School of Physiotherapy, La Trobe University, , Melbourne, Victoria, Australia.
Thorax. 2014 Feb;69(2):137-43. doi: 10.1136/thoraxjnl-2013-203425. Epub 2013 Sep 4.
Positive expiratory pressure (PEP) is a technique used to enhance sputum clearance during acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The impact of PEP therapy during acute exacerbations on clinically important outcomes is not clear. This study sought to determine the effect of PEP therapy on symptoms, quality of life and future exacerbations in patients with AECOPD.
90 inpatients (58 men; mean age 68.6 years, FEV(1) 40.8% predicted) with AECOPD and sputum expectoration were randomised to receive usual care (including physical exercise)±PEP therapy. The Breathlessness, Cough and Sputum Scale (BCSS), St George's Respiratory Questionnaire (SGRQ) and BODE index (Body mass index, airflow Obstruction, Dyspnoea, Exercise tolerance) were measured at discharge, 8 weeks and 6 months following discharge, and analysed via linear mixed models. Exacerbations and hospitalisations were recorded using home diaries.
There were no significant between-group differences over time for BCSS score [mean (SE) at discharge 5.2 (0.4) vs 5.0 (0.4) for PEP and control group, respectively; p=0.978] or SGRQ total score [41.6 (2.6) vs 40.8 (2.8) at 8 weeks, p=0.872]. Dyspnoea improved more rapidly in the PEP group over the first 8 weeks (p=0.006), however these benefits were not observed at 6 months. Exacerbations (p=0.986) and hospitalisations (p=0.359) did not differ between groups.
We found no evidence that PEP therapy during AECOPD improves important short-term or long-term outcomes. There does not appear to be a routine role for PEP therapy in the management of such individuals.
呼气正压通气（PEP）是一种用于在慢性阻塞性肺疾病（COPD）急性加重期促进排痰的技术。PEP 治疗对急性加重期临床重要结局的影响尚不清楚。本研究旨在确定 PEP 治疗对 AECOPD 患者症状、生活质量和未来加重的影响。
90 名住院患者（58 名男性；平均年龄 68.6 岁，FEV1 预测值 40.8%）因 AECOPD 且有痰排出被随机分为接受常规治疗（包括运动锻炼）+PEP 治疗或常规治疗。在出院时、出院后 8 周和 6 个月，使用呼吸困难、咳嗽和咳痰量表（BCSS）、圣乔治呼吸问卷（SGRQ）和 BODE 指数（体重指数、气流阻塞、呼吸困难、运动耐量）进行测量，并通过线性混合模型进行分析。使用家庭日记记录加重和住院情况。
两组间在 BCSS 评分[出院时平均（SE）分别为 5.2（0.4）和 5.0（0.4）；p=0.978]或 SGRQ 总分[8 周时分别为 41.6（2.6）和 40.8（2.8）；p=0.872]方面均无显著的组间差异。PEP 组呼吸困难在最初 8 周内改善更快（p=0.006），但在 6 个月时未观察到这些益处。两组间加重次数（p=0.986）和住院次数（p=0.359）无差异。
我们没有发现 PEP 治疗在 COPD 急性加重期能改善重要的短期或长期结局的证据。PEP 治疗似乎不适合常规用于此类患者的管理。
