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Original Research

Oscillatory Positive Expiratory Pressure in Chronic Obstructive Pulmonary Disease

Sarah SvenningsenImaging Research Laboratories, Robarts Research Institute, The University of Western Ontario, London, Canada;Department of Medical Biophysics, The University of Western Ontario, London, Canada

Gregory A. PaulinImaging Research Laboratories, Robarts Research Institute, The University of Western Ontario, London, Canada;Department of Medical Biophysics, The University of Western Ontario, London, Canada

Khadija SheikhImaging Research Laboratories, Robarts Research Institute, The University of Western Ontario, London, Canada;Department of Medical Biophysics, The University of Western Ontario, London, Canada

Fumin GuoImaging Research Laboratories, Robarts Research Institute, The University of Western Ontario, London, Canada;Graduate Program in Biomedical Engineering, The University of Western Ontario, London, Canada

Aasim HasanyImaging Research Laboratories, Robarts Research Institute, The University of Western Ontario, London, Canada

Miranda KirbyImaging Research Laboratories, Robarts Research Institute, The University of Western Ontario, London, Canada;Department of Medical Biophysics, The University of Western Ontario, London, Canada

Roya Etemad RezaiDepartment of Medical Imaging, The University of Western Ontario, London, Canada

David G. McCormackDivision of Respirology, Department of Medicine, The University of Western Ontario, London, Canada

Grace ParragaImaging Research Laboratories, Robarts Research Institute, The University of Western Ontario, London, Canada;Department of Medical Biophysics, The University of Western Ontario, London, Canada;Graduate Program in Biomedical Engineering, The University of Western Ontario, London, Canada;Department of Medical Imaging, The University of Western Ontario, London, CanadaCorrespondence[email protected]

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Figures & data

Figure 1. Randomized crossover study design. At visit 1 participants were randomized to oPEP (dark-gray) or baseline care (light-gray) on a 1:1 allocation basis and after 3 or 4 weeks were crossed-over to the other option at visit 2 and evaluated a final time at visit 3. On-Off Treatment (—), participants randomized to oPEP and crossed-over to baseline care; Off-On Treatment (– –), participants randomized to baseline care and crossed-over to oPEP.

Table 1. Subject demographic and baseline measurements

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Table 2. Pre- and Post-oPEP measurements

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Figure 2. ³He MRI ventilation in representative sputum and non-sputum-producers. Pre- and post-oPEP ventilation (in cyan) registered to ¹H anatomical MRI (in grey-scale) for sputum- and non-sputum-producers. Yellow arrows identify regional differences in ³He ventilation post-oPEP. Sputum-producers: S11, 56 year-old female, Δ FEV₁ = −11%_pred, Δ FVC = −13%_pred, Δ 6MWD = −78m, Δ SGRQ = 20, Δ VDP = 6%. S7, 72 year-old female, Δ FEV₁ = −6% _pred, Δ FVC = −24% _pred, Δ 6MWD = −24m, Δ SGRQ = 19, Δ VDP = 4%. S8, 79 year-old female, Δ FEV₁ = 2%_pred, Δ FVC = 3%_pred, Δ 6MWD = −63m, Δ SGRQ = 2, Δ VDP = −3%. Non-sputum-producers: S25, 72 year-old female, Δ FEV₁ = −5%_pred, Δ FVC = 0%_pred, Δ 6MWD = −18m, Δ SGRQ = −3, Δ VDP = 3%. S23, 77 year-old female, Δ FEV₁ = −2%_pred, Δ FVC = −2%_pred, Δ 6MWD = 12m, Δ SGRQ = 2, Δ VDP = 1%. S28, 51 year-old male, Δ FEV₁ = −1%_pred, Δ FVC = −1%_pred, Δ 6MWD = −6m, Δ SGRQ = −11, Δ VDP = −1%.

Figure 2. 3He MRI ventilation in representative sputum and non-sputum-producers. Pre- and post-oPEP ventilation (in cyan) registered to 1H anatomical MRI (in grey-scale) for sputum- and non-sputum-producers. Yellow arrows identify regional differences in 3He ventilation post-oPEP. Sputum-producers: S11, 56 year-old female, Δ FEV1 = −11%pred, Δ FVC = −13%pred, Δ 6MWD = −78m, Δ SGRQ = 20, Δ VDP = 6%. S7, 72 year-old female, Δ FEV1 = −6% pred, Δ FVC = −24% pred, Δ 6MWD = −24m, Δ SGRQ = 19, Δ VDP = 4%. S8, 79 year-old female, Δ FEV1 = 2%pred, Δ FVC = 3%pred, Δ 6MWD = −63m, Δ SGRQ = 2, Δ VDP = −3%. Non-sputum-producers: S25, 72 year-old female, Δ FEV1 = −5%pred, Δ FVC = 0%pred, Δ 6MWD = −18m, Δ SGRQ = −3, Δ VDP = 3%. S23, 77 year-old female, Δ FEV1 = −2%pred, Δ FVC = −2%pred, Δ 6MWD = 12m, Δ SGRQ = 2, Δ VDP = 1%. S28, 51 year-old male, Δ FEV1 = −1%pred, Δ FVC = −1%pred, Δ 6MWD = −6m, Δ SGRQ = −11, Δ VDP = −1%.

Figure 3. Clinically relevant post-oPEP improvements. Values = n improved ≥ minimum-clinically important-difference (FEV₁, 6MWD, SGRQ Total Score), smallest detectable difference (VDP) or 1-point score improvement (PEQ). FEV₁, forced expiratory volume in 1 second; 6MWD, 6-minute walk distance; SGRQ, St. George's Respiratory Questionnaire total score; PEQ, Patient Evaluation Questionnaire; VDP, ventilation defect percent; ^* n = 13 for 6MWD and VDP.

Figure 3. Clinically relevant post-oPEP improvements. Values = n improved ≥ minimum-clinically important-difference (FEV1, 6MWD, SGRQ Total Score), smallest detectable difference (VDP) or 1-point score improvement (PEQ). FEV1, forced expiratory volume in 1 second; 6MWD, 6-minute walk distance; SGRQ, St. George's Respiratory Questionnaire total score; PEQ, Patient Evaluation Questionnaire; VDP, ventilation defect percent; * n = 13 for 6MWD and VDP.

Table 3. Correlations for post-oPEP changes in PEQ Ease-Bringing-Up-Sputum and PEQ Patient-Global-Assessment

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Figure 4. Relationships for post-oPEP changes in clinical measurements and change in ³He MRI VDP. Significant relationship for post-oPEP changes in ³He MRI VDP with A) FEV₁ (r = −0.50, r² = 0.25, p = 0.009), and B) PEQ Ease-Bringing-Up-Sputum (r = 0.65, r² = 0.39, p = 0.0004). Dotted lines = 95% confidence intervals.

Figure 4. Relationships for post-oPEP changes in clinical measurements and change in 3He MRI VDP. Significant relationship for post-oPEP changes in 3He MRI VDP with A) FEV1 (r = −0.50, r2 = 0.25, p = 0.009), and B) PEQ Ease-Bringing-Up-Sputum (r = 0.65, r2 = 0.39, p = 0.0004). Dotted lines = 95% confidence intervals.

Supplemental material

ICOP_1043523_SUPPLEMENTARY_TABLES.pdf

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Oscillatory Positive Expiratory Pressure in Chronic Obstructive Pulmonary Disease

Table 1. Subject demographic and baseline measurements

Table 2. Pre- and Post-oPEP measurements

Table 3. Correlations for post-oPEP changes in PEQ Ease-Bringing-Up-Sputum and PEQ Patient-Global-Assessment

ICOP_1043523_SUPPLEMENTARY_TABLES.pdf

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Oscillatory Positive Expiratory Pressure in Chronic Obstructive Pulmonary Disease

Figures & data

Table 1. Subject demographic and baseline measurements

Table 2. Pre- and Post-oPEP measurements

Table 3. Correlations for post-oPEP changes in PEQ Ease-Bringing-Up-Sputum and PEQ Patient-Global-Assessment

ICOP_1043523_SUPPLEMENTARY_TABLES.pdf

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