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

• Published in: Thorax Vol. 78; no. 2; pp. 136 - 143
• Main Authors: Alghamdi, Saeed M, Alsulayyim, Abdullah S, Alasmari, Ali M, Philip, Keir E J, Buttery, Sara C, Banya, Winston A S, Polkey, Michael I, Birring, Surinder S, Hopkinson, Nicholas S
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Thoracic Society 01.02.2023; BMJ Publishing Group LTD
• Subjects: Aged; Chronic obstructive pulmonary disease; COPD Exacerbations; Cough; Cough/Mechanisms/Pharmacology; Female; Humans; Male; Middle Aged; Patients; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - therapy; Quality of Life; Questionnaires; Respiratory Muscles; Respiratory Therapy - methods; Sleep; Sputum; Systematic review; United States > US; Cough/Mechanisms/Pharmacology; COPD Exacerbations; Respiratory Muscles
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax-2022-219077

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 number ISRCTN44651852.