Positive Expiratory Pressure Device Shows Some Results for Patients With COPD

Alison Rodriguez

Adjunctive therapy with a positive expiratory pressure (PEP) device may possibly decrease the length of hospital stays for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), researchers suggested in a set of 2 small studies published in the International Journal of Chronic Obstructive Pulmonary Disease. 

Comprehensive, multicenter, randomized controlled trials are needed, the researchers said.

The 2 studies tried to determine if therapy with a PEP device with or without an oscillatory mechanism (OM) in addition to standard care would result in a reduction in hospital length of stay (LOS) of AECOPD patients.

“Despite the need for effective, safe, and convenient treatment for mucus hypersecretion, there are limited options for mucus clearance devices,” explained the authors. “Non-pharmacologic therapies in COPD with the use of positive expiratory pressure (PEP), oscillatory positive expiratory pressure (OPEP), and/or forced expiratory techniques (FET) have been studied to evaluate their usefulness in improving expectoration of secretions, response to bronchodilator therapy, lung function, and mortality; limited data support their efficacy as adjunct therapy to standard COPD treatment.”

Study 1, a prospective trial, enrolled 91 patients admitted with AECOPD and sputum production in order to compare PEP therapy to Oscillatory PEP (OPEP) therapy. Median hospital LOS was 3.2 days (95% CI, 3.0–4.3) in the OPEP group and 4.8 days (95% CI 3.9–6.1) in the PEP group (P = .16). 

Study 2, a retrospective historical cohort, matched 182 patients to compare to prospectively collected data to determine the effect of PEP ± OM versus standard care on hospital LOS. In fully adjusted models comparing the prospective trial data with the retrospective cohort (Study 2; 182 subjects), there was a median hospital LOS of 4.2 days (95% CI, 3.8–5.1) versus 5.2 days (95% CI, 4.4–6.0) in controls, consistent with a shorter hospital LOS with adjunctive PEP±OM therapy versus standard care (P = .04).

While the cohort study generated positive findings, the randomized controlled trial in study 1 was negative. Taken together, this suggests that PEP with or without OM may be beneficial, but would require confirmation with a larger randomized controlled sample.

“A combination of non-pharmacologic therapies to assist in mucociliary clearance in patients with chronic obstructive pulmonary disease appears to be safe and effective in lowering hospital LOS during an AECOPD and has the potential of improving overall COPD-related health outcomes such as quality of life indicators and overall survival. This study suggests that the essential underlying components are positive expiratory pressure with forced expiratory techniques (“huff coughs”) with or without oscillations,” concluded the authors.

Further research, such as multicenter prospective trials, is needed in order to characterize the role of these interventions in AECOPD management, the authors said.


Milan S, Bondalapati P, Megally M, et al. Positive expiratory pressure therapy with and without oscillation and hospital length of stay for acute exacerbation of chronic obstructive pulmonary disease [published online November 20, 2019]. Int J Chron Obstruct Pulmon Dis.

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