Introduction Oscillatory positive pressure devices can be used as adjuncts to improve sputum clearance in COPD, though the evidence base is incomplete. The attitudes of physiotherapists towards the place of these devices in the care of COPD patients is not known. In addition, their actual use in practice compared to the prescription of medications has not been studied.
Methods We analysed English prescribing data, obtained from OpenPrescribing.net, for a three year period from 2013. In addition we conducted an online survey of members of the Association of Chartered Physiotherapists in Respiratory Care (ACPRC) asking about awareness of devices, thresholds for treatment and device preference.
Results Out of a potential 3.2 million COPD patient years of treatment between 2013-2015, 422,744 patient years of treatment with carbocisteine, at a cost of £73 million were prescribed, as well as 1.1 million years treatment with tiotropium. In the same period only 4,989 OPEP devices were prescribed. Given overlapping indications for OPEP devices and carbocisteine this disparity requires explanation. There were 116 responses to the survey (12% response rate), 72% in hospital practice, 28% based in the community. There were variations in respondents’ threshold for treatment with sputum adjuncts in COPD. Asked to choose between the Acapella®, Flutter® and Positive Expiratory Pressure mask (PEP), if only one were available, preferences were 69%, 24% and 6% respectively.
Conclusions There is a one-hundred fold difference between use of carbocisteine and OPEP devices in COPD, with far fewer devices being prescribed than are included in the phenotypes that clinicians believe they are effective in. Variation in physiotherapist attitudes to treatment thresholds highlights the need for research into the effectiveness of OPEP devise in specific patient phenotypes.