Comparing airways clearance techniques in chronic obstructive pulmonary disease and bronchiectasis: positive expiratory pressure or temporary positive expiratory pressure? A retrospective study.
Francesco D'Abrosca, Barbara Garabelli, Gloria Savio and 5 others
PMID 28442070WHAT IT FOUND
In a pulmonary rehab program, PEP mask and temporary PEP had similar after-treatment breathing and blood-gas results.
Neither clearly outperformed the other, so the technique alone cannot be credited.
Key findings
01Both the PEP mask group and the temporary PEP group improved in ventilatory measures and gas exchange after treatment, while PaCO2 remained unchanged.
02The improvements were observed after a comprehensive pulmonary rehabilitation program that included daily exercise, so they cannot be attributed to the airway clearance device alone.
03Subgroup analyses suggested temporary PEP may reduce oxygen need in some patients with emphysema or oxygen therapy, while PEP mask may improve mid-expiratory flow in patients on nocturnal mechanical ventilation.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was retrospective, not randomised, and patients were allocated to PEP mask or temporary PEP according to preference, comfort, dyspnea, and collaboration, so the groups may differ in ways not measured. No intention-to-treat analysis was possible because patients with missing pre- or post-treatment data were excluded. All patients received a comprehensive pulmonary rehabilitation program with daily exercise, so the study cannot determine how much of the improvement came from the airway clearance device alone. Dyspnea, sputum volume, sputum characteristics, symptoms, and health-related quality of life were not collected in a standardized way, so the study does not show patient-centred benefit. More patients in the temporary PEP group had an acute exacerbation at baseline (p = 0.037), and the temporary PEP group was smaller because the device was newer. Subgroup findings were exploratory and not confirmed by randomised comparison.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not conclude that PEP mask or temporary PEP alone caused the improvements, because all patients also received daily exercise and a comprehensive pulmonary rehabilitation program. Do not treat the oxygen-need or flow subgroup differences as proven superiority, because the study was retrospective and the main between-group comparison showed no clear difference.