Department of Medical and Surgical Sciences, University of Modena, Pavullo-Modena, Italy.
Clin Rehabil. 2013 Apr;27(4):336-46. doi: 10.1177/0269215512458940. Epub 2012 Sep 11.
To evaluate whether temporary positive expiratory pressure provides benefit in patients with lung diseases and chronic hypersecretion.
Single blind multicentre randomized trial.
Five Italian rehabilitation centres.
Ninety-eight patients with chronic obstructive pulmonary disease and/or chronic bronchitis (n=78), or bronchiectasis (n=20), with a peak cough expiratory flow >150 l/min and sputum production >30 ml/day, randomly included into two treatment groups.
For 10 consecutive days, the active group performed twice a day 20-minute cycles of manually assisted breathing techniques in sequence with the addition of 15 minutes of temporary positive expiratory pressure, while the control group was treated by manually assisted breathing techniques alone.
Within and between group changes of arterial oxygenation index, lung volumes and respiratory muscles strength were recorded at enrolment and after 3 and 10 treatment sessions. Pre-to-post treatment change of sputum volume and bronchial encumbrance (Δ-visual analog scale), sputum density and purulence were compared daily within the study period.
No significant changes were recorded for the oxygenation index, while dynamic lung volumes and respiratory muscle strength significantly (P <0.05) improved in the active group. The group comparison analysis of the pre-to-post change showed that inspiratory capacity was significantly higher in the active than in the control group (+19.5% and +2.2%, P=0.044) at day 10. A greater improvement in Δ-visual analog scale was recorded in the active group at day 3 and 8.
These preliminary data suggest that temporary positive expiratory pressure improves lung volumes and speeds up the improvement of bronchial encumbrance in patients with lung diseases and hypersecretion.
评估临时正压呼气是否对肺部疾病和慢性高分泌患者有益。
单盲多中心随机试验。
五家意大利康复中心。
98 名慢性阻塞性肺疾病和/或慢性支气管炎患者（n=78）或支气管扩张症患者（n=20），峰值咳嗽呼气流量>150 l/min，痰液生成量>30 ml/天，随机分为两组。
在 10 天内，主动组每天进行两次手动辅助呼吸技术的 20 分钟循环，同时额外进行 15 分钟的临时正压呼气，而对照组仅接受手动辅助呼吸技术治疗。
在入组时和治疗后 3 天和 10 天时记录动脉血氧指数、肺容积和呼吸肌力量的组内和组间变化。在研究期间，每天比较治疗前后痰液量和支气管阻塞（Δ-视觉模拟量表）、痰液密度和脓性的变化。
氧合指数无明显变化，而主动组的动态肺容积和呼吸肌力量显著（P<0.05）改善。治疗前后的组间比较分析显示，在第 10 天，主动组的吸气量明显高于对照组（+19.5%和+2.2%，P=0.044）。在第 3 天和第 8 天，主动组的Δ-视觉模拟量表改善更为显著。
这些初步数据表明，临时正压呼气可改善肺部容积，并加速肺部疾病和高分泌患者支气管阻塞的改善。
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