Effectiveness of temporary positive expiratory pressure (T-PEP) at home and at hospital in patients with severe chronic obstructive pulmonary disease

Valentina Mascardi, Bruna Grecchi, Cornelius Barlascini, Paolo Banfi, Antonello Nicolini

Research output: Contribution to journalArticle

Abstract

Background: Temporary positive airway pressure (T-PEP) is a tool recently introduced in the treatment of chronic obstructive pulmonary disease (COPD) or bronchiectasis. It demonstrated encouraging results also in severe COPD patients. The aim of this study is verify if adding T-PEP to best bronchodilator therapy both in clinic and home administering could reduce disease exacerbations and improve lung function in patients with severe COPD. Methods: A total of 142 patients with severe COPD (FEV1 < 50%) were enrolled; 120 were randomized in three groups: a group treated with T-PEP at home, a group with T-PEP at hospital and a group with medical therapy only (control group). Number of acute exacerbations COPD (AECOPD) after 1 month and 3 months were the primary outcomes. Secondary outcomes were changes in respiratory function parameters (FVC, FEV1, TLC, RV), arterial blood gases, dyspnea and health status assessment scales (Modified Medical Research Council (MMRC), Breathlessness, Cough and Sputum scale (BCSS) and COPD Assessment Test (CAT). The time of daily use of the T-PEP was registered as well as its acceptance using a Likert scale. Results: Ninety-nine patients completed the study. Both the groups who used T-PEP showed a statistical lower number of AECOPD after 1 month and 3 months (P < 0.01). Some respiratory functional parameters improved in the two groups treated with T-PEP (FVC, FEV1, RV) (P < 0.02) and dyspnea and health status assessment scales (MMRC, BCSS, CAT) (P < 0.04; P < 0.01; P < 0.009). The time of daily using was similar in the two T-PEP groups. Patients treated at home showed a greater acceptance than those treated at hospital (Likert scale 4.7 vs. 5.9) (P < 0.01). Conclusions: Patients treated with T-PEP showed a lower number of AECOPD. T-PEP improves functional respiratory parameters and improves dyspnea and health status assessment scales. No adherence difference in hospital and home treatment was found. Patients preferred home treatment.

Original languageEnglish
Pages (from-to)2895-2902
Number of pages8
JournalJournal of Thoracic Disease
Volume8
Issue number10
DOIs
Publication statusPublished - 2016

Fingerprint

Chronic Obstructive Pulmonary Disease
Pressure
Dyspnea
Health Status
Sputum
Cough
Biomedical Research
Group Homes
Therapeutics
Bronchiectasis
Bronchodilator Agents
Disease Progression
Gases
Lung
Control Groups

Keywords

  • Home administering
  • Hospital administering
  • Severe chronic obstructive pulmonary disease
  • Temporary expiratory pressure (T-PEP)

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Effectiveness of temporary positive expiratory pressure (T-PEP) at home and at hospital in patients with severe chronic obstructive pulmonary disease. / Mascardi, Valentina; Grecchi, Bruna; Barlascini, Cornelius; Banfi, Paolo; Nicolini, Antonello.

In: Journal of Thoracic Disease, Vol. 8, No. 10, 2016, p. 2895-2902.

Research output: Contribution to journalArticle

Mascardi, Valentina ; Grecchi, Bruna ; Barlascini, Cornelius ; Banfi, Paolo ; Nicolini, Antonello. / Effectiveness of temporary positive expiratory pressure (T-PEP) at home and at hospital in patients with severe chronic obstructive pulmonary disease. In: Journal of Thoracic Disease. 2016 ; Vol. 8, No. 10. pp. 2895-2902.
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AU - Banfi, Paolo

AU - Nicolini, Antonello

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AB - Background: Temporary positive airway pressure (T-PEP) is a tool recently introduced in the treatment of chronic obstructive pulmonary disease (COPD) or bronchiectasis. It demonstrated encouraging results also in severe COPD patients. The aim of this study is verify if adding T-PEP to best bronchodilator therapy both in clinic and home administering could reduce disease exacerbations and improve lung function in patients with severe COPD. Methods: A total of 142 patients with severe COPD (FEV1 < 50%) were enrolled; 120 were randomized in three groups: a group treated with T-PEP at home, a group with T-PEP at hospital and a group with medical therapy only (control group). Number of acute exacerbations COPD (AECOPD) after 1 month and 3 months were the primary outcomes. Secondary outcomes were changes in respiratory function parameters (FVC, FEV1, TLC, RV), arterial blood gases, dyspnea and health status assessment scales (Modified Medical Research Council (MMRC), Breathlessness, Cough and Sputum scale (BCSS) and COPD Assessment Test (CAT). The time of daily use of the T-PEP was registered as well as its acceptance using a Likert scale. Results: Ninety-nine patients completed the study. Both the groups who used T-PEP showed a statistical lower number of AECOPD after 1 month and 3 months (P < 0.01). Some respiratory functional parameters improved in the two groups treated with T-PEP (FVC, FEV1, RV) (P < 0.02) and dyspnea and health status assessment scales (MMRC, BCSS, CAT) (P < 0.04; P < 0.01; P < 0.009). The time of daily using was similar in the two T-PEP groups. Patients treated at home showed a greater acceptance than those treated at hospital (Likert scale 4.7 vs. 5.9) (P < 0.01). Conclusions: Patients treated with T-PEP showed a lower number of AECOPD. T-PEP improves functional respiratory parameters and improves dyspnea and health status assessment scales. No adherence difference in hospital and home treatment was found. Patients preferred home treatment.

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