Oscillatory Positive Expiratory Pressure Research Articles

The Effect of Incentive Spirometry and Oscillatory Positive Expiratory Pressure Therapies on Functional Capacity, Dyspnea, and Saturation in Burn Patients with Inhalation Injury: A Randomized Controlled Study

Amaç: Bu çalışmanın amacı inhalasyon hasarı olan yanık hastalarında standart pulmoner fizyoterapi egzersizlerine ek olarak verilen insentif spirometre (triflo) ve osilasyonlu pozitif ekspiratuar basınç tedavisinin (acapella kullanımı) fonksiyonel kapasite, dispne ve satürasyon üzerine etkilerinin incelenmesidir. Yöntem: Çalışmaya Gaziantep Şehir Hastanesi Yanık Merkezi yoğun bakım ve servis ünitelerinde yatan toplam 24 hasta dahil edildi. Hastalar tabakalı randomizasyon yöntemiyle 3 gruba ayrıldı. Birinci gruba Medikal ve cerrahi tedaviye ek olarak standart fizyoterapi egzersizleri, ikinci gruba bu standart tedaviye ek olarak insentif spirometre (trfilo) ve üçüncü gruba da standart tedavi + osilasyonlu pozitif ekspiratuar basınç tedavisi (Acapella Kullanımı) verildi. Tüm gruplar 4 hafta boyunca takip edildi. Tüm grupların tedavi öncesi ve tedavi sonrası olmak üzere altı dakika yürüme testi, dispne modified medical research council (mmrc) skalası ve satürasyon değerleri karşılaştırıldı. Bulgular: Çalışmaya yaşları 19-63 arasında değişen 22 erkek 2 kadın toplam 24 hasta dahil edildi. Tüm grupların altı dakika yürüme testi, dispne skalası (MRC) ve satürasyon değerlerinin ilk ve son hafta ölçümleri karşılaştırıldığında bir fark olmadığı belirlendi (p>0,05). Sonuç: İnhalasyon hasarı olan yanık hastalarında standart fizyoterapi egzersizlerine ek olarak osilasyonlu pozitif ekspiratuar basınç tedavisi (acapella kullanımı) ve insentif spirometre (triflo) verilebilir. Bu egzersizler inhalasyon hasarı olan yanık hastalarının fonksiyonel kapasiteleri, dispne ve satürasyon düzeylerinde benzer derecede etkilidir

The Effect of Incentive Spirometry and Oscillatory Positive Expiratory Pressure Therapies on Functional Capacity, Dyspnea, and Saturation in Burn Patients with Inhalation Injury: A Randomized Controlled Study

The Effect of Incentive Spirometry and Oscillatory Positive Expiratory Pressure Therapies on Functional Capacity, Dyspnea, and Saturation in Burn Patients with Inhalation Injury: A Randomized Controlled Study

Nurse-led oscillating positive expiratory pressure (OPEP)

Emma Rickards looks at new forms of airway clearance techniques, and how patients take to them

Use of the Lung Flute ECO to assist in sputum collection for tuberculosis testing: a randomised crossover trial.

The Lung Flute ECO, a self-powered, low-cost oscillatory positive expiratory pressure device, assisted people with presumptive tuberculosis to produce an adequate sputum volume for diagnostic testing and was well tolerated https://bit.ly/47sDq8W.

The use of oscillatory positive expiratory pressure devices for voice therapy

Over the last three years, a variety of oscillatory positive expiratory pressure (OPEP) devices have been commonly used by voice therapist and trainers (e.g. Acapella Choice, Shaker Deluxe, Shaker Medic Plus, New Shaker), even if they were not originally created for voice-treatment purposes. OPEP are intended to be used by physiotherapists to mobilize secretions from the lower airway when treating excessive sputum or secretion retention. The mechanism of oscillatory OPEP is based on a continuous and rapid shuttering of airflow, which in turn produces modulation of the oral and tracheal air pressure as patients blows into them. People diagnosed with cystic fibrosis and neurogenic diseases are usually recommended using OPEP devices [1, 2]. OPEP devices are different from expiratory/inspiratory muscle strength training devices, which have no oscillatory mechanisms inside.

Impact of Aerobika® oscillating positive expiratory pressure in improving small airway resistance, lung function, symptoms and exercise capacity in chronic obstructive pulmonary disease.

Aerobika® oscillating positive expiratory pressure (OPEP) device promotes airway clearance in many respiratory diseases. However, studies have yet to focus on its effectiveness in improving small airway resistance via impulse oscillometry (IOS) measurement in COPD subjects. We aim to evaluate the improvement of small airway resistance (via IOS), lung function (spirometry), exercise capacity [via 6-min walking test (6MWT)], symptoms [COPD assessment test (CAT)] and severe exacerbation events among COPD subjects using Aerobika® OPEP. This was a prospective, single-arm interventional study among COPD subjects with small airway disease. Subjects were instructed to use twice daily Aerobika® OPEP (10 min each session); for 24 weeks; as an additional to standard therapy. IOS, spirometry, 6MWT, CAT score and severe exacerbation events were evaluated at baseline, 12 weeks and 24 weeks. Fifty-three subjects completed the study. Aerobika® usage showed improvement of IOS parameters; e.g. measurement of airway resistance at 5 Hz (R5), cmH20/L/s, (12-week p = 0.008, 24-week p < 0.001), R5% predicted (12-week p = 0.007, 24-week p < 0.001) and small airway resistance (R5-R20), cmH20/L/s, (12-week p = 0.021, 24-week p < 0.001). There were improvement of lung function; e.g. FEV1, L (12-week p = 0.018, 24-week p = 0.001), FEV1% predicted (12-week p = 0.025, 24-week p = 0.001), FEF25-75, L (12-week p = 0.023, 24-week p = 0.002), and FEF25-75% predicted (12-week p = 0.024, 24-week p < 0.001). CAT score improved at 12 weeks (p < 0.001) and 24 weeks (p < 0.001). Subjects had improved exercise capacity (6MWT, metres) after 24 weeks (p = 0.016). However, there was no significant difference in severe exacerbation events 24 weeks before and after Aerobika® usage. Aerobika® OPEP demonstrated significant improvement in small airway resistance as early as 12 weeks of usage, with sustained improvement at 24 weeks. Aerobika® OPEP administration had significantly improved lung function, 6MWT, and CAT scores over 24 weeks. There was no difference in severe exacerbation events.

Effectiveness of the use of an oscillating positive expiratory pressure device in bronchiectasis with frequent exacerbations: a single-arm pilot study.

Impaired airway clearance in patients with non-cystic fibrosis bronchiectasis causes frequent bacterial infection, chronic inflammation, and progressive tissue destruction. We aimed to evaluate whether an oscillating positive expiratory pressure (OPEP) device could allow effective sputum expectoration and prevent acute exacerbations in patients with bronchiectasis who had frequent acute exacerbations. This open-label, single-arm, prospective study included 17 patients who experienced three or more acute exacerbations in the past year. We evaluated the prevention of acute exacerbations, subjective symptom improvement, and change in sputum amount during the use of the Aerobika (Trudell Medical International, London, ON) OPEP device twice daily for 6 months. Of all enrolled patients, only two acute exacerbations occurred during the study period, indicating a significant decrease compared with the number of acute exacerbations before the device use (p < 0.001). Additionally, Bronchiectasis Health Questionnaire score changed from 58.7 to 66.6, showing significant improvement over the treatment period (p < 0.001). The largest sputum volume was observed 3 months after OPEP device use (baseline: 10 ml, 3rd month 25 ml, p = 0.325). There were no major adverse events related to the use of OPEP devices. Twice-daily physiotherapy with OPEP device in patients with bronchiectasis who have frequent exacerbations may facilitate symptomatic improvement and prevention of acute exacerbations without serious adverse events.

Critically appraised paper: In patients with chronic obstructive pulmonary disease, the addition of oscillatory positive expiratory pressure to usual care improves cough-specific and general quality of life [commentary

Critically appraised paper: In patients with chronic obstructive pulmonary disease, the addition of oscillatory positive expiratory pressure to usual care improves cough-specific and general quality of life [commentary

Critically appraised paper: In patients with chronic obstructive pulmonary disease, the addition of oscillatory positive expiratory pressure to usual care improves cough-specific and general quality of life.

Critically appraised paper: In patients with chronic obstructive pulmonary disease, the addition of oscillatory positive expiratory pressure to usual care improves cough-specific and general quality of life.

Active cycle of breathing technique versus oscillating PEP therapy versus walking with huffing during an acute exacerbation of bronchiectasis: a randomised, controlled trial protocol

BackgroundAirway clearance techniques (ACTs) for individuals with bronchiectasis are routinely prescribed in clinical practice and recommended by international guidelines, especially during an acute exacerbation. However, there is limited evidence of the efficacy of these techniques during an exacerbation to improve sputum expectoration, health-related quality-of-life (HRQOL) or exercise tolerance. The primary aim of this study is to compare the effects of the active cycle of breathing technique (ACBT), oscillating positive expiratory pressure (O-PEP) therapy, and walking with huffing on sputum expectoration for adults hospitalised with an acute exacerbation of bronchiectasis. Secondary aims are to compare the effects of these interventions on HRQOL, health status, exacerbation rates and hospital admissions in a six-month period following hospital discharge.MethodsThis multi-centre randomised controlled trial will recruit adults with an acute exacerbation of bronchiectasis requiring hospital admission. Participants will be randomised to receive one of three interventions: ACBT, O-PEP therapy, and walking with huffing. Outcome measures including sputum volume during and 1-h post ACT session, and 24-h sputum, as well as health status, HRQOL and exercise capacity will be completed during inpatient stay on day 2 and day 6 of admission, and within 24 h of hospital discharge. Time to first exacerbation, and time to first hospitalisation will be monitored via monthly phone calls for six months post hospital discharge. Health status and HRQOL will be assessed after discharge at two and six months, and exercise capacity will be assessed at six months post hospital discharge.DiscussionDespite recommendations regarding the importance of ACT for individuals with bronchiectasis during an acute exacerbation, there is a gap in the literature regarding effectiveness of ACT when undertaken by individuals in this clinical state. This study will add to the evidence base regarding the effectiveness of commonly implemented ACTs during a hospital admission with an exacerbation of bronchiectasis. Additionally, it will contribute to knowledge of the long term effects on important and patient-centred outcomes, including incidence of future exacerbations, and HRQOL, which has not been previously established.Trial registration Registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12621000428864).

Effect of Aerobika Device versus Acapella Device on Sputum Volume and Lung Functions in Chronic Obstructive Lung Disease Patients- A Research Protocol

Introduction: Chronic Obstructive Lung Disease (COPD) is an incurable, gradually worsening respiratory condition characterised by airflow limitation and blockage that cannot be completely reversed. Productive cough caused due to mucus hypersecretion is a common symptom of COPD. Clearing the lungs may aid in the conservation of energy and oxygen, as well as the prevention of lung infections. Therefore, Oscillating Positive Expiratory Pressure (OPEP) devices are designed to aid in sputum clearing in COPD patients. They are available in a variety of sizes and shapes and clear the airway with air pressure, oscillation, or high-frequency sound waves. Need of the Study: Chronic Obstructive Pulmonary Disease (COPD) makes it challenging for air to flow freely into and out of the lungs. Shortness of breath, cough, and mucus in the lungs are all possible symptoms. Clearing the lungs may aid in the conservation of energy and oxygen, as well as the prevention of lung infections. To help clear away excess sputum, numerous airway clearance devices can be used. They are available in a variety of sizes and shapes and clear the airway with air pressure, oscillation, or high-frequency sound waves. Aim: To compare the effect of Aerobika vs. Acaplla device on sputum volume and lung function in COPD patients. Materials and Methods: A comparative study will be performed in respiratory medicine OPD of Ravi Nair Physiotherapy College, Sawangi (Meghe), Wardha. Ethical approval was received from the Ethical Review Committee of Datta Meghe Institute of Medical Sciences, Deemed to be University. In this study 30 patients diagnosed with COPD will be categorised into two groups one group will receive aerobika device with conventional physiotherapy and another group will receive acapella device with conventional physiotherapy twice a day. Treatment will be given five days for one week. The assessment will be done on day one of the treatment and at the end of treatment which is first week. Sputum volume and lung function will be assessed by sputum collector and Pulmonary Function Test (PFT), respectively. The statistical analysis will be done using chisquare test. The parameters will be compared between both the groups for sputum volume and lung function over a period of one week. Data will be analysed in a statistical software SPSS 27.0.V.

The Effect of Aerobika Device and Acapella Device on Rehospitalisation and Pulmonary Functions in Patients with Chronic Obstructive Pulmonary Disease-A Systematic Review

Introduction: Controlling and preventing symptoms of exacerbations, shortness of breath, cough and mucus in the lungs are important goals of Chronic Obstructive Pulmonary Disease (COPD) treatment. Oscillating Positive Expiratory Pressure (OPEP) devices have been shown to improve clinical results. The conservation of energy and oxygen, as well as, the prevention of lung infections and reducing rehospitalisation may be facilitated by clearing the lungs. There are several airway clearance devices, that can be used to help clear excessive sputum. Aim: To identify the effect of aerobika device versus acapella device on rehospitalisation and lung functions in COPD patients. Materials and Methods: This systematic review was conducted in the Department of Physiotherapy at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, India. The duration of the study was three months, from march 2022 to june 2022. Five databases (PubMed, scopus, web of science, google scholar) were searched from 2012 to 2022. Inclusion criteria consisted of studies on the effect of aerobika device and acapella device on rehospitalisation and lung functions only in COPD patients. Data extraction included baseline features, treatment intervention, training frequency, supervision level, breathlessness, acute exacerbation, and outcomes. High quality experimental trials and comparative studies were chosen for the study. Results: A total of 20 articles were extracted; five were utilised for the purpose of writing the review, emphasising the effect of aerobika device versus acapella device on rehospitalisation and lung functions in COPD patients. Studies had showed inconsistent results on the effect of aerobika device versus acapella device on rehospitalisation and lung functions in COPD patients. Conclusion: Rehospitalisation, readmission and length of the stay can be reduced by using both, aerobika and acapella devices. Both devices are effective in improving lung function in COPD patients.

2022 Canadian Surgery Forum Sept. 15–17, 202201. Operative classification of ventral abdominal hernias: new and practical classification02. Watchful waiting for large primary splenic cysts03. Transversus abdominis plane (TAP) blocks with and without dexamethasone in colorectal surgery04. What factors determine publication of resident research day projects?05. Characterization of near-infrared imaging and indocyanine green use amongst general surgeons06. Variation in opioid prescribing

# 01. Operative classification of ventral abdominal hernias: new and practical classification {#article-title-2} Ventral hernias of the abdomen are defined as a noninguinal, nonhiatal defect in the fascia of the abdominal wall. Unfortunately, there is not currently a universal classification system

Design and initial testing of a novel disposable oscillating positive expiratory pressure device.

Oscillating positive expiratory pressure (OPEP) devices play a key role in airway clearance, particularly in patients with cystic fibrosis. These devices, however, have the potential to become reservoirs for pathogenic organisms and require daily, or even more frequent, cleaning. This places a large burden on patients and their carers. The objective of this work was to develop a disposable OPEP device, with comparable mechanical performance to commercial devices, that negates the need for cleaning after use thus reducing microbiological risks. 3D printing was used to iterate and develop a prototype disposable device (The University of Limerick OPEP, abbreviated to the UL-OPEP) that was compared with a selection of commercially available devices for mean pressure and oscillation amplitude (cmH2O), as well as oscillation frequency (Hz). All devices were tested using a healthy volunteer at a target expiratory flow of ~ 20 L/min. The target therapeutic range was 10-20 cmH2O at a flow rate of 10-20 L/min as is reported widely in the literature. The prototype disposable device achieved a mean pressure of 14.82 cmH2O at a mean flow rate of 18.82 L/min, and generated an oscillation frequency of 26Hz with an amplitude of 1.28 cmH2O. These characteristics compare favourably with existing, more complex, reusable OPEP devices. The UL-OPEP device is a small, disposable OPEP device, that generates pressure and oscillation amplitudes for clinically effective airway clearance. The device negates the need for cleaning and disinfecting, removing the risk of devices acting as a potential reservoir for pathogenic organisms while maintaining mucus-clearing benefits.

272 Effect of an oscillatory positive expiratory pressure device on lung function change in children with cystic fibrosis

272 Effect of an oscillatory positive expiratory pressure device on lung function change in children with cystic fibrosis

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

BackgroundOscillatory 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....

Effect of airway clearance therapies on mucociliary clearance in adults with cystic fibrosis: A randomized controlled trial.

Cystic fibrosis (CF) is an inherited disorder causing impaired mucociliary clearance within the respiratory tract, and is associated with bronchiectasis, chronic respiratory infections, and early death. Airway clearance therapies have long been a cornerstone of management of individuals with CF, although evidence supporting their use is lacking. We designed a randomized controlled trial to quantitatively compare the effects of different forms of airway clearance on mucociliary clearance. Three different physiotherapy methods to augment cough-clearance were studied in addition to cough-clearance alone: high-frequency chest-wall oscillating vest, oscillatory positive expiratory pressure, and whole-body vibration. We used gamma scintigraphy after inhalation of radiolabeled particles to quantify mucus clearance before, during, and after physiotherapy. As secondary endpoints, we measured concentrations of small molecules in exhaled breath that may impact mucus clearance. Ten subjects were enrolled and completed study procedures. No differences were identified between any method of airway clearance, including cough clearance alone. We did identify changes in certain small molecule concentrations in exhaled breath following airway clearance. Due to the limitations of this study, we do not believe the negative results suggest a change in clinical practice with regard to airway clearance. Findings pertaining to small molecules in exhaled breath may serve as future opportunities for study.

"Efficacy Respiratory Physiotherapy On Allergic Bronchopulmonary Aspergillosis. A Case Report"

Background: Allergic bronchopulmonary aspergillosis (ABPA) is a disease characterized by reversible airway obstruction. The clinical symptomatology involves recurrent episodes predominantly in subjects with asthma, those with cystic fibrosis, and subjects with bronchiectasis.Methods: A respiratory physiotherapy treatment plan of home training with The Acapella DH® provides the oscillatory positive expiratory pressure (OPEP) and POWERbreathe Plus® for two weeks, five days a week, twice a day (10 minutes in the morning and another 10 minutes in the afternoon) and to analyze the effectiveness of respiratory therapy using spirometry, as a treatment for a clinical case suffering from allergic bronchopulmonary aspergillosis, bronchial asthma, and bronchiectasis.Results: The first spirometric assessment carried out on week zero revealed that after the home treatment plan in week one and week two assessments, a significant increase in all spirometric lung function values was assessed with % change, such as Vital Capacity (VC), resulting in week 1 (0.80%) week 2 (1.09%), Tidal Volume (VT) resulting in week 1 (0.91%) week 2 (1.04%), Expiratory Reserve Volume (ERV) resulting in week 1 (1.14%) week 2 (1.24%), Inspiratory Reserve Volume (IRV) resulting in week 1 (0.66%) week 2 (1.04%) and Inspiratory Capacity (IC) resulting in week 1 (0.69%) week 2 (0.71%), together with decreasing respiratory times; inspiratory time (Ti) resulting in week 1 (-0.31%) week 2 (-0.38%), expiratory time (Te) and total inspiratory and expiratory time (Tt) resulting in week 1 (-0.24%) week 2 (-0.31%).Conclusions: A home pulmonary treatment plan with OPEP and POWERbreathe Plus® shows a clear improvement in lung function in subjects with ABPA, bronchiectasis, and asthma, thus improving quality of life.

Therapeutic efficacy of oscillating positive expiratory pressure therapy in stable chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airway and the lung to noxious particles or gases. Sputum production is a cardinal feature in COPD. Airway clearance techniques have been the mainstay of management. Oscillating positive expiratory pressure (OPEP) devices are handheld devices that provide a combination of positive expiratory pressure (PEP) with high frequency oscillations which involve exhaling against a resistance that is fluctuating. It encourages airflow within secretions, whereas oscillations induce vibrations within airway wall to displace secretions into airway lumen and help in expectoration. A randomized control trial was conducted at the department of pulmonary medicine, Government Medical College & Hospital, Chandigarh, in which 50 patients with stable COPD were enrolled for one- and- half years. After taking proper history, they were subjected to spirometry, six- minute walk test, and were asked to fill the St. George's Respiratory Questionnaire (SGRQ) and COPD Assessment Test (CAT). These patients were randomized into group A (intervention group) and group B (control group), where group A was prescribed Aerobika OPEP device for daily use for a period of three months. After three months of use of device, the patients were again subjected to assessment parameters and inquired about any exacerbation within the three- month period. At the end of three months were compared with baseline results. The median change in FEV1, FVC, 6MWD from baseline in group A was significantly more as compared to group B (FEV1: P < 0.001; FVC: P < 0.001; 6MWD: P = 0.08), whereas SGRQ score showed a significant improvement in both the intervention and control groups (P < 0.001) and CAT score showed significant improvement in comparison to the control group (P < 0.001). The median change in 6MWD and CAT from baseline in group A was significantly more as compared to group B (SGRQ: P < 0.001; CAT: P < 0.001), whereas it was not significant in case of SGRQ (P = 0.233). There was no significant difference in the incidence of exacerbation in the two groups (P = 0.19). The device did not help in controlling the rate of exacerbation in the present study at three months. Stable COPD patients who were given OPEP therapy as an adjunct to the standard drug therapy showed improvement in the spirometry parameters, exercise capacity and symptom burden in comparison to the drug only group.

Non-Pharmaceutical Techniques for Obstructive Airway Clearance Focusing on the Role of Oscillating Positive Expiratory Pressure (OPEP): A Narrative Review.

Mucus secretion in the lungs is a natural process that protects the airways from inhaled insoluble particle accumulation by capture and removal via the mucociliary escalator. Diseases such as cystic fibrosis (CF) and associated bronchiectasis, as well as chronic obstructive pulmonary disease (COPD), result in mucus layer thickening, associated with high viscosity in CF, which can eventually lead to complete airway obstruction. These processes severely impair the delivery of inhaled medications to obstructed regions of the lungs, resulting in poorly controlled disease with associated increased morbidity and mortality. This narrative review article focuses on the use of non-pharmacological airway clearance therapies (ACTs) that promote mechanical movement from the obstructed airway. Particular attention is given to the evolving application of oscillating positive expiratory pressure (OPEP) therapy via a variety of devices. Advice is provided as to the features that appear to be the most effective at mucus mobilization.