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

Autor:	Alghamdi SM; Clinical Technology, Umm Al-Qura University, Makkah, Saudi Arabia.; National Heart and Lung Institute, Imperial College London, London, UK., Alsulayyim AS; National Heart and Lung Institute, Imperial College London, London, UK.; Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia., Alasmari AM; National Heart and Lung Institute, Imperial College London, London, UK.; College of Medical Rehabilitation, Taibah University, Madinah, Saudi Arabia., Philip KEJ; National Heart and Lung Institute, Imperial College London, London, UK., Buttery SC; National Heart and Lung Institute, Imperial College London, London, UK., Banya WAS; National Heart and Lung Institute, Imperial College London, London, UK., Polkey MI; National Heart and Lung Institute, Imperial College London, London, UK., Birring SS; Respiratory Medicine, Kings College Hospital, London, UK., Hopkinson NS; National Heart and Lung Institute, Imperial College London, London, UK n.hopkinson@ic.ac.uk.
Jazyk:	angličtina
Zdroj:	Thorax [Thorax] 2023 Feb; Vol. 78 (2), pp. 136-143. Date of Electronic Publication: 2022 Aug 10.
DOI:	10.1136/thorax-2022-219077
Abstrakt:	Background: Oscillatory 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. Methods: We 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. Results: 122 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. Conclusions: Regular 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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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