Oscillatory Positive Expiratory Pressure (OPEP) therapy in COPD
File(s)
Author(s)
Alghamdi, Saeed Mardy K
Type
Thesis
Abstract
People with chronic obstructive pulmonary disease (COPD) commonly have a productive cough
due to mucus hypersecretion. Clearing mucus from the chest can be difficult, as lung hyperinflation, respiratory muscle dysfunction and premature airway collapse impede the ability
to generate an effective cough. Airway Clearance Techniques (ACTs) with the use of oscillating
positive expiratory pressure (OPEP) devices can be added to the usual care for sputum clearance.
However, assessment of the effect of OPEP devices is so far based on short-term studies with
low-grade evidence and there is a lack of information regarding their long-term impact and
effectiveness. In this thesis, I have four results chapters to discuss this gap. First, using accepted
systematic review methodology to rigorously examine the current evidence on the use of OPEP
devices for the treatment of cough and sputum clearance in patients with COPD who frequently
produce sputum. Second, conduct a randomised clinical trial (acronym: O-COPD) to evaluate the
impact of an OPEP device (the Acapella) on the health-related quality of life in patients with COPD
over three-months. Third, study cough characteristics and its relationship to overnight sleep disturbances. Fourth, evaluate the impact of an OPEP device (the Acapella) on cough frequency
and sleep actigraphy in a subset of the O-COPD group. In summary, results from the O-COPD trial,
coupled with the systematic review, can address the concerns raised regarding the long-term
effectiveness of OPEP devices in treating sputum aspects in stable COPD patients. COPD patients
with sputum production who received OPEP treatment for three months, compared to the usual
care, demonstrated better disease management and improvement in general and cough-related
quality of life (LCQ). The findings suggest that adding the OPEP device is effective in optimising
the usual care and, perhaps, can be the new mode of usual care in managing cough and sputum
production in COPD patients. Larger and longer clinical trials are required to guide the long-term
use of OPEP and patient selection.
due to mucus hypersecretion. Clearing mucus from the chest can be difficult, as lung hyperinflation, respiratory muscle dysfunction and premature airway collapse impede the ability
to generate an effective cough. Airway Clearance Techniques (ACTs) with the use of oscillating
positive expiratory pressure (OPEP) devices can be added to the usual care for sputum clearance.
However, assessment of the effect of OPEP devices is so far based on short-term studies with
low-grade evidence and there is a lack of information regarding their long-term impact and
effectiveness. In this thesis, I have four results chapters to discuss this gap. First, using accepted
systematic review methodology to rigorously examine the current evidence on the use of OPEP
devices for the treatment of cough and sputum clearance in patients with COPD who frequently
produce sputum. Second, conduct a randomised clinical trial (acronym: O-COPD) to evaluate the
impact of an OPEP device (the Acapella) on the health-related quality of life in patients with COPD
over three-months. Third, study cough characteristics and its relationship to overnight sleep disturbances. Fourth, evaluate the impact of an OPEP device (the Acapella) on cough frequency
and sleep actigraphy in a subset of the O-COPD group. In summary, results from the O-COPD trial,
coupled with the systematic review, can address the concerns raised regarding the long-term
effectiveness of OPEP devices in treating sputum aspects in stable COPD patients. COPD patients
with sputum production who received OPEP treatment for three months, compared to the usual
care, demonstrated better disease management and improvement in general and cough-related
quality of life (LCQ). The findings suggest that adding the OPEP device is effective in optimising
the usual care and, perhaps, can be the new mode of usual care in managing cough and sputum
production in COPD patients. Larger and longer clinical trials are required to guide the long-term
use of OPEP and patient selection.
Version
Open Access
Date Issued
2022-05
Date Awarded
2022-09
Copyright Statement
Creative Commons Attribution NonCommercial Licence
License URL
Advisor
Hopkinson, Nicholas
Polkey, Michael
Birring, Surinder
Sponsor
Saudi Arabia. Safārah (UK)
Imperial College London
Umm Al-Qura University
Publisher Department
National Heart & Lung Institute
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)