Oscillatory positive expiratory pressure therapy in COPD (O-COPD): a randomised controlled trial

Abstract

BackgroundOscillatory positive expiratory pressure (OPEP) devices are intended to facilitate sputum clearance and reduce cough, but there is limited evidence for their effectiveness in COPD, or to guide patient selection. We aimed to assess the impact of OPEP therapy on quality of life and objective measures of cough and sleep disturbance in patients with COPD with regular sputum production.MethodsWe enrolled stable patients with COPD, who reported sputum production every day or most days, into an assessor-blind, parallel-group, randomised controlled trial comparing 3 months of using an Acapella device against usual care (including use of the active cycle of breathing technique). The primary outcome was cough-related quality of life measured using the Leicester Cough Questionnaire (LCQ). Secondary outcomes included fatigue (Functional Assessment of Chronic Illness Therapy, FACIT score) and generic quality of life (EuroQol-5 Dimensions, EQ-5D). In a substudy (n=45), objective monitoring of cough and disturbance/movement during sleep were also available.Results122 participants (61/61 OPEP/control) were recruited, 40% female, 17% smokers, FEV1 38 (25–56)% predicted, and age 62±10 years. 103 completed the study (55/48 OPEP/control). Use of OPEP was associated with an improvement in LCQ compared with controls; MD (95% CI) 1.03 (0.71 to 2.10); (p=0.03), FACIT score 4.68 (1.34 to 8.02); (p<0.001) and EQ-5D 4.00 (0.49 to 19.75); (p=0.04). There was also an improvement in cough frequency −60 (−43 to −95) coughs/24 hours (p<0.001), but no statistically significant effect on sleep disturbance was identified.ConclusionsRegular use of an Acapella device improves symptoms and quality of life in people with COPD who produce sputum daily or most days.Trial registration numberISRCTN44651852.

Changing practice by changing pressures: a role for oscillating positive expiratory pressure in chronic obstructive pulmonary disease

“…This is significant considering the high numbers of individuals who hadn't 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 Dr Alghamdi et al (1) are clinically relevant and relate well to current provision restrictions during COVID.…”

“…In this example, usual care comprised face-to-face physiotherapy but no structured airway clearance. Dr Alghamdi et al (1) examined people with stable disease who were sputum producers and compared OPEP to another airway clearance technique (ACBT), and found evidence of clinical benefits. The longer duration of the OPEP intervention and the ongoing indication for airway clearance therapy in such patients likely accounts for some of this disparity.…”

“…The longer duration of the OPEP intervention and the ongoing indication for airway clearance therapy in such patients likely accounts for some of this disparity. Exacerbations were an a priori secondary outcome of this study (1), recorded as adverse events collected at six weeks and 3 months. The recent TIDe Trial (9) may offer closer comparison.…”

“…Dr Alghamdi et al (1) provide important data on the efficacy of the 'Acapella' Oscillating Positive Expiratory Pressure (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.…”

“…But pragmatism helps to mirror real life practice. Alghamdi et al (1) delivered their intervention via video-conferencing. On the one hand, this might be perceived as limiting the external validity of a face-to-face clinical intervention, but again was very appropriate considering COVID-19 restrictions.…”