title: Oscillatory Positive Expiratory Pressure in Chronic Obstructive Pulmonary Disease.
abstract: Evidence-based guidance for the use of airway clearance techniques (ACT) in chronic obstructive pulmonary disease (COPD) is lacking in-part because well-established measurements of pulmonary function such as the forced expiratory volume in 1s (FEV1) are relatively insensitive to ACT. The objective of this crossover study was to evaluate daily use of an oscillatory positive expiratory pressure (oPEP) device for 21-28 days in COPD patients who were self-identified as sputum-producers or non-sputum-producers. COPD volunteers provided written informed consent to daily oPEP use in a randomized crossover fashion. Participants completed baseline, crossover and study-end pulmonary function tests, St. George's Respiratory Questionnaire (SGRQ), Patient Evaluation Questionnaire (PEQ), Six-Minute Walk Test and (3)He magnetic resonance imaging (MRI) for the measurement of ventilation abnormalities using the ventilation defect percent (VDP). Fourteen COPD patients, self-identified as sputum-producers and 13 COPD-non-sputum-producers completed the study. Post-oPEP, the PEQ-ease-bringing-up-sputum was improved for sputum-producers (p = 0.005) and non-sputum-producers (p = 0.04), the magnitude of which was greater for sputum-producers (p = 0.03). There were significant post-oPEP improvements for sputum-producers only for FVC (p = 0.01), 6MWD (p = 0.04), SGRQ total score (p = 0.01) as well as PEQ-patient-global-assessment (p = 0.02). Clinically relevant post-oPEP improvements for PEQ-ease-bringing-up-sputum/PEQ-patient-global-assessment/SGRQ/VDP were observed in 8/7/9/6 of 14 sputum-producers and 2/0/3/3 of 13 non-sputum-producers. The post-oPEP change in (3)He MRI VDP was related to the change in PEQ-ease-bringing-up-sputum (r = 0.65, p = 0.0004) and FEV1 (r = -0.50, p = 0.009). In COPD patients with chronic sputum production, PEQ and SGRQ scores, FVC and 6MWD improved post-oPEP. FEV1 and PEQ-ease-bringing-up-sputum improvements were related to improved ventilation providing mechanistic evidence to support oPEP use in COPD. Clinical Trials # NCT02282189 and NCT02282202.
authors.affiliation: a Imaging Research Laboratories, Robarts Research Institute , The University of Western Ontario , London , Canada.|b Department of Medical Biophysics , The University of Western Ontario , London , Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Svenningsen
authors.affiliation: a Imaging Research Laboratories, Robarts Research Institute , The University of Western Ontario , London , Canada.|b Department of Medical Biophysics , The University of Western Ontario , London , Canada.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Paulin
authors.affiliation: a Imaging Research Laboratories, Robarts Research Institute , The University of Western Ontario , London , Canada.|b Department of Medical Biophysics , The University of Western Ontario , London , Canada.
authors.forename: Khadija
authors.initials: K
authors.lastname: Sheikh
authors.affiliation: a Imaging Research Laboratories, Robarts Research Institute , The University of Western Ontario , London , Canada.|c Graduate Program in Biomedical Engineering , The University of Western Ontario , London , Canada.
authors.forename: Fumin
authors.initials: F
authors.lastname: Guo
authors.affiliation: a Imaging Research Laboratories, Robarts Research Institute , The University of Western Ontario , London , Canada.
authors.forename: Aasim
authors.initials: A
authors.lastname: Hasany
authors.affiliation: a Imaging Research Laboratories, Robarts Research Institute , The University of Western Ontario , London , Canada.|b Department of Medical Biophysics , The University of Western Ontario , London , Canada.
authors.forename: Miranda
authors.initials: M
authors.lastname: Kirby
authors.affiliation: d Department of Medical Imaging , The University of Western Ontario , London , Canada.
authors.forename: Roya Etemad
authors.initials: RE
authors.lastname: Rezai
authors.affiliation: e Division of Respirology, Department of Medicine , The University of Western Ontario , London , Canada.
authors.forename: David G
authors.initials: DG
authors.lastname: McCormack
authors.affiliation: a Imaging Research Laboratories, Robarts Research Institute , The University of Western Ontario , London , Canada.|b Department of Medical Biophysics , The University of Western Ontario , London , Canada.|c Graduate Program in Biomedical Engineering , The University of Western Ontario , London , Canada.|d Department of Medical Imaging , The University of Western Ontario , London , Canada.
authors.forename: Grace
authors.initials: G
authors.lastname: Parraga
mesh_terms: D000368:Aged; D018592:Cross-Over Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D012123:Pulmonary Ventilation; D012138:Respiratory Therapy / Q000379:methods*; D013183:Sputum; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D014797:Vital Capacity
keywords: airway clearance; chronic bronchitis; pulmonary ventilation; sputum