Use of oscillatory positive expiratory pressure (OPEP) devices to augment sputum clearance in COPD: a systematic review and meta-analysis

Alghamdi, Saeed M; Barker, Ruth E; Alsulayyim, Abdullah S; Alasmari, Ali; Banya, Winston; Polkey, Michael I.; Birring, Surinder S.; Hopkinson, Nicholas S

doi:10.1136/thoraxjnl-2019-214360

Cited by 17 publications

(25 citation statements)

References 34 publications

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“…It is notable that although mucolytic therapies are widely prescribed, adjuncts to assist sputum clearance such as oscillatory positive expiratory pressure (OPEP) are much less commonly prescribed 52 . The evidence base to support the latter remains strikingly limited, given how common productive cough is in COPD 53 …”

Section: Addressing the Burden Of Copdmentioning

confidence: 99%

Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity

et al. 2021

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An individual's experience of COPD is determined by many factors in addition to the pathological features of chronic bronchitis and emphysema and the symptoms that derive directly from them. Multimorbidity is the norm rather than the exception, so most people with COPD are living with a range of other medical problems which can decrease overall quality of life. COPD is caused by the inhalation of noxious particles or gases, in particular tobacco smoke, but also by early life disadvantage impairing lung development and by occupations where inhaled exposures are common (e.g. industrial, farming and cleaning work). Wealthy people are therefore relatively protected from developing COPD and people who do develop the condition may have reduced resources to cope. COPD is also no longer a condition that predominantly affects men. The prevalence of COPD among women has equalled that of men since 2008 in many high‐income countries, due to increased exposure to tobacco, and in low‐income countries due to biomass fuels. COPD is one of the leading causes of death in women in the USA, and death rates attributed to COPD in women in some countries are predicted to overtake those of men in the next decade. Many factors contribute to this phenomenon, but in addition to socioeconomic and occupational factors, there is increasing evidence of a higher susceptibility of females to smoking and pollutants. Quality of life is also more significantly impaired in women. Although most medications (bronchodilators and inhaled corticosteroids) used to treat COPD demonstrate similar trends for exacerbation prevention and lung function improvement in men and women, this is an understudied area and clinical trials frequently have a preponderance of males. A better understanding of gender‐based predictors of efficacy of all therapeutic interventions is crucial for comprehensive patient care. There is an urgent need to recognize the increasing burden of COPD in women and to facilitate global improvements in disease prevention and management in this specific population. Many individuals with COPD follow a trajectory of both lung function decline and also multimorbidity. Unfavourable lung function trajectories throughout life have implications for later development of other chronic diseases. An enhanced understanding of the temporal associations underlying the development of coexisting diseases is a crucial first step in unravelling potential common disease pathways. Lessons can be learned from exploring disease trajectories of other NCD as well as multimorbidity development. Further research will be essential to explain how early life risk factors commonly influence trajectories of COPD and other diseases, how different diseases develop in relation to each other in a temporal way and how this ultimately leads to different multimorbidity patterns in COPD. This review integrates new knowledge and ideas pertaining to three broad themes (i) the overall burden of disease in COPD, (ii) an unappreciated high burden in women and (iii) the contrast...

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Section: Addressing the Burden Of Copdmentioning

confidence: 99%

Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity

et al. 2021

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“…Current systematic reviews provide a comprehensive description and summary of the acceptance and dropout rates of different forms of TH interventions for patients with COPD. Generally, TH interventions are acceptable among the COPD population [ 11 , 20 , 23 , 24 , 67 , 68 , 74 , 75 ]. Nevertheless, methodological queries remain regarding the design of a more acceptable and feasible TH intervention, the best strategy to provide TH interventions (individual vs. community), components of TH interventions (solo vs. joint other treatments), technological aspects (classic vs. advanced), and COPD phenotypes (stable vs. non-stable) that will obtain more benefits from TH interventions.…”

Section: Discussionmentioning

confidence: 99%

“…The synthesized results in this review focused on the key outcomes of interest, including the acceptance and dropout rates, reasons for dropout, and the possible factors that might impact acceptance and dropout rates. The overall acceptance rate in this paper refers to the number of participants who consented to participate divided by the number of participants who were approached to participate in the trial [ 23 , 24 ], and dropout rate refers to the total number of participants in each treatment arm who dropped out from the clinical trial divided by the total number of the participants who consented to participate in the clinical trial [ 23 ].…”

Section: Methodsmentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease Patients’ Acceptance in E-Health Clinical Trials

Alghamdi

Rajah

Aldabayan

et al. 2021

IJERPH

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Introduction: Telehealth (TH) interventions with Chronic Obstructive Pulmonary Disease (COPD) management were introduced in the literature more than 20 years ago with different labeling, but there was no summary for the overall acceptance and dropout rates as well as associated variables. Objective: This review aims to summarize the acceptance and dropout rates used in TH interventions and identify to what extent clinical settings, sociodemographic factors, and intervention factors might impact the overall acceptance and completion rates of TH interventions. Methods: We conducted a systematic search up to April 2021 on CINAHL, PubMed, MEDLINE (Ovid), Cochrane, Web of Sciences, and Embase to retrieve randomized and non-randomized control trials that provide TH interventions alone or accompanied with other interventions to individuals with COPD. Results: Twenty-seven studies met the inclusion criteria. Overall, the unweighted average of acceptance and dropout rates for all included studies were 80% and 19%, respectively. A meta-analysis on the pooled difference between the acceptance rates and dropout rates (weighted by the sample size) revealed a significant difference in acceptance and dropout rates among all TH interventions 51% (95% CI 49% to 52; p < 0.001) and 63% (95% CI 60% to 67; p < 0.001), respectively. Analysis revealed that acceptance and dropout rates can be impacted by trial-related, sociodemographic, and intervention-related variables. The most common reasons for dropouts were technical difficulties (33%), followed by complicated system (31%). Conclusions: Current TH COPD interventions have a pooled acceptance rate of 51%, but this is accompanied by a high dropout rate of 63%. Acceptance and dropout levels in TH clinical trials can be affected by sociodemographic and intervention-related factors. This knowledge enlightens designs for well-accepted future TH clinical trials. PROSPERO registration number CRD4201707854.

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“…Burudpakdee et al [ 39 ] reported that use of the Aerobika OPEP device (Trudell Medical, Ontario, Canada) reduced exacerbations by 30% compared to no PEP/OPEP after an inpatient stay in a sample of 405 patients, while Tse et al [ 9 ] found that the use of OPEP significantly reduced all cause inpatient admissions at 12 month follow up in a retrospective study of 2476 patients. A recent systematic review of the use of OPEP to augment sputum clearance in COPD by Alghadmi et al [ 40 ] found that while OPEP devices can have a positive impact in COPD, confidence in the effect size is low, and the quality of evidence was low to moderate grade overall.…”

Section: Discussionmentioning

confidence: 99%

An initial evaluation of the safety of a disposable oscillating positive expiratory pressure device in patients with chronic obstructive pulmonary disease: a short-term pilot study

et al. 2021

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Background Handheld oscillating positive expiratory pressure (OPEP) devices have been a mainstay of treatment for patients with hypersecretory conditions such as cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) since the 1970s. Current devices are reusable and require regular cleaning and disinfection to prevent harbouring potentially pathogenic organisms. Adherence to cleaning regimens for respiratory devices is often poor and in response to this, a prototype disposable OPEP device—the ‘UL-OPEP’ (University of Limerick—Oscillating Positive Expiratory Pressure device)—was developed to mitigate the risk of contamination by pathogens. The device was previously evaluated successfully in a group of paediatric CF patients. The aim of the current study was to initially evaluate the safety of the prototype in patients with COPD over a period of 1 month to ensure no adverse events, negative impacts on lung function, exercise tolerance, or quality of life. Data on user experience of the device were also collected during post-study follow-up. Methods A sample of 50 volunteer participants were recruited from pulmonary rehabilitation clinics within the local hospital network. The patients were clinically stable, productive, and not current or previous users of OPEP devices. Participants were invited to use a prototype disposable OPEP device daily for a period of 1 month. Pre- and post-study lung function was assessed with standard spirometry, and exercise tolerance with the 6-min-walk-test (6MWT). Quality of life was assessed using the St. George’s Respiratory Questionnaire (SGRQ), and user experience of the prototype device evaluated using a post-study questionnaire. Results 24 Participants completed the study: 9 were female. Overall median age was 67.5 years, range 53–85 years. Lung function, 6-min walk test, and SGRQ scores showed no significant change post-study. User feedback was positive overall. Conclusions The results indicate that the UL-OPEP is safe to use in patients with COPD. No adverse events were recorded during the study or in the follow-up period of 2 weeks. The device did not negatively impact patients’ lung function, exercise tolerance, or quality of life during short term use (1 month), and usability feedback received was generally positive. Larger, longer duration studies will be required to evaluate efficacy. Registration The study was approved as a Clinical Investigation by the Irish Health Products Regulatory Authority (CRN-2209025-CI0085).

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Use of oscillatory positive expiratory pressure (OPEP) devices to augment sputum clearance in COPD: a systematic review and meta-analysis

Cited by 17 publications

References 34 publications

Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity

Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity

Chronic Obstructive Pulmonary Disease Patients’ Acceptance in E-Health Clinical Trials

An initial evaluation of the safety of a disposable oscillating positive expiratory pressure device in patients with chronic obstructive pulmonary disease: a short-term pilot study

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