A Systematised Literature Review investigating the effects of Oscillating Positive Expiratory Pressure (OPEP) therapy on clinical outcomes in patients with Chronic Obstructive Pulmonary Disease (COPD)

Background: Use of airway clearance techniques to remove excess secretions is widely used in the management of COPD. Intra-thoracic Oscillating Positive Expiratory Pressure (OPEP) produces high-frequency oscillations and increases expiratory airflow, to create shearing forces, which reduce secretion viscosity and aid secretion mobilisation.
Aims: To establish the effects of OPEP on clinical outcomes in stable and acute exacerbations of COPD.
Methods: A comprehensive search of MEDLINE, Academic Search Complete, CINAHL complete, psychINFO, SPORTdiscus, TRIP, ProQuest Central, and PubMed was conducted in order to identify randomised controlled trials or randomised crossover studies, which investigated the effects of intrathoracic OPEP in COPD. Methodological rigour, quality and validity of each record was assessed with the PEDro scale.
Results: 322 participants from 10 studies were included. The results of the review showed a significant improvement in FVC, 6MWT and exertional breathlessness and slowed deterioration in FEV1 and was equally as effective in improving Sp02, sputum volume, and PEFR, as other ACTs in stable COPD. In AECOPD, OPEP significantly improved ABGs, significantly reduced the requirement and duration of NIV treatment and reduced hospital length of stay.
Conclusions: This review suggests that in stable COPD, OPEP is associated with an improvement in exercise capacity, and in acute exacerbation of COPD, reduces the requirement and duration of NIV treatment and reduces hospital length of stay. More long-term trials are required, particularly investigating the effect of OPEP as an adjunct to pulmonary rehabilitation.