Oscillating positive expiratory pressure (OPEP) device therapy in Canadian respiratory disease management: Review, care gaps and suggestion for use

Abstract

Oscillating positive expiratory pressure (OPEP) devices are a non-pharmacologic therapy that can increase mobilization and elimination of airway mucus hypersecretions. In respiratory diseases such as chronic obstructive pulmonary disease, cystic fibrosis and others, mucus clearance can improve pulmonary mechanics and facilitate gas exchange, reduce breathlessness, prevent recurring infection, reduce exacerbations and hospitalization and improve quality of life. Several OPEP devices are available, although only a few have published evidence of efficacy, cost effectiveness and benefit to patients. We review the evidence and provide suggestions on inclusion of some OPEP devices in mucus clearance therapy regimens.

RÉSUMÉ

Les dispositifs à pression expiratoire positive oscillatoire (OPEP) sont une thérapie non pharmacologique qui augmente la mobilisation et l’élimination des hypersécrétions de mucus dans les voies respiratoires. Dans le cas de maladies respiratoires comme la maladie pulmonaire obstructive, la fibrose kystique et autres, le dégagement du mucus peut améliorer la mécanique pulmonaire et faciliter l’échange de gaz; réduire l’essoufflement; prévenir les infections récurrentes; réduire les exacerbations et l’hospitalisation; et améliorer la qualité de vie. Plusieurs dispositifs OPEP sont disponibles, bien que seulement quelques-uns d’entre eux aient publié des données probantes sur leur efficacité, leur efficience et les bienfaits qu’ils entraînent pour les patients. Nous examinons les données probantes et présentons des suggestions pour l’inclusion de dispositifs OPEP dans les thérapies de dégagement du mucus.

Keywords:

• Chronic obstructive pulmonary disease (COPD)
• cystic fibrosis
• oscillating positive expiratory pressure (OPEP)
• mucus hypersecretion
• respiratory disease management
• mucociliary clearance

Acknowledgments

No funding, consultation fee or honorarium was provided to J. Bourbeau, R.A. McIvor or A. Kaplan for this article. H. Devlin provided research and writing assistance.

Disclosures

J. Bourbeau is on the Advisory Board or Speakers bureau for: Astra Zeneca, Boehringer Ingelheim, Grifols, GSK, Novartis and Trudell. Bourbeau’s research grants were administered by the Research Institute of the MUHC: Aerocrine, Astra Zeneca, Boehringer Ingelheim, Grifols, GSK and Novartis. Andrew McIvor has received Honoraria for providing CME, attending Advisory Boards and Clinical trials for Astra-Zeneca, Boehringer-Ingelheim, GSK, Merck, Novartis, Takeda, Teva and Trudell. McIvor is an employee of McMaster University and St. Joseph's Healthcare, Hamilton Ontario. Hollie Devlin has received Honoraria received from Trudell Medical International. Alan Kaplan is on the Advisory Board or Speakers bureau for: Astra Zeneca. Benton Dickinson, Boehringer Ingelheim, Grifols GSK, Johnson & Johnson, Mylan, Merck, Novartis, Novo Nordisk, Paladdin, Pfizer, Purdue, Sanofi, Takeda and Trudell.