Oscillatory Positive Expiratory Pressure (oPEP) Treatment in Chronic Obstructive Pulmonary Disease

Abstract

PURPOSE: We evaluated a handheld oscillating positive expiratory pressure (oPEP) device (Aerobika®, Trudell Medical International, Canada) that combines positive expiratory pressure therapy and airway vibrations with the goal being mobilization of pulmonary secretions and consequent improved dyspnea. The purpose of this pilot study was to evaluate the safety and efficacy of the oPEP device in subjects with chronic obstructive pulmonary disease (COPD). Efficacy was evaluated using pulmonary function test results, validated questionnaires as well as pulmonary functional imaging using hyperpolarized 3He magnetic resonance imaging (MRI) and safety was evaluated using adverse events (AE). METHODS: Seventeen subjects with COPD were enrolled in an eight-week cross-over study with subjects randomized to receive the device (or no device) for four weeks daily use and then crossed over. All subjects underwent pulmonary function tests, 6-minute walk test and answered the St. George's Respiratory and Patient Evaluation Questionnaires at baseline, and after 2 and 4 weeks during each cross-over period. Hyperpolarized 3He MRI was performed at baseline and at the end of each 4 week treatment period for the measurement of ventilation defect percent (VDP). RESULTS: Fourteen COPD subjects (6 males; mean age=73±5 yrs) completed the study. Three subjects withdrew; two subjects because of AE judged unrelated to the use of oPEP and one subject withdrew without a reason. There were nine mild-moderate AE in seven subjects, all of which judged unrelated to oPEP. For all subjects, dyspnea was significantly reduced after oPEP therapy (p=0.03). For six subjects with improved VDP, the ease in bringing up sputum was significantly increased after oPEP therapy (p=0.02). CONCLUSIONS: Four-weeks of oPEP use was well-tolerated in COPD subjects. In COPD subjects not phenotyped with respect to emphysema or airways disease/bronchiectasis, oPEP therapy showed improved/reduced dyspnea and in a subset of subjects with objective imaging improvements there was also increased ease in bringing up sputum.