Acute Effects of Oscillatory PEP and Thoracic Compression on Secretion Removal and Impedance of the Respiratory System in Non-Cystic Fibrosis Bronchiectasis

• Published in: Respiratory care Vol. 64; no. 7; pp. 818 - 827
• Main Authors: de Souza Simoni, Letícia Helena, Dos Santos, Daniele Oliveira, de Souza, Hugo Celso Dutra, Baddini-Martinez, José Antonio, Santos, Marcel Koenigkam, Gastaldi, Ada Clarice
• Format: Journal Article
• Language: English
• Published: United States Daedalus Enterprises, Inc 01-07-2019
• Subjects: Analysis; Bronchiectasis; Care and treatment; Cystic fibrosis; Fibrosis; Medical research; Patient monitoring equipment; Physical therapy; Brazil; pulmonary function; chest physiotherapy; impulse oscillometry; bronchiectasis
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.06025

Bronchiectasis is characterized by abnormal and permanent dilatation of the bronchi, caused mainly by the progression of inflammatory processes and loss of the ability to remove mucus. Techniques to clear the airways are essential for the treatment of these patients. In this study, we aimed to evaluate the acute effects of oscillatory PEP and thoracic compression on both the clearance of secretions and impedance of airways in subjects with bronchiectasis.
This was a randomized crossover single-blinded study that involved both subjects with bronchiectasis and healthy subjects evaluated by using an impulse oscillometry system, which assessed resistance at 5 Hz and resistance 20 Hz, reactance at 5 Hz, reactance area, and resonant frequency, before, after, and 30 min after oscillatory PEP, chest compression, or control sessions. Dry and total weights, adhesiveness, purulence of the expectorated secretions, the dyspnea scale score, the acceptability and tolerance scale score, pulse oximetry, and difficulty in expectoration were also assessed.
The dry and total weights of secretions were higher after the use of the oscillatory PEP technique than those in a control session (
= .005 and
= .039, respectively). In the bronchiectasis group, there was a decrease after oscillatory PEP in total airway resistance (
= .04), peripheral resistance (
= .005), and reactance area (
= .001). After compression, there was a decrease in peripheral resistance Hz (
= .001) and reactance area (
= .001). In the healthy group, there was an increase in resistance at 5 Hz (
= .02) after oscillatory PEP. There were no differences in acceptability and tolerance, dyspnea, and oxygen saturation.
The oscillatory PEP technique was effective for the removal of secretions and in decreasing total and peripheral respiratory system resistance; thoracic compression had comparable positive effects on the peripheral resistance. Both techniques were safe and well tolerated by the subjects with bronchiectasis. ClinicalTrials.gov registration NCT02509637.).