A Functional Respiratory Imaging Approach to the Effect of an Oscillating Positive Expiratory Pressure Device in Chronic Obstructive Pulmonary Disease

Glenn Leemans, Dennis Belmans, Cedric Van Holsbeke, Vladimir Kushnarev, Jason Sugget, Kris Ides, Dirk Vissers, Wilfried De Backer, Glenn Leemans, Dennis Belmans, Cedric Van Holsbeke, Vladimir Kushnarev, Jason Sugget, Kris Ides, Dirk Vissers, Wilfried De Backer

Abstract

Purpose: Chronic obstructive pulmonary disease (COPD) patients are prone to suffer from chronic bronchitis, which ultimately affects their quality of life and overall prognosis. Oscillating positive expiratory pressure (oPEP) devices are designed to aid in the mucus clearance by generating positive pressure pulses in the airways. The main aim of this study was to analyze the impact of a specific oPEP device - Aerobika® - on top of standard of care medication in COPD patients' lung dynamics and drug deposition.

Patients and methods: In this single-arm pilot study, patients were assessed using standard spirometry tests and functional respiratory imaging (FRI) before and after a period of 15±3 days of using the oPEP device twice daily (before their standard medication).

Results: The utilization of the oPEP device led to a significant increase of 2.88% in specific airway volume after two weeks (1.44 (SE: 0.18) vs 1.48 (SE: 0.19); 95% CI = [0.03%,5.81%]; p=0.048). Moreover, the internal airflow distribution (IAD) was affected by the treatment: patients' changes ranged from -6.74% to 4.51%. Furthermore, IAD changes at the lower lobes were also directly correlated with variations in forced expiratory volume in one second and peak expiratory flow; conversely, IAD changes at the upper lobes were inversely correlated with these clinical parameters. Interestingly, this change in IAD was significantly correlated with changes in lobar drug deposition (r2=0.30, p<0.001).

Conclusion: Our results support that the Aerobika device utilization leads to an improved airflow, which in turn causes a shift in IAD and impacts the drug deposition patterns of the concomitant medication in patients with COPD.

Keywords: airway clearance techniques; drug deposition; functional respiratory imaging; internal airflow distribution; mucus hypersecretion.

Conflict of interest statement

Glenn Leemans is affiliated with the University of Antwerp and responsible for the statistical analysis, clinical interpretation and discussion of the results. He was employed by FLUIDDA when the study was conducted. Dennis Belmans and Cedric Van Holsbeke are affiliated with FLUIDDA and also responsible for statistical analysis, clinical interpretation and discussion of the results. Wilfried De Backer, Kris Ides and Dirk Vissers are affiliated with the University of Antwerp and contributed with clinical experience to the analysis and discussion of results. Wilfried De Backer also received compensation for study costs from University Hospital of Antwerp, during the conduct of the study. Vladimir Kushnarev and Jason Suggest are employees of Trudell Medical International, sponsor of the study. The authors report no other conflicts of interest in this work.

© 2020 Leemans et al.

Figures

Figure 1
Figure 1
Individual changes in IAD between baseline and post-oPEP for upper and lower lobes. Note: The upper lobe value per subject is the sum of the IAD value of the right upper lobe, right middle lobe and left upper lobe. The lower lobe value per subject is the sum of the IAD value of the right lower lobe and left lower lobe. The mean±SD for upper and lower lobes respectively are indicated in the X-axis. Abbreviation: IAD, internal airflow distribution.
Figure 2
Figure 2
Correlation between lobar drug deposition changes and IAD changes after oPEP treatment. Note: marginal r2 (linear mixed-effect model) = 0.30, p<0.001. Abbreviation: IAD, internal airflow distribution.
Figure 3
Figure 3
Changes of IAD throughout the experimental period for Subject 9 (left) and Subject 5 (right). Abbreviation: IAD, internal airflow distribution.

References

    1. Ramos FL, Krahnke JS, Kim V. Clinical issues of mucus accumulation in COPD. Int J COPD. 2014;9:139–150.
    1. Volsko T. Airway clearance therapy: finding the evidence. Respir Care. 2013;58(10):1669–1678. doi:10.4187/respcare.02590
    1. Osadnik CR, McDonald CF, Holland AE. Airway clearance techniques for chronic obstructive pulmonary disease. Expert Rev Respir Med. 2013;7(6):673–685. doi:10.1586/17476348.2013.847368
    1. Prescott E, Lange P, Vestbo J. Chronic mucus hypersecretion in COPD and death from pulmonary infection. Eur Respir J. 1995;8(8):1333–1338. doi:10.1183/09031936.95.08081333
    1. Osadnik CR, McDonald CF, Holland AE, Ramos FL, Krahnke JS, Kim V. Clinical issues of mucus accumulation in COPD. Int J Chron Obstruct Pulmon Dis. 2014;9:139–150. doi:10.2147/COPD.S38938
    1. Ides K, Vissers D, Vissers D, De Backer L, Leemans G, De Backer W. Airway clearance in COPD: need for a breath of fresh air? A systematic review. COPD. 2011;8(3):196–205. doi:10.3109/15412555.2011.560582
    1. Svenningsen S, Paulin GA, Sheikh K, et al. Oscillatory positive expiratory pressure in chronic obstructive pulmonary disease. COPD. 2016;13(1):66–74. doi:10.3109/15412555.2015.1043523
    1. Suggett J. Quality of Life (QOL) responder rate analysis following use of an Oscillating Positive Expiratory Pressure (OPEP) device for Chronic Obstructive Pulmonary Disease (COPD): SGRQV CAT assessments - abstract presentations, COPD10, Birmingham, United Kingdom. Chronic Obs Pulm Dis. 2017;4(3):225–246.
    1. Burudpakdee C, Seetasith A, Dunne P, et al. A real-world study of 30-day exacerbation outcomes in chronic obstructive pulmonary disease (COPD) patients managed with aerobika OPEP. Pulm Ther. 2017;3(1):163–171. doi:10.1007/s41030-017-0027-5
    1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease - 2019 Report. Glob Initiat Chronic Obstr Lung Dis Inc; 2019.
    1. De Backer JW, Vos WG, Vinchurkar SC, et al. Validation of computational fluid dynamics in CT-based airway models with SPECT/CT. Radiology. 2010;257(3):854–862. doi:10.1148/radiol.10100322
    1. Bates D, Mächler M, Bolker BM, Walker SC. Fitting linear mixed-effects models using lme4. J Stat Softw. 2015;67(1). doi:10.18637/jss.v067.i01
    1. Koller M, Stahel WA. Sharpening Wald-type inference in robust regression for small samples. Comput Stat Data Anal. 2011;55(8):2504–2515. doi:10.1016/j.csda.2011.02.014
    1. De Backer J, Vos W, Vinchurkar S, et al. The effects of extrafine beclometasone/formoterol (BDP/F) on lung function, dyspnea, hyperinflation, and airway geometry in COPD patients: novel insight using functional respiratory imaging. J Aerosol Med Pulm Drug Deliv. 2014;27:1–12. doi:10.1089/jamp.2013.1049
    1. Vos W, Backer De J, Poli G, et al. Novel functional imaging of changes in small airways of patients treated with extrafine beclomethasone/formoterol. Respiration. 2013;86(5):393–401. doi:10.1159/000347120
    1. De Backer W, Vos W, Van Holsbeke C, et al. The effect of roflumilast in addition to LABA/LAMA/ICS treatment in COPD patients. Eur Respir J. 2014;44(2):527–529. doi:10.1183/09031936.00011714
    1. Vos W, Hajian B, De Backer J, et al. Functional respiratory imaging to assess the interaction between systemic roflumilast and inhaled ICS/LABA/LAMA. Int J Chron Obstruct Pulmon Dis. 2016;11:263–271. doi:10.2147/COPD.S93830
    1. Kim Y, Schroeder J, Lynch D, et al. Gender differences of airway dimensions in anatomically matched sites on CT in smokers. COPD J Chronic Obstr Pulm Dis. 2011;8(4):285–292. doi:10.3109/15412555.2011.586658
    1. Kim CS, Hu SC. Regional deposition of inhaled particles in human lungs; comparison between men and women. J Appl Physiol. 1998;84(6):1834–1844. doi:10.1152/jappl.1998.84.6.1834
    1. Svenningsen S, Guo F, McCormack DG, Parraga G. Noncystic fibrosis bronchiectasis: regional abnormalities and response to airway clearance therapy using pulmonary functional magnetic resonance imaging. Acad Radiol. 2017;24(1):4–12. doi:10.1016/j.acra.2016.08.021
    1. Rodriguez Hortal MC, Hjelte L. Time point to perform lung function tests evaluating the effects of an airway clearance therapy session in cystic fibrosis. Respir Care. 2014;59(10):1537–1541. doi:10.4187/respcare.02823
    1. Ides K, Vos W, De Backer L, et al. Acute effects of intrapulmonary percussive ventilation in COPD patients assessed by using conventional outcome parameters and a novel computational fluid dynamics technique. Int J Chron Obstruct Pulmon Dis. 2012;7:667–671. doi:10.2147/COPD.S29847

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅