor face mask on dynamic hyperinflation during exercise. The study was conducted with COPD patients who developed dynamic hyperinflation during a previous submaximal timelimited exercise test. Those patients repeated the exercise test 48 hours later, using the face mask coupled with a spring load resistor which delivered an EPAP of around 5-10 cm H 2 O. When comparing the lung volumes measured before and immediately after exercise in both conditions (without and with EPAP), the authors found that inspiratory capacity and functional residual capacity changed significantly less when EPAP was applied (inspiratory capacity Ϫ0.57 Ϯ 0.45 L vs Ϫ0.18 Ϯ 0.35 L, P ϭ .021, functional residual capacity 0.69 Ϯ 1.10 L vs 0.22 Ϯ 0.68 L, P ϭ .02). The authors hypothesize that this attenuation in dynamic hyperinflation with the use of EPAP during exercise is probably linked to reduced expiratory dynamic airway compression and collapse, in addition to a reduction in the inspiratory threshold load on hyperinflated lungs of patients with COPD, enhancing neuromuscular coupling. SEE THE ORIGINAL STUDY ON PAGE 1405Possibly the most relevant novel finding derived from this study is that EPAP applied through a simple and affordable device was able to reduce dynamic hyperinflation after exercise in patients with COPD. This was observed specifically in those patients who were characterized by developing hyperinflation during exercise. Unfortunately, the authors did not assess dyspnea and/or fatigue perception of the studied patients during exercise when it was performed with and without EPAP. The comparison of those variables would be useful to evaluate the clinical benefits of EPAP from the patient's perspective. It is reasonable to hypothesize that the use of EPAP may reduce symptoms during exercise, since decrease of the dynamic hyperinflation occurred. Although EPAP does not assist the ventilatory muscles, as observed in other modalities such as continuous positive airway pressure or bi-level positive airway pressure, it generates a reduction of the inspiratory load imposed by intrinsic PEEP. In addition, another methodological aspect of the study is that, in case patients were submitted to a non-time-limited exercise test, it would be possible to evaluate the effect of EPAP on increasing exercise capacity.Despite its noncontrolled design, the study by Monteiro and colleagues 1 was undoubtedly able to demonstrate that the spring load resistor face mask is suitable and safe to deliver EPAP to patients with COPD during exercise. Another recent study has shown that a similar EPAP device increased inspiratory capacity and marginally prolonged exercise duration. 2 Furthermore, evidence has e...

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Conical-PEP is safe, reduces lung hyperinflation and contributes to improved exercise endurance in patients with COPD: a randomised cross-over trial

Cited by 19 publications

References 21 publications

Effects of Expiratory Positive Airway Pressure on Dynamic Hyperinflation During Exercise in Patients With COPD

Effects of Expiratory Positive Airway Pressure on Dynamic Hyperinflation During Exercise in Patients With COPD

Use of positive expiratory pressure during six minute walk test: results in patients with moderate to severe chronic obstructive pulmonary disease

Use of Expiratory Positive Airway Pressure Delivered by a Spring Load Resistor During Exercise: A New Tool to Optimize Exercise Training in Patients With COPD?

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