Kosura Nimit, Nwe Aung Aung, Phimphasak Chatchai, Chumpangern Worawat, Sriya Kongrit, Ubolsakka-Jones Chulee
Department of Physical Therapy Prince of Songkla University.
School of Physical Therapy Khon Kaen University.
Can J Respir Ther. 2025 Jun 16;61:132-144. doi: 10.29390/001c.138738. eCollection 2025.
Conical-positive expiratory pressure (conical-PEP) has been applied during exercise to improve exercise capacity, dynamic hyperinflation (DH), and dyspnea in COPD. However, evidence remains limited regarding the individualized selection of its resistor (orifice size) and its effects on exercise duration, DH development, and dyspnea.
A randomized crossover trial was conducted to evaluate the effects of conical-PEP. Participants performed spot marching exercise while breathing through a conical-PEP device with a mask, compared to a sham-PEP condition in which a similar mask was worn without the conical-PEP component. The conical-PEP resistor was selected to achieve the minimum required PEP level, calculated by the proposed formula, while ensuring that pressure did not exceed 35 cmH₂O. Exercise endurance time, end-exercise inspiratory capacity (IC) to assess DH, and dyspnea using the modified Borg scale were recorded.
Twenty moderate to severe COPD subjects (19 male, 1 female, age 67.40 ± 8.22 years, FEV1% predicted 56.05 ± 16.90) participated. Conical-PEP resulted in longer exercise time (4.98 ± 2.97 minutes) than sham-PEP (3.99 ± 2.19 minutes, p = 0.004). End-exercise IC was significantly better in conical-PEP (1.51 [1.24, 1.85] L) than sham-PEP (1.42 [1.16, 1.84] L, = 0.020). Dyspnea was significantly lower in conical-PEP at iso-time (4 [4, 5]) compared to sham-PEP (5 [5, 6], = 0.005), though no significant difference was found at end exercise.
Conical-PEP with minimum required PEP level improves exercise capacity, delays DH development, and delays dyspnea onset in COPD patients.
锥形呼气末正压（conical-PEP）已应用于运动过程中，以改善慢性阻塞性肺疾病（COPD）患者的运动能力、动态肺过度充气（DH）和呼吸困难。然而，关于其电阻器（孔口大小）的个体化选择及其对运动持续时间、DH发展和呼吸困难的影响，证据仍然有限。
进行了一项随机交叉试验，以评估锥形呼气末正压（conical-PEP）的效果。与佩戴类似面罩但无conical-PEP组件的假PEP情况相比，参与者在通过带有面罩的conical-PEP装置呼吸的同时进行原地踏步运动。选择conical-PEP电阻器以达到通过提议公式计算出的最低所需PEP水平，同时确保压力不超过35 cmH₂O。记录运动耐力时间、运动结束时用于评估DH的吸气容量（IC）以及使用改良的Borg量表评估的呼吸困难情况。
20名中度至重度COPD受试者（19名男性，1名女性，年龄67.40±8.22岁，预测FEV1%为56.05±16.90）参与了研究。与假PEP（3.99±2.19分钟，p = 0.004）相比，conical-PEP导致更长的运动时间（4.98±2.97分钟）。运动结束时的IC在conical-PEP组（1.51 [1.24, 1.85] L）显著优于假PEP组（1.42 [1.16, 1.84] L，p = 0.020）。在相同时间点，conical-PEP组的呼吸困难程度（4 [4, 5]）显著低于假PEP组（5 [5, 6]，p = 0.005），尽管在运动结束时未发现显著差异。
具有最低所需PEP水平的conical-PEP可提高COPD患者的运动能力，延缓DH的发展，并延迟呼吸困难的发作。
