Comparación de la respiración con presión positiva intermitente y la presión espiratoria positiva temporal en pacientes con enfermedad pulmonar obstructiva crónica grave / Comparison of Intermittent Positive Pressure Breathing and Temporary Positive Expiratory Pressure in Patients With Severe Chronic Obstructive Pulmonary Disease

ANTECEDENTES: Los resultados que respaldan el uso y la efectividad de los dispositivos de presión espiratoria positiva en pacientes con enfermedad pulmonar obstructiva (EPOC) continúan siendo objeto de controversia. Hemos evaluado la hipótesis de que la adición de la TPEP o la IPPB a un tratamiento farmacológico estándar pueda aportar un beneficio clínico adicional respecto al tratamiento farmacológico solo en los pacientes con EPOC grave. MÉTODOS: Un total de 45 pacientes fueron asignados aleatoriamente a los 3 grupos siguientes: un grupo fue tratado con IPPB, otro fue tratado con TPEP y un tercer grupo recibió únicamente tratamiento farmacológico (grupo de control).Las variables de valoración principales fueron la puntuación de la escala o cuestionario relativo a la disnea (escala del MRC); la de disnea, tos y esputo (BCSS); y la de calidad de vida (test de evaluación de la EPOC) (CAT). Las variables de valoración secundarias fueron las pruebas de la función respiratoria, la gasometría arterial y los análisis hematológicos. RESULTADOS: Tanto los pacientes del grupo de IPPB como los del grupo de TPEP mostraron una mejoría significativa en 2 de las 3 evaluaciones (MRC y CAT) en comparación con el grupo de control. Sin embargo, en el análisis de comparación de los grupos para las mismas variables en el grupo de IPPB frente al grupo de TPEP observamos una mejoría significativa en el grupo de IPPB (p ≤ 0,05 para la escala del MRC y p ≤ 0,01 para el CAT).La diferencia de efecto de las 2 técnicas se pone de manifiesto en los resultados de las pruebas de la función pulmonar: la IPPB aumenta los valores de FVC, FEV1 y MIP; esto refleja su capacidad de aumentar el volumen pulmonar. Por su parte, la TPEP aumenta la FVC y el FEV1 (en menor medida que la IPPB), pero eleva la MEP, mientras que reduce la capacidad pulmonar total y el volumen residual. CONCLUSIONES: Las 2 técnicas (IPPB y TPEP) mejoran significativamente la disnea, los instrumentos de valoración de la calidad de vida y la función pulmonar en los pacientes con una EPOC grave. La IPPB mostró una mayor efectividad en la mejora de los instrumentos de evaluación de la disnea y la calidad de vida (MRC y CAT) en comparación con la TPEP

BACKGROUND: Results supporting the use and the effectiveness of positive expiratory, pressure devices in chronic obstructive pulmonary disease (COPD) patients are still controversial, We have tested the hypothesis that adding TPEP or IPPB to standard pharmacological therapy may provide additional clinical benefit over, pharmacological therapy only in patients with severe COPD. METHODS: Fourty-five patients were randomized in three groups: a group was treated; with IPPB, a group was treated with TPEP and a group with pharmacological; therapy alone (control group). Primary outcome measures included the measurement of scale or, questionnaire concerning dyspnea (MRC scale), dyspnea, cough, and, sputum (BCSS) and quality of life (COPD assessment test) (CAT). Secondary, outcome measures were respiratory function testing, arterial blood gas, analysis, and hematological examinations. RESULTS: Both patients in the IPPB group and in the TPEP group showed a significant, improvement in two of three tests (MRC, CAT) compared to the control, group. However, in the group comparison analysis for, the same variables between IPPB group and TPEP group we observed a, significant improvement in the IPPB group (P≤0.05 for MRC and P≤0.01 for, CAT).The difference of action of the two techniques are evident in the results of, pulmonary function testing: IPPB increases FVC, FEV1, and MIP; this reflects, its capacity to increase lung volume. Also TPEP increases FVC and FEV1 (less, than IPPB), but increases MEP, while decreasing total lung capacity and, residual volume. CONCLUSIONS: The two techniques (IPPB and TPEP) improves significantly dyspnea; quality of; life tools and lung function in patients with severe COPD. IPPB demonstrated a greater effectiveness to improve dyspnea and quality of life tools (MRC, CAT) than TPEP

Comparison of intermittent positive pressure breathing and temporary positive expiratory pressure in patients with severe chronic obstructive pulmonary disease.

BACKGROUND: Results supporting the use and the effectiveness of positive expiratory, pressure devices in chronic obstructive pulmonary disease (COPD) patients are still controversial, We have tested the hypothesis that adding TPEP or IPPB to standard pharmacological therapy may provide additional clinical benefit over, pharmacological therapy only in patients with severe COPD. METHODS: Fourty-five patients were randomized in three groups: a group was treated; with IPPB,a group was treated with TPEP and a group with pharmacological; therapy alone (control group). Primary outcome measures included the measurement of scale or, questionnaire concerning dyspnea (MRC scale),dyspnea,cough, and, sputum (BCSS) and quality of life (COPD assessment test) (CAT). Secondary, outcome measures were respiratory function testing,arterial blood gas,analysis,and hematological examinations. RESULTS: Both patients in the IPPB group and in the TPEP group showed a significant, improvement in two of three tests (MRC,CAT) compared to the control, group.However,in the group comparison analysis for, the same variables between IPPB group and TPEP group we observed a, significant improvement in the IPPB group (P≤.05 for MRC and P≤.01 for, CAT). The difference of action of the two techniques are evident in the results of, pulmonary function testing: IPPB increases FVC, FEV1, and MIP; this reflects, its capacity to increase lung volume. Also TPEP increases FVC and FEV1 (less, than IPPB), but increases MEP, while decreasing total lung capacity and, residual volume. CONCLUSIONS: The two techniques (IPPB and TPEP) improves significantly dyspnea; quality of; life tools and lung function in patients with severe COPD. IPPB demonstrated a greater effectiveness to improve dyspnea and quality of life tools (MRC, CAT) than TPEP.

Effectiveness of treatment with high-frequency chest wall oscillation in patients with bronchiectasis.

BACKGROUND: High-frequency airway clearance (HFCWC) assist devices generate either positive or negative trans-respiratory pressure excursions to produce high-frequency, small-volume oscillations in the airways.HFCWC can lead to changes in volume of 15-57 ml and in flow up to 1.6 L/s, which generate minimal coughing to mobilize secretions. The typical treatment lasts 20-30 minutes, and consists of short periods of compression at different frequencies, separated by coughing.The aim of this study was to find the more efficacious treatment in patients with bronchiectasis: traditional techniques of chest physiotherapy (CPT) versus high frequency oscillation of the chest wall in patients with bronchiectasis. METHODS: 37 patients were enrolled. Seven of them were excluded. Computer randomization divided the patients into three groups: - 10 patients treated with HFCWO by using the Vest® Airway Clearance System; - 10 patients treated with traditional techniques of air way clearance (PEP bottle, PEP mask, ELTGOL, vibratory positive expiratory pressure); - 10 patients received medical therapy only (control group). To be eligible for enrollment, participants had to be between 18 and 85 years old and have a diagnosis of bronchiectasis, confirmed on high resolution computed tomography. EXCLUSION CRITERIA: lack of informed consent, signs of exacerbation, cystic fibrosis. Before the treatment, each patient had blood tests, sputum volume and cell count, pulmonary function tests and on the quality of life inventories (MMRC, CAT, BCSS). The results were processed through the covariance analysis, performed with the R-Project statistical program. It has been considered a positive result p <005. RESULTS: Both treatments (traditional CPT and HFCWO) showed a significant improvement in some biochemical and functional respiratory tests as well as in the quality of life compared to the control group. The use of HFCWO compared to CPT also produced a significant improvement in blood inflammation parameter C-RP (p ≤0.019), parameters of lung functionality associated with bronchial obstruction (FVC, FEV1) (p ≤0.006 and p ≤0.001), and in the dyspnea. Improvement in quality of life scales was noted. (BCSS, CAT) (both p ≤0.001). No significant changes of total cell counts in sputum samples were observed in the two groups. In the HFCWO group a significant reduction of neutrophils percentage (p≤0.002) and a significant increase of macrophages percentage (p ≤0.012). CONCLUSIONS: The HFCWO technique provides an improvement both in pulmonary function and quality of life related parameters in patients with chronic hypersecretive disease. Since those patients need daily airway clearance, this treatment should be included among the principal options in chest physiotherapy. The study was registered as ChiCTR-TRC-12002134 at http://www.chictr.org.