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Stephen Milan, Praveen Bondalapati, Michael Megally, Eshan Patel, Pramil Vaghasia, Liam Gross, Elizabeth M Bachman, Puja Chadha, Jeremy A Weingarten Weill Cornell Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USACorrespondence: Jeremy A WeingartenWeill Cornell Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY 11215, USATel +1 718 780 5835Fax +1 718 780 5836Email jaw9031@nyp.orgIntroduction: Pharmacologic management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is well-established. Our aim in the current study is to determine if therapy with a positive expiratory pressure (PEP) device with or without an oscillatory mechanism (OM) in addition to standard care results in a reduction in hospital length of stay (LOS) among patients hospitalized for AECOPD.Methods: Two studies were performed and are reported here. Study 1: Patients admitted with AECOPD and sputum production were enrolled in a prospective trial comparing PEP therapy versus Oscillatory PEP (OPEP) therapy. Study 2: A retrospective historical cohort, matched in a 2 to 1 manner by age, gender, and season of admission, was compared with the prospectively collected data to determine the effect of PEP ± OM versus standard care on hospital LOS.Results: In the prospective trial (Study 1; 91 subjects), median hospital LOS was 3.2 (95% CI 3.0–4.3) days in the OPEP group and 4.8 (95% CI 3.9–6.1) days in the PEP group (p=0.16). In fully adjusted models comparing the prospective trial data with the retrospective cohort (Study 2; 182 subjects), cases had a median hospital LOS of 4.2 days (95% CI 3.8–5.1) versus 5.2 days (95% CI 4.4–6.0) in controls, consistent with a shorter hospital LOS with adjunctive PEP±OM therapy versus standard care (p=0.04).Conclusion: Adjunctive therapy with a PEP device versus standard care may reduce hospital LOS in patients admitted for AECOPD. Although the addition of an OM component to PEP therapy suggests a further reduction in hospital LOS, comprehensive multicenter randomized controlled trials are needed to confirm these findings.Clinical trial registration number: NCT03094806.Keywords: length of stay, acute exacerbation of COPD, PEP, hospitalization |
