Abstract
Questions: Dyspnea is a major factor limiting exercise for people with COPD and is associated with dynamic hyperinflation (DH). Can breathing with a positive expiratory pressure (PEP) accelerate the recovery of exertional dyspnea? Can PEP reduce post-exercise DH? Are there drawbacks or risks of PEP breathing, such as CO2 retention? Participants: Thirteen male COPD participants (59±7 yrs; GOLD stage II and III). Design: Single blind randomized cross over trial of PEP and Sham breathing to reduce dyspnea and DH following 5 min exercise. Dyspnea (Borg, RPB) and Inspiratory capacity (IC) and cardiopulmonary functions were assessed before, at the end of, exercise, following interventions and during recovery. Intervention: 6 slow breaths with a PEP of 5 cm H2O, with no load (Sham) or no intervention (Control). Results: End exercise dyspnea was 3-4 RPB, which recovered faster after PEP (95% CI, 2.6 to 3.1 min time to baseline) compared to Sham which was similar to Control (95% CI, 4.9 to 5.6 min). IC decreased by between 100 to 520 ml at the end of exercise and after PEP, returned to values, on average, 130 ml greater than resting whilst IC was still lower than resting in Sham. There were no adverse cardiopulmonary changes associated with PEP breathing. Conclusion: PEP was effective in reducing both post-exercise dyspnea and DH; there was no CO2 retention or adverse events. The benefits of PEP were seen with all participants irrespective of the extent of DH and may be a valuable addition to pulmonary rehabilitation programs.
Published Version
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