The effects of oscillating positive expiratory pressure therapy in adults with stable non-cystic fibrosis bronchiectasis

Abstract

Airway clearance techniques (ACTs) are recommended for patients with stable non-cystic fibrosis (non-CF) bronchiectasis, but the efficacy of oscillating positive expiratory pressure (PEP) therapy compared to other techniques has not been reviewed. A systematic review of studies was conducted in stable patients comparing the effect of oscillating PEP therapy to other ACTs or a control condition. Data were extracted related to sputum expectoration, lung function, gas exchange, quality of life (QOL), symptoms, and exacerbation rate. Seven studies were included with a total of 146 patients, with a mean (SD) PEDro score of 7(1). Oscillating PEP therapy enhanced sputum expectoration compared to no treatment, but has equivalent benefits as the active cycle of breathing technique with gravity-assisted drainage (mean difference [95% CI] À2.8 g [À8.8 to 3.2 g]). Oscillating PEP has a similar effect as other ACTs on dynamic lung volumes, gas exchange and breathlessness. Use of oscillating PEP improved disease-specific QOL (p < 0.001) and cough-related QOL (p < 0.002) compared to no treatment but did not reduce exacerbation rate. In conclusion, in stable non-CF bronchiectasis, oscillating PEP therapy is associated with improvement in sputum expectoration and QOL compared to no treatment. Compared to other ACTs, the effect upon sputum expectoration, lung function, gas exchange, and symptoms are equivalent.

British Thoracic Society Guideline for bronchiectasis in adults

“…144 In the seven studies reviewed (n=146 patients), OPEP therapy was associated with improvements in sputum expectoration and quality of life measures compared with no treatment. Moreover they concluded that compared with other ACTs, the effects in terms of sputum expectoration, lung function, gas exchange, and symptoms were equivalent.…”

Pediatric bronchiectasis: No longer an orphan disease

“…There are no pediatric RCTs on exercise training, but in adults a RCT found that exercise training with airway clearance therapy improved short‐term exercise capacity, dyspnea, and fatigue with fewer exacerbations over a 12‐month period . A systematic review of seven studies reported that compared to no treatment, adults with stable bronchiectasis receiving oscillating positive expiratory pressure therapy had improved sputum expectoration and QoL …”

“…165 A systematic review of seven studies reported that compared to no treatment, adults with stable bronchiectasis receiving oscillating positive expiratory pressure therapy had improved sputum expectoration and QoL. 166…”

Compared to maximal current management standards, oscillating positive expiratory pressure devices have not been shown to improve clinically relevant outcomes in COPD patients with acute exacerbation

“…There were 31 results, most of which were investigating bronchiectasis or cystic fibrosis patients, which were again excluded. [5][6][7][8][9][10][11] We felt that the anatomical and pathophysiological processes were too dissimilar to inform the management of our patient. Additionally, we found a trial incorporating COPD patients, but the article had been retracted.…”