Oscillatory Positive Expiratory Pressure Devices: Effective for COPD?

In patients with chronic obstructive pulmonary disease (COPD) who have a sputum-producing phenotype, the use of an oscillatory positive expiratory pressure (OPEP) device has been shown to improve symptoms and quality of life (QoL), according to study findings published in Thorax.

There is limited research on the effectiveness of OPEP in facilitating sputum clearance and cough reduction in COPD or on the characteristics of patients with COPD who might be the best candidates for this therapy. Researchers in London therefore conducted the O-COPD study to evaluate the impact of OPEP therapy in patients with COPD and regular sputum production with respect to QoL, as well as objective measures of cough and sleep disturbance.

The single-center, randomized controlled parallel-group trial, conducted between February 2020 and October 2021, compared 3 months’ use of OPEP (using an Acapella device) with usual care (using the active cycle of breathing and pursed-lip breathing techniques). The trial enrolled 122 stable patients with COPD who reported sputum production every day or on most days (average age 62±10 years; 40% female; 17% patients who smoked). Patients were divided into an OPEP group and a usual-care group, each with 61 patients. Patients’ mean forced expiratory volume in 1 second (FEV₁) % predicted was 38 (range, 25 to 56).

The study’s primary outcome was cough-related QoL, as measured with use of the Leicester Cough Questionnaire (LCQ). Secondary outcomes included fatigue, as measured with the Functional Assessment of Chronic Illness Therapy (FACIT) score and generic QoL (EuroQoL-5 Dimensions [EQ-5D]).

OPEP treatment was associated with significant improvement in LCQ score, compared with usual care (mean difference [MD], 1.03; 95% CI, 0.71-2.10; P =.03). Additionally, OPEP treatment was associated with significant improvements in FACIT score (MD, 4.68; 95% CI, 1.34-8.02; P <.001), EQ-5D (MD, 4.00; 95% CI, 0.49-19.75; P =.04), and sputum frequency scale (MD, 0.44; 95% CI, 0.27-0.60; P <.001).

A significant reduction in 24-hour cough frequency was reported in the OPEP arm compared with the usual-care arm (geometric MD, –60; 95% CI, -43 to -95; P <.001). No statistically significant effect on sleep disturbance was detected.

Acute exacerbations of COPD (AECOPD) were reported among 32% of those in the OPEP group vs 54% of participants in the usual-care group (odds ratio, 0.41; 95% CI, 0.18-0.91; P =.029). The discontinuation rate was lower in the OPEP group than in the usual-care group (9% vs 21%, respectively). Side effects associated with use of the device (headache and nausea) were experienced by 2 patients in the OPEP arm.

Some limitations of the present study should be noted. Although the reduction in AECOPD reported is encouraging, the duration of the study was not long enough for the researchers to be confident about the health economic benefits of the OPEP device in the patient population evaluated. Additionally, although the study was originally intended to be multicenter in design, it had to be conducted at a single center because of COVID-19 pandemic constraints.

The researchers concluded that the findings from the current study “suggest that adding an OPEP device to usual care is beneficial for people with COPD and regular sputum production.” Additional research is warranted, “to evaluate longer-term clinical and health economic outcomes.”

Reference

Alghamdi SM, Alsulayyim AS, Alasmari AM, et al Oscillatory positive expiratory pressure therapy in COPD (O-COPD): a randomised controlled trial. Thorax. Published online
August 10, 2022. doi:10.1136/thorax-2022-219077