Background: Oscillatory Positive Expiratory Pressure (OPEP) devices are intended to facilitate sputum clearance and reduce cough, but there is limited evidence for their effectiveness in COPD, or to guide patient selection. We aimed to assess the impact of OPEP therapy on quality of life and objective measures of cough and sleep disturbance in COPD patients with regular sputum production.
Methods: We enrolled stable COPD patients, who reported sputum production every day or most days, into an assessor-blind, parallel group, randomised controlled trial comparing three months of using an Acapella device against usual care (including use of the active cycle of breathing technique (ACBT)). The primary outcome was cough-related quality of life measured using the Leicester Cough Questionnaire (LCQ). Secondary outcomes included fatigue (FACIT score) and generic quality of life(EQ-5D). In a sub study(n=45), objective monitoring of cough and disturbance/movement during sleep were also available.
Results: 122 participants (61/61 OPEP/control) were recruited, 40% female, 17% smokers, FEV1 38(25-56)% predicted, and age 62±10 years. 103 completed the study (55/48 OPEP/control). Use of OPEP was associated with an improvement in LCQ compared to controls; MD [95% CI] +1.03[0.71 to 2.10]; (p=0.03), FACIT score +4.68[1.34 to 8.02];(p<0.001) and EQ-5D +4.00[0.49 to 19.75];(p=0.04). There was also an improvement in cough frequency -60[-43 to -95] coughs/24 hours (P<0.001), but no statistically significant effect on sleep disturbance was identified.
Conclusions: Regular use of an Acapella device improves symptoms and quality of life in people with COPD who produce sputum daily or most days.