SESSION TITLE: Pulmonary Physiology SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Oscillating positive expiratory pressure (OPEP) devices can be used to manage a variety of conditions, such as CF, COPD, bronchiectasis and post-surgery recovery through a general mechanism of opening / vibrating airways and loosening mucus, however, the specific mechanism by which this is achieved differs between different devices. This investigation assesses the positive pressure oscillation waveforms of various devices and evaluates each critically in terms of consequential efficiency and effectiveness of action. METHODS: A simulated OPEP exhalation maneuver was generated based on previous research1 in which a flowmeter (TSI4040 TSI, US) was used to record the waveforms of 5 healthy adults. An average profile was then scaled so the peak expiratory flow rate (PEF) was 30 L/min, thereby being more patient representative. This patient representative waveform was then used to operate, via a breathing simulator (ASL5000 IngMar, US), a range of different OPEP devices: Aerobika* (TMI, Canada); vPEP (D R Burton, US); VibraPEP (Curaplex, US); Acapella Choice (Smiths Medical, US); Flutter (Axcan, US), (n=3 devices, 3 replicates of each). The pressure / time waveforms were recorded (Pressure Transducer, Honeywell, US) for each device, set at their highest resistance to enable direct comparison. In addition, critical performance parameters such as: a) percentage of exhaled breath with discernable oscillations (> 1.0 cm H2O), tosc [%] ; b) average oscillation amplitude; and c) total pressure pulse impact (TPPI), equivalent to the sum of pressure amplitudes for all discernable oscillations, were determined. RESULTS: Each device waveform had its own unique pattern. In terms of the percentage of breath with oscillations and the average oscillation pressure amplitude, the Aerobika* device exhibited the highest values for both (81% tosc and 13.9 cm H2O), with the vPEP (45% tosc) and Flutter (3.0 cm H2O) devices the lowest for each respectively. The TPPI values were highest for the Aerobika* device (495 cm H2O), almost double the value of the second ranking device, VibraPEP (256 cm H2O), which was similar to the Acapella (236 cm H2O) and then a further drop to the lowest two devices, Flutter (139 cm H2O ) and vPEP (112 cm H2O). CONCLUSIONS: The therapeutic effectiveness of the air flow oscillations, as assessed here via the TPPI value, is considered to be dependent, in part, on the ability of the device to generate and maintain a pressure amplitude or turbulent spike throughout the maneuver2. The TPPI values showed the Aerobika* device to be the most effective, almost double the value of the second ranking device, VibraPEP, which was similar to the Acapella with a further drop to the lowest two devices, Flutter and vPEP. CLINICAL IMPLICATIONS: Such differences in laboratory performance should be considered when evaluating clinical performance studies and when selecting a device for clinical practice. 1Meyer A et al, Assessment of Oscillating Positive Pressure Devices by Means of Adult Expiratory Waveforms: A Laboratory Study, Am J Respir Crit Care Med 2014; 189:A3036 2Van Fleet et al, Evaluation of Functional Characteristics of 4 Oscillatory Positive Pressure Devices in a Simulated Cystic Fibrosis Model, Resp Care 2017;62(4):451-458. DISCLOSURE: Jason Suggett: Employee: I am employed by the manufacturer of one of the devices investigated in the study, within an R&D / Clinical function Adam Meyer: Employee: Employee of one of the manufacturers of the devices investigated, in a R&D function. No Product/Research Disclosure Information