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Reychler G, Audag N, Prieur G, Poncin W, Contal O. [Guidelines for the management of airway mucus secretions by airway clearance techniques]. Rev Mal Respir 2024; 41:512-537. [PMID: 39025771 DOI: 10.1016/j.rmr.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 07/20/2024]
Affiliation(s)
- G Reychler
- Institut de recherche expérimentale et clinique (IREC), pôle de pneumologie, ORL et dermatologie, université catholique de Louvain, Brussels, Belgique; Service de pneumologie, cliniques universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgique; Secteur de kinésithérapie et ergothérapie, cliniques universitaires Saint-Luc, Brussels, Belgique.
| | - N Audag
- Institut de recherche expérimentale et clinique (IREC), pôle de pneumologie, ORL et dermatologie, université catholique de Louvain, Brussels, Belgique; Service de pneumologie, cliniques universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgique; Secteur de kinésithérapie et ergothérapie, cliniques universitaires Saint-Luc, Brussels, Belgique
| | - G Prieur
- Physiotherapy Department, Le Havre Hospital, 76600 Le Havre, France
| | - W Poncin
- Institut de recherche expérimentale et clinique (IREC), pôle de pneumologie, ORL et dermatologie, université catholique de Louvain, Brussels, Belgique; Service de pneumologie, cliniques universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgique; Secteur de kinésithérapie et ergothérapie, cliniques universitaires Saint-Luc, Brussels, Belgique
| | - O Contal
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts of Western Switzerland, 1005 Lausanne, Suisse
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Alghamdi SM, Alzahrani A, Alshahrani YM, Al Ruwaithi AA, Aldhahir AM, Alsulayyim AS, Siraj RA, Almansour AH, Alasmari AM, Alqahtani JS, Alanazi AM, Jaishi ST, Allehyani BA, Hopkinson NS. Perception and clinical practice regarding mucus clearance devices with chronic obstructive pulmonary disease: a cross-sectional study of healthcare providers in Saudi Arabia. BMJ Open 2023; 13:e074849. [PMID: 37709318 PMCID: PMC10503362 DOI: 10.1136/bmjopen-2023-074849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES Clearing secretions from the airway can be difficult for people with chronic obstructive pulmonary disease (COPD). Mucus clearance devices (MCDs) are an option in disease management to help with this, but healthcare provider awareness and knowledge about them as well as current clinical practice in Saudi Arabia are not known. DESIGN A cross-sectional online survey consisting of four themes; demographics, awareness, recommendations and clinical practice, for MCDs with COPD patients. SETTING Saudi Arabia. PARTICIPANTS 1188 healthcare providers including general practitioners, family physicians, pulmonologists, nursing staff, respiratory therapists and physiotherapists. PRIMARY OUTCOME MEASURES Healthcare providers' level of awareness about MCDs, and the identification of current clinical practices of COPD care in Saudi Arabia. RESULTS 1188 healthcare providers (44.4% female) completed the survey. Regarding devices, 54.2% were aware of the Flutter, 23.8% the Acapella and 5.4% the positive expiratory pressure mask. 40.7% of the respondents identified the Acapella, and 22.3% the Flutter as first choice for COPD management. 75% would usually or always consider their use in COPD patients reporting daily difficulty clearing mucus, whereas 55.9% would sometimes or usually consider the use of MCDs with COPD patients who produced and were able to clear mucus with cough. In clinical practice, 380 (32%) of the respondents would prescribe MCDs, 378 (31.8%) would give MCDs without prescriptions, 314 (26.4%) would not provide them at all and 116 (9.8%) would only advise patients about them. CONCLUSION Healthcare providers are aware of the existence of MCDs and their benefits for sputum clearance and believe that MCDs are beneficial for sputum clearance in some COPD patients. TRIAL REGISTRATION NUMBER ISRCTN44651852.
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Affiliation(s)
- Saeed Mardy Alghamdi
- Department of Clinical Technology, Respiratory Care Program, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdulaziz Alzahrani
- Department of Clinical Technology, Respiratory Care Program, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Yousef M Alshahrani
- Department of Clinical Technology, Emergency Medical Services Program, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdulhadi A Al Ruwaithi
- Department of Clinical Technology, Emergency Medical Services Program, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | | | - Rayan A Siraj
- Department of Respiratory Therapy, King Faisal University, Al-Hasa, Saudi Arabia
| | - Abdulelah H Almansour
- Department of Family Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ali M Alasmari
- Department of Respiratory Therapy, College of Medical Rehabilitation Services, Taibah University, Madinah, Saudi Arabia
| | - Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Abdullah M Alanazi
- Department of Respiratory Care, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Siraj T Jaishi
- Al-Noor Specialist Hospital, Saudi Arabia Ministry of Health, Makkah, Saudi Arabia
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Lewis A, Osadnik CR. Changing practice by changing pressures: a role for oscillating positive expiratory pressure in chronic obstructive pulmonary disease. Thorax 2023; 78:113-115. [PMID: 36167723 DOI: 10.1136/thorax-2022-219451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Adam Lewis
- Department of Health Sciences, Brunel University London, Uxbridge, UK
| | - Christian Robert Osadnik
- Department of Physiotherapy, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
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Alghamdi SM, Alsulayyim AS, Alasmari AM, Philip KEJ, Buttery SC, Banya WAS, Polkey MI, Birring SS, Hopkinson NS. Oscillatory positive expiratory pressure therapy in COPD (O-COPD): a randomised controlled trial. Thorax 2023; 78:136-143. [PMID: 35948418 DOI: 10.1136/thorax-2022-219077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/20/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Oscillatory 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. We aimed to assess the impact of OPEP therapy on quality of life and objective measures of cough and sleep disturbance in patients with COPD with regular sputum production. METHODS We enrolled stable patients with COPD, who reported sputum production every day or most days, into an assessor-blind, parallel-group, randomised controlled trial comparing 3 months of using an Acapella device against usual care (including use of the active cycle of breathing technique). The primary outcome was cough-related quality of life measured using the Leicester Cough Questionnaire (LCQ). Secondary outcomes included fatigue (Functional Assessment of Chronic Illness Therapy, FACIT score) and generic quality of life (EuroQol-5 Dimensions, EQ-5D). In a substudy (n=45), objective monitoring of cough and disturbance/movement during sleep were also available. RESULTS 122 participants (61/61 OPEP/control) were recruited, 40% female, 17% smokers, FEV1 38 (25-56)% predicted, and age 62±10 years. 103 completed the study (55/48 OPEP/control). Use of OPEP was associated with an improvement in LCQ compared with controls; MD (95% CI) 1.03 (0.71 to 2.10); (p=0.03), FACIT score 4.68 (1.34 to 8.02); (p<0.001) and EQ-5D 4.00 (0.49 to 19.75); (p=0.04). There was also an improvement in cough frequency -60 (-43 to -95) coughs/24 hours (p<0.001), but no statistically significant effect on sleep disturbance was identified. CONCLUSIONS Regular use of an Acapella device improves symptoms and quality of life in people with COPD who produce sputum daily or most days. TRIAL REGISTRATION NUMBER ISRCTN44651852.
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Affiliation(s)
- Saeed M Alghamdi
- Clinical Technology, Umm Al-Qura University, Makkah, Saudi Arabia.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Abdullah S Alsulayyim
- National Heart and Lung Institute, Imperial College London, London, UK.,Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Ali M Alasmari
- National Heart and Lung Institute, Imperial College London, London, UK.,College of Medical Rehabilitation, Taibah University, Madinah, Saudi Arabia
| | - Keir E J Philip
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sara C Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Winston A S Banya
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael I Polkey
- National Heart and Lung Institute, Imperial College London, London, UK
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Fernandes O, D'Silva C, Mascarenhas DG, Rebello SR. Comparison of Lung Flute and threshold positive expiratory pressure devices for airway clearance in patients with chronic obstructive pulmonary disease: a randomised clinical trial. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2020.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Mucus hypersecretion and altered lung functions leads to adverse clinical outcomes in chronic obstructive pulmonary disease. The aim of this study was to compare the effects of the Lung Flute and threshold positive expiratory pressure devices on sputum quantity and pulmonary functions in chronic obstructive pulmonary disease patients. Methods A total of 50 patients with chronic obstructive pulmonary disease were randomly divided into two groups. Group 1 used the Lung Flute device and group 2 used a threshold positive expiratory pressure device. Sputum quantity was measured post-intervention on a daily basis. Forced expiratory volume in the first second, forced vital capacity, and peak expiratory flow rate were evaluated on day 1 and day 6. Results The mean sputum quantity in group 1 was 11.40 ml and it was 11.04 ml in group 2. Between-group comparison demonstrated a significant improvement in forced expiratory volume in the first second for group 1 compared to group 2 (P<0.005). Conclusions The Lung Flute was found to be slightly more effective than the threshold positive expiratory pressure device for airway clearance and also had a positive effect on pulmonary functions in patients with chronic obstructive pulmonary disease.
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Affiliation(s)
- Orein Fernandes
- Department of Physiotherapy, Father Muller College of Allied Health Sciences Mangalore, Mangalore, India
| | - Cherishma D'Silva
- Department of Physiotherapy, Father Muller College of Allied Health Sciences Mangalore, Mangalore, India
| | - Don Gregory Mascarenhas
- Department of Physiotherapy, Father Muller College of Allied Health Sciences Mangalore, Mangalore, India
| | - Sydney Roshan Rebello
- Department of Physiotherapy, Father Muller College of Allied Health Sciences Mangalore, Mangalore, India
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Buttery SC, Zysman M, Vikjord SAA, Hopkinson NS, Jenkins C, Vanfleteren LEGW. Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity. Respirology 2021; 26:419-441. [PMID: 33751727 DOI: 10.1111/resp.14032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/21/2021] [Indexed: 12/13/2022]
Abstract
An individual's experience of COPD is determined by many factors in addition to the pathological features of chronic bronchitis and emphysema and the symptoms that derive directly from them. Multimorbidity is the norm rather than the exception, so most people with COPD are living with a range of other medical problems which can decrease overall quality of life. COPD is caused by the inhalation of noxious particles or gases, in particular tobacco smoke, but also by early life disadvantage impairing lung development and by occupations where inhaled exposures are common (e.g. industrial, farming and cleaning work). Wealthy people are therefore relatively protected from developing COPD and people who do develop the condition may have reduced resources to cope. COPD is also no longer a condition that predominantly affects men. The prevalence of COPD among women has equalled that of men since 2008 in many high-income countries, due to increased exposure to tobacco, and in low-income countries due to biomass fuels. COPD is one of the leading causes of death in women in the USA, and death rates attributed to COPD in women in some countries are predicted to overtake those of men in the next decade. Many factors contribute to this phenomenon, but in addition to socioeconomic and occupational factors, there is increasing evidence of a higher susceptibility of females to smoking and pollutants. Quality of life is also more significantly impaired in women. Although most medications (bronchodilators and inhaled corticosteroids) used to treat COPD demonstrate similar trends for exacerbation prevention and lung function improvement in men and women, this is an understudied area and clinical trials frequently have a preponderance of males. A better understanding of gender-based predictors of efficacy of all therapeutic interventions is crucial for comprehensive patient care. There is an urgent need to recognize the increasing burden of COPD in women and to facilitate global improvements in disease prevention and management in this specific population. Many individuals with COPD follow a trajectory of both lung function decline and also multimorbidity. Unfavourable lung function trajectories throughout life have implications for later development of other chronic diseases. An enhanced understanding of the temporal associations underlying the development of coexisting diseases is a crucial first step in unravelling potential common disease pathways. Lessons can be learned from exploring disease trajectories of other NCD as well as multimorbidity development. Further research will be essential to explain how early life risk factors commonly influence trajectories of COPD and other diseases, how different diseases develop in relation to each other in a temporal way and how this ultimately leads to different multimorbidity patterns in COPD. This review integrates new knowledge and ideas pertaining to three broad themes (i) the overall burden of disease in COPD, (ii) an unappreciated high burden in women and (iii) the contrast of COPD trajectories and different multimorbidity patterns with trajectories of other NCD. The underlying pathology of COPD is largely irreversible, but many factors noted in the review are potentially amenable to intervention. Health and social care systems need to ensure that effective treatment is accessible to all people with the condition. Preventive strategies and treatments that alter the course of disease are crucial, particularly for patients with COPD as one of many problems.
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Affiliation(s)
- Sara C Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Maéva Zysman
- Centre de Recherche cardio-thoracique de Bordeaux, Univ-Bordeaux, Pessac, France.,Service des Maladies Respiratoires, CHU Bordeaux, Pessac, France
| | - Sigrid A A Vikjord
- Department of Medicine and Rehabilitation, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Levanger, Norway
| | | | - Christine Jenkins
- Respiratory Group, The George Institute for Global Health, Sydney, NSW, Australia
| | - Lowie E G W Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Tse J, Wada K, Wang Y, Coppolo D, Kushnarev V, Suggett J. Impact of Oscillating Positive Expiratory Pressure Device Use on Post-Discharge Hospitalizations: A Retrospective Cohort Study Comparing Patients with COPD or Chronic Bronchitis Using the Aerobika ® and Acapella ® Devices. Int J Chron Obstruct Pulmon Dis 2020; 15:2527-2538. [PMID: 33116469 PMCID: PMC7585550 DOI: 10.2147/copd.s256866] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose Managing and preventing disease exacerbations are key goals of COPD care. Oscillating positive expiratory pressure (OPEP) devices have been shown to improve clinical outcomes when added to COPD standard of care. This retrospective database study compared real-world resource use and disease exacerbation among patients with COPD or chronic bronchitis prescribed either of two commonly used OPEP devices. Patients and methods Patients using the Aerobika® (Trudell Medical International, London, ON, Canada) or Acapella® (Smiths Medical, Wampsville, New York, USA) OPEP device for COPD or chronic bronchitis were identified from hospital claims linked to medical and prescription claims between September 2013 and April 2018; the index date was the first hospital visit with an OPEP device. Severe disease exacerbation, defined as an inpatient visit with a COPD or chronic bronchitis diagnosis, and all-cause healthcare resource utilization over 30 days and 12 months post-discharge were compared in propensity score (PS)-matched Aerobika device and Acapella device users. Results In total, 619 Aerobika device and 1857 Acapella device users remained after PS matching. After discharge from the index visit, Aerobika device users were less likely to have ≥1 severe exacerbation within 30 days (12.0% vs 17.4%, p=0.01) and/or 12 months (39.6% vs 45.3%, p=0.01) and had fewer 12-month severe exacerbations (mean, 0.7 vs 0.9 per patient per year, p=0.01), with significantly longer time to first severe exacerbation than Acapella users (log-rank p=0.01). Aerobika device users were also less likely to have ≥1 all-cause inpatient visit within 30 days (13.9% vs 20.3%, p<0.001) and 12 months (44.9% vs 51.8%, p=0.003) than Acapella users. Conclusion Patients receiving the Aerobika OPEP device, compared to the Acapella device, had lower rates of subsequent severe disease exacerbation and all-cause inpatient admission. This suggests that Aerobika OPEP device may be a beneficial add-on to usual care and that OPEP devices may vary in clinical effectiveness.
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Affiliation(s)
- Jenny Tse
- IQVIA, Medical and Scientific Services, Real World Solutions, Cambridge, MA, USA
| | - Keiko Wada
- IQVIA, Medical and Scientific Services, Real World Solutions, Cambridge, MA, USA
| | - Yi Wang
- IQVIA, Medical and Scientific Services, Real World Solutions, Cambridge, MA, USA
| | - Dominic Coppolo
- Monaghan Medical Corporation, Clinical Strategy and Development, Plattsburgh, NY, USA
| | - Vladimir Kushnarev
- Trudell Medical International, Science and Technology, London, ON, Canada
| | - Jason Suggett
- Trudell Medical International, Science and Technology, London, ON, Canada
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Alghamdi SM, Barker RE, Alsulayyim ASS, Alasmari AM, Banya WAS, Polkey MI, Birring SS, Hopkinson NS. Use of oscillatory positive expiratory pressure (OPEP) devices to augment sputum clearance in COPD: a systematic review and meta-analysis. Thorax 2020; 75:855-863. [DOI: 10.1136/thoraxjnl-2019-214360] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 11/04/2022]
Abstract
IntroductionOscillating positive expiratory pressure (OPEP) devices are intended to facilitate sputum clearance in chronic obstructive pulmonary disease (COPD), but there is uncertainty as to their place in treatment pathways. We aimed to review the existing literature to establish the evidence base for their use.MethodsA systematic search of records up to March 2020 was performed on PubMed, CINAHL, Medline (Ovid), Cochrane and Embase to retrieve clinical trials that evaluated the efficacy of OPEP devices in patients with COPD. Two independent reviewers retrieved the titles, abstracts and full texts, and completed the data extraction.ResultsFollowing full-text review of 77 articles, eight (six randomised control trials and 2 cross-over studies) were eligible for inclusion. Pooled analysis showed low-grade evidence that the use of OPEP devices was associated with decreased COPD symptoms and exacerbations (OR 0.37, 95% CI 0.19 to 0.72), and enhanced exercise capacity; 6 min walk distance (mean difference (95% CI), 49.8 m (14.2 m to 85.5 m); p=0.009]). However, studies were mostly short term with the majority having a high risk of bias. The average acceptance, completion and drop-out rates were 82%, 91% and 8%, respectively.ConclusionThe use of OPEP devices can have a positive impact in COPD, but confidence in effect sizes is low and there is a need for further, higher quality studies to examine their long-term efficacy in COPD as well as to identify specific patient phenotypes that are more likely to respond.PROSPERO registration numberCRD 42016041835.
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