Positive Expiratory Pressure Therapy With And Without Oscillation And Hospital Length Of Stay For Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Abstract

Introduction

Pharmacologic management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is well-established. Our aim in the current study is to determine if therapy with a positive expiratory pressure (PEP) device with or without an oscillatory mechanism (OM) in addition to standard care results in a reduction in hospital length of stay (LOS) among patients hospitalized for AECOPD.

Methods

Two studies were performed and are reported here. Study 1: Patients admitted with AECOPD and sputum production were enrolled in a prospective trial comparing PEP therapy versus Oscillatory PEP (OPEP) therapy. Study 2: A retrospective historical cohort, matched in a 2 to 1 manner by age, gender, and season of admission, was compared with the prospectively collected data to determine the effect of PEP ± OM versus standard care on hospital LOS.

Results

In the prospective trial (Study 1; 91 subjects), median hospital LOS was 3.2 (95% CI 3.0–4.3) days in the OPEP group and 4.8 (95% CI 3.9–6.1) days in the PEP group (p=0.16). In fully adjusted models comparing the prospective trial data with the retrospective cohort (Study 2; 182 subjects), cases had 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=0.04).

Conclusion

Adjunctive therapy with a PEP device versus standard care may reduce hospital LOS in patients admitted for AECOPD. Although the addition of an OM component to PEP therapy suggests a further reduction in hospital LOS, comprehensive multicenter randomized controlled trials are needed to confirm these findings.

Clinical trial registration number

NCT3094806.

Keywords:

• length of stay
• acute exacerbation of COPD
• PEP
• hospitalization

Acknowledgments

The authors wish to thank Vrajesh Patel, MD, and Christina Edwards for their contribution to this work. This research was made possible by the provision of OPEP devices (Acapella Choice) from Smiths Medical. No other monetary compensation was provided. This was an investigator-initiated study. Smiths Medical had no role in conception, design, acquisition of data, analysis and interpretation of data, or manuscript preparation. These findings were presented at the American Thoracic Society International Conferences in both 2014 and 2016 as poster presentations with interim findings. The poster’s abstracts were published in “Poster Abstracts” with the references as follows: Am J Respir Crit Care Med 189;2014:A5196; and Am J Respir Crit Care Med 193;2016:A5196.

Abbreviations

AECOPD, acute exacerbation of chronic obstructive pulmonary disease; COPD, chronic obstructive pulmonary disease; PEP, positive expiratory pressure; OPEP, oscillatory positive expiratory pressure; OM, oscillatory mechanism; LOS, length of stay; FET, forced expiratory technique; CHF, congestive heart failure; FRC, functional residual capacity.

Disclosure

The authors report no conflicts of interest in this work.