Oscillating Positive Expiratory Pressure on Respiratory Resistance in Chronic Obstructive Pulmonary Disease With a Small Amount of Secretion: A Randomized Clinical Trial

Ada Clarice Gastaldi, Paolo Paredi, Anjana Talwar, Sally Meah, Peter J Barnes, Omar S Usmani, Ada Clarice Gastaldi, Paolo Paredi, Anjana Talwar, Sally Meah, Peter J Barnes, Omar S Usmani

Abstract

This study aims to evaluate the acute effects of an oscillating positive expiratory pressure device (flutter) on airways resistance in patients with chronic obstructive pulmonary disease (COPD).Randomized crossover study: 15 COPD outpatients from Asthma Lab-Royal Brompton Hospital underwent spirometry, impulse oscillometry (IOS) for respiratory resistance (R) and reactance (X), and fraction exhaled nitric oxide (FeNO) measures.Thirty minutes of flutter exercises: a "flutter-sham" procedure was used as a control, and airway responses after a short-acting bronchodilator were also assessed.Respiratory system resistance (R): in COPD patients an increase in X5insp (-0.21 to -0.33 kPa/L/s) and Fres (24.95 to 26.16 Hz) occurred immediately after flutter exercises without bronchodilator. Following 20 min of rest, a decrease in the R5, ΔR5, R20, X5, and Ax was observed, with R5, R20, and X5 values lower than baseline, with a moderate effect size; there were no changes in FeNO levels or spirometry.The use of flutter can decrease the respiratory system resistance and reactance and expiratory flow limitation in stable COPD patients with small amounts of secretions.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Flow diagram of patients.
FIGURE 2
FIGURE 2
Respiratory system resistance, reactance, and resonant frequency from COPD patients using flutter and flutter plus bronchodilator. COPD = chronic obstructive pulmonary disease.
FIGURE 3
FIGURE 3
Respiratory system resistance and reactance during inspiration and expiration from COPD patients using flutter and flutter plus bronchodilator. COPD = chronic obstructive pulmonary disease.

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