Oscillating Positive Expiratory Pressure (OPEP) Devices and Airway Clearance Therapy in the Covid-19 Patient Care Pathway: A Review of Where There May Be Clinical Value

Abstract

RATIONALE: In the Covid-19 environment it is unclear what role airway clearance devices such as OPEP have in therapy. Hence, it would be useful to assess the care pathway of a Covid-19 patient and review the evidence available to support (or otherwise) the use of OPEP devices. METHODS: The assessment distinguished between two types of care pathway: a) Covid patients with an existing respiratory condition associated with excess mucus production, and b) Covid patients with no underlying respiratory condition. Within each of these two types there was further segregation into i) pre-infection, ii) infection being managed at home/in hospital, and iii) recovery post infection. The evidence-based positioning of OPEP therapy in each was evaluated. RESULTS: For patients with a pre-existing respiratory condition, if they were pre-infection and had presence of excess mucus, evidence exists to support use of OPEP therapy to manage their chronic condition and therefore reduce likelihood of needing to seek medical attention with consequent risk of exposure to Covid-19. Similarly, for post infection recovery, use of OPEP to manage excess mucus associated with the pre-existing respiratory condition may reduce risk of early re-entry to hospital system. Use of OPEP while Covid positive and admitted to hospital may still be beneficial in order to manage underlying respiratory condition, however it would need to be undertaken in line with local hospital protocols to protect against airborne contamination. When assessing Covid-19 pathway for patients with no underlying chronic respiratory condition, there is no evidence to support use of OPEP pre-infection. Post-infection, there is limited evidence. For example, if the patient has been ventilated or immobile for an extended period of time there is some adjacent evidence associated with reduced post-operative complications when using OPEP. As a treatment for Covid-19, OPEP therapy is not proven, and the infection is not typically associated with excess mucus, however a couple of references advocate the use of OPEP as required in those instances where airway clearance may be beneficial. CONCLUSIONS: Management of Covid-19 is a complex and not fully understood area. Patients with a pre-existing chronic respiratory condition exhibiting excess mucus will likely benefit from use of an appropriate OPEP device. The evidence is less clear for those patients without pre-existing respiratory conditions, with further evidence beneficial to support OPEP in treatment and post infection rehabilitation.