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The effect of positive expiratory pressure (PEP) therapy on symptoms, quality of life and incidence of re-exacerbation in patients with acute exacerbations of chronic obstructive pulmonary disease: a multicentre, randomised controlled trial.
Thorax. 2014 Feb; 69(2):137-43.T

Abstract

BACKGROUND

Positive expiratory pressure (PEP) is a technique used to enhance sputum clearance during acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The impact of PEP therapy during acute exacerbations on clinically important outcomes is not clear. This study sought to determine the effect of PEP therapy on symptoms, quality of life and future exacerbations in patients with AECOPD.

METHODS

90 inpatients (58 men; mean age 68.6 years, FEV(1) 40.8% predicted) with AECOPD and sputum expectoration were randomised to receive usual care (including physical exercise)±PEP therapy. The Breathlessness, Cough and Sputum Scale (BCSS), St George's Respiratory Questionnaire (SGRQ) and BODE index (Body mass index, airflow Obstruction, Dyspnoea, Exercise tolerance) were measured at discharge, 8 weeks and 6 months following discharge, and analysed via linear mixed models. Exacerbations and hospitalisations were recorded using home diaries.

RESULTS

There were no significant between-group differences over time for BCSS score [mean (SE) at discharge 5.2 (0.4) vs 5.0 (0.4) for PEP and control group, respectively; p=0.978] or SGRQ total score [41.6 (2.6) vs 40.8 (2.8) at 8 weeks, p=0.872]. Dyspnoea improved more rapidly in the PEP group over the first 8 weeks (p=0.006), however these benefits were not observed at 6 months. Exacerbations (p=0.986) and hospitalisations (p=0.359) did not differ between groups.

CONCLUSIONS

We found no evidence that PEP therapy during AECOPD improves important short-term or long-term outcomes. There does not appear to be a routine role for PEP therapy in the management of such individuals.

Authors+Show Affiliations

School of Physiotherapy, La Trobe University, , Melbourne, Victoria, Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24005444

Citation

Osadnik, Christian R., et al. "The Effect of Positive Expiratory Pressure (PEP) Therapy On Symptoms, Quality of Life and Incidence of Re-exacerbation in Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease: a Multicentre, Randomised Controlled Trial." Thorax, vol. 69, no. 2, 2014, pp. 137-43.
Osadnik CR, McDonald CF, Miller BR, et al. The effect of positive expiratory pressure (PEP) therapy on symptoms, quality of life and incidence of re-exacerbation in patients with acute exacerbations of chronic obstructive pulmonary disease: a multicentre, randomised controlled trial. Thorax. 2014;69(2):137-43.
Osadnik, C. R., McDonald, C. F., Miller, B. R., Hill, C. J., Tarrant, B., Steward, R., Chao, C., Stodden, N., Oliveira, C. C., Gagliardi, N., & Holland, A. E. (2014). The effect of positive expiratory pressure (PEP) therapy on symptoms, quality of life and incidence of re-exacerbation in patients with acute exacerbations of chronic obstructive pulmonary disease: a multicentre, randomised controlled trial. Thorax, 69(2), 137-43. https://doi.org/10.1136/thoraxjnl-2013-203425
Osadnik CR, et al. The Effect of Positive Expiratory Pressure (PEP) Therapy On Symptoms, Quality of Life and Incidence of Re-exacerbation in Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease: a Multicentre, Randomised Controlled Trial. Thorax. 2014;69(2):137-43. PubMed PMID: 24005444.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of positive expiratory pressure (PEP) therapy on symptoms, quality of life and incidence of re-exacerbation in patients with acute exacerbations of chronic obstructive pulmonary disease: a multicentre, randomised controlled trial. AU - Osadnik,Christian R, AU - McDonald,Christine F, AU - Miller,Belinda R, AU - Hill,Catherine J, AU - Tarrant,Ben, AU - Steward,Ranjana, AU - Chao,Caroline, AU - Stodden,Nicole, AU - Oliveira,Cristino C, AU - Gagliardi,Nadia, AU - Holland,Anne E, Y1 - 2013/09/04/ PY - 2013/9/6/entrez PY - 2013/9/6/pubmed PY - 2014/3/19/medline KW - COPD Exacerbations KW - Exercise SP - 137 EP - 43 JF - Thorax JO - Thorax VL - 69 IS - 2 N2 - BACKGROUND: Positive expiratory pressure (PEP) is a technique used to enhance sputum clearance during acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The impact of PEP therapy during acute exacerbations on clinically important outcomes is not clear. This study sought to determine the effect of PEP therapy on symptoms, quality of life and future exacerbations in patients with AECOPD. METHODS: 90 inpatients (58 men; mean age 68.6 years, FEV(1) 40.8% predicted) with AECOPD and sputum expectoration were randomised to receive usual care (including physical exercise)±PEP therapy. The Breathlessness, Cough and Sputum Scale (BCSS), St George's Respiratory Questionnaire (SGRQ) and BODE index (Body mass index, airflow Obstruction, Dyspnoea, Exercise tolerance) were measured at discharge, 8 weeks and 6 months following discharge, and analysed via linear mixed models. Exacerbations and hospitalisations were recorded using home diaries. RESULTS: There were no significant between-group differences over time for BCSS score [mean (SE) at discharge 5.2 (0.4) vs 5.0 (0.4) for PEP and control group, respectively; p=0.978] or SGRQ total score [41.6 (2.6) vs 40.8 (2.8) at 8 weeks, p=0.872]. Dyspnoea improved more rapidly in the PEP group over the first 8 weeks (p=0.006), however these benefits were not observed at 6 months. Exacerbations (p=0.986) and hospitalisations (p=0.359) did not differ between groups. CONCLUSIONS: We found no evidence that PEP therapy during AECOPD improves important short-term or long-term outcomes. There does not appear to be a routine role for PEP therapy in the management of such individuals. SN - 1468-3296 UR - https://www.unboundmedicine.com/medline/citation/24005444/The_effect_of_positive_expiratory_pressure__PEP__therapy_on_symptoms_quality_of_life_and_incidence_of_re_exacerbation_in_patients_with_acute_exacerbations_of_chronic_obstructive_pulmonary_disease:_a_multicentre_randomised_controlled_trial_ L2 - https://thorax.bmj.com/lookup/pmidlookup?view=long&pmid=24005444 DB - PRIME DP - Unbound Medicine ER -