Comparison of Intermittent Positive Pressure Breathing (IPPB) and Temporary Positive Expiratory Pressure (TPEP) in Patients With Severe Chronic Obstructive Pulmonary Disease

Abstract

Background Results supporting the use and the effectiveness of positive expiratory, pressure devices in chronic obstructive pulmonary disease (COPD) patients are still controversial. We have tested the hypothesis that adding TPEP or IPPB to standard pharmacological therapy may provide additional clinical benefit over, pharmacological therapy only in patients with severe COPD. Methods Forty-five patients were randomised in three groups: a group was treated with IPPB, a group was treated with TPEP and a group with pharmacological therapy alone (control group). Primary outcome measures included the measurement of scale, or questionnaire concerning dyspnoea (MRC scale); dyspnoea, cough, and sputum (BCSS) and quality of life (COPD assessment test) (CAT). Secondary outcome measures were respiratory function testing, arterial blood gas analysis and haematological examinations. Results Patients in both the IPPB group and the TPEP group showed a significant improvement in two of three tests (MRC, CAT) compared to the control group. However, in the group comparison analysis for the same variables between the IPPB group and the TPEP group, we observed a significant improvement in the IPPB group (P≤.05 for MRC and P≤.01 for CAT). The difference of action of the two techniques is evident in the results of pulmonary function testing: IPPB increases FVC, FEV1, and MIP; this reflects its capacity to increase lung volume. Also TPEP increases FVC and FEV1 (less than IPPB), and MEP, while decreasing total lung capacity and residual volume. Conclusions The two techniques (IPPB and TPEP) improve significantly dyspnoea, quality of life tools and lung function in patients with severe COPD. IPPB demonstrated a greater effectiveness in improving dyspnoea and quality of life tools (MRC, CAT) than TPEP.