The effectiveness of additional long-term use of bottle-positive expiratory pressure in chronic obstructive pulmonary disease: A single-blind, randomized study

Objectives

This study aimed to investigate the long-term use of bottle-positive expiratory pressure (PEP) in addition to breathing exercises as a home-based rehabilitation aid on exercise capacity, spirometric parameters, and quality of life in chronic obstructive pulmonary disease (COPD) patients.

Patients and methods

From a total of 30 patients with stable moderate-to-severe COPD, 24 (22 males, 2 females; mean age: 62.4+7.2 years; range, 40 to 75 years) were included in the final study and randomized into two groups: the group that performed breath retaining techniques and the group that was instructed to use the bottle-PEP in addition to these techniques. Patients were evaluated with modified Medical Research Council scale, COPD assessment test (CAT), spirometry, St. George`s Respiratory Questionnaire (SGRQ), and 6-min walk distance (6MWD) before, three months and six months after the initiation of the program.

Results

In the bottle-PEP group, patients` mean 6MWD increased from 380.6±67.6 to 444.1±22.0 m (p=0.002), the mean CAT score decreased from 17.8±36.8 to 12.9±6.2 (p=0.03), and the mean SGRQ total score significantly decreased from 57.1±23.1 to 47.6±21.9 (p<0.05) after three months. The improvement in 6MWD continued in six months but disappeared in SGRQ and CAT scores. In the exercise group, only the 6MWD improved, and there were no significant improvements in other parameters regardless of time. There were no significant differences between the groups in any of the parameters at any follow-up session.

Conclusion

While bottle-PEP does not significantly contribute when added to breathing exercises in patients with moderate-to-severe COPD in improving function and quality of life, it can be used as a safe choice in patients` home rehabilitation programs.

Wearable positive end-expiratory pressure valve improves exercise performance

We tested a PEEP (4.2 cmH₂O) mouthpiece (PMP) on maximal cycling performance in healthy adults. Experiment-1, PMP vs. non-PMP mouthpiece (CON) [n = 9 (5♂), Age = 30 ± 2 yr]; Experiment-2, PMP vs. no mouthpiece (NMP) [n = 10 (7♂), Age = 27 ± 1 yr]. At timepoint 1 in both experiments (mouthpiece condition randomized) subjects performed graded cycling testing (GXT) (Corival® cycle ergometer) to determine V˙O_{2peak (ml∗kg∗min}⁻¹), O₂pulse _(mlO2∗bt⁻¹), GXT endurance time (GXT-T_(s)), and V˙O_{2(ml∗kg∗min}⁻¹)-at-ventilatory-threshold (V˙O₂ @VT). At timepoint 2 72 h later, subjects completed a ventilatory-threshold-endurance-ride [VTER_(s)] timed to exhaustion at V˙O₂ @VT power _(W). One week later at timepoints 3 and 4 (time-of-day controlled), subjects repeated testing protocols under the alternate mouthpiece condition. Selected results (paired T-test, p<0.05): Experiment 1 PMP vs. CON, respectively: V˙O_2peak ​= ​45.2 ​± ​2.4 vs. 42.4 ​± ​2.3 p<0.05; V˙O₂@VT ​= ​33.7 ​± ​2.0 vs. 32.3 ​± ​1.6; GXT-TTE ​= ​521.7 ​± ​73.4 vs. 495.3 ​± ​72.8 (p<0.05); VTER ​= ​846.2 ​± ​166.0 vs. 743.1 ​± ​124.7; O2pulse ​= ​24.5 ​± ​1.4 vs. 23.1 ​± ​1.3 (p<0.05). Experiment 2 PMP vs. NMP, respectively: V˙O_2peak ​= ​43.3 ​± ​1.6 vs. 41.7 ​± ​1.6 (p<0.05); V˙O₂@VT ​= ​31.1 ​± ​1.2 vs. 29.1 ​± ​1.3 (p<0.05); GXT-TTE ​= ​511.7 ​± ​49.6 vs. 486.4 ​± ​49.6 (p<0.05); VTER 872.4 ​± ​134.0 vs. 792.9 ​± ​122.4; O₂pulse ​= ​24.1 ​± ​0.9 vs. 23.4 ​± ​0.9 (p<0.05). Results demonstrate that the PMP conferred a significant performance benefit to cyclists completing high intensity cycling exercise.

An integrative review on the positive expiratory pressure (PEP)-bottle therapy for patients with pulmonary diseases

BACKGROUND AND PURPOSE

Positive expiratory pressure (PEP)-bottle device delivers a PEP within a range of 10-20 cmH₂ O. PEP treatment is applied to different pathological conditions also in combination with other physiotherapeutic techniques. The primary aim of the present review was to investigate the effects of PEP-bottle therapy in patients with pulmonary diseases and, secondarily, to provide a physiological analysis of its use.

METHODS

The databases PubMed, Scopus, Web of Science, Cinahl, and Cochrane Library were searched for citations published from their inception until May 2019. Adult participants (>18 years) with pulmonary disease who underwent PEP-bottle treatment, with no restriction on gender, were included in the study. There were no restrictions about the therapeutic settings and the condition of the disease (either acute or chronic).

RESULTS

The literature review returned 97 citations. After duplicates removal, the remaining 77 articles have been screened: 66 have been assessed as not eligible at first because the abstract did not meet the inclusion criteria. Eleven articles were left after the first two steps of selection: four have been excluded after full-text reading.

CONCLUSION

PEP-bottle therapy has been proved to improve lung volume, to reduce hyperinflation, and to remove secretions. The device delivers a pressure equal to the water column only if the inner diameter of the tubing and the width of the air escape orifice are equal or greater than 8 mm, and the length of tubing ranges between 20 and 80 cm. The cost of a PEP-bottle device is significantly lower if compared with other commercially available devices having the same therapeutic purposes.

Manual Massage Therapy for Patients with COPD: A Scoping Review

Background and objectives: Manual massage therapy is a therapeutic option for the treatment of several pathological conditions affecting the musculoskeletal system. It has been pointed out that massage might be beneficial for chronic obstructive pulmonary disease (COPD) patients thanks to therapeutic effects primarily related to hyperemia (increased skin temperature and blood flow), and activation of the lymphatic system. The present study reports current evidence on the systemic effects of manual massage in patients with COPD. Materials and Methods: A scoping review was conducted on five major databases. The search went through all databases since their inception until December 2018. Results: Seventy-eight citations were retrieved; after the selection process was completed, seven articles were considered eligible. In patients receiving manual massage, improvements were observed in Forced Expiratory Volume in 1 s, dyspnea perception, and in the 6-min walking test. Conclusions: To date, the use of manual massage in patients with COPD is not supported by substantial evidence in the literature: indeed, it is proposed as a therapeutic option in association with other interventions such as physical exercise.