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Positive Expiratory Pressure for the Treatment of Acute Asthma Exacerbations: A Randomized Controlled Trial
Nidhya Navanandan1, Monica Federico2, Rakesh D Mistry1
1Children's Hospital Colorado, University of Colorado School of Medicine, Section of Pediatric Emergency Medicine, Aurora, CO.
Insights
Positive expiratory pressure (PEP) therapy did not significantly improve clinical severity in children with acute asthma in the emergency department. This intervention did not reduce the need for additional treatments or hospitalizations.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Care
- Clinical Trials
Background:
- Acute asthma exacerbations are a common reason for pediatric emergency department visits.
- Current treatment guidelines involve bronchodilators and corticosteroids, but some children require additional therapies.
- Positive expiratory pressure (PEP) therapy is a potential adjunctive treatment for improving airway clearance and reducing work of breathing.
Purpose of the Study:
- To evaluate the efficacy of a single, brief administration of PEP therapy in children with moderate-to-severe acute asthma.
- To determine if PEP therapy reduces clinical severity and the need for second-line treatments or hospitalization.
- To assess the impact of PEP therapy on emergency department length of stay and patient disposition.
Main Methods:
- A prospective randomized controlled trial was conducted with 52 children (2-18 years) presenting with moderate-to-severe asthma exacerbations.
- Participants received initial therapies and were then randomized to either PEP therapy or standard care.
- The primary outcome was the change in a physician-assessed Pulmonary Asthma Score; secondary outcomes included need for additional therapies and ED length of stay.
Main Results:
- No significant difference was observed in the primary outcome (change in Pulmonary Asthma Score) between the PEP group and the standard care group (P=0.12).
- Secondary outcomes, including the need for additional therapies, ED length of stay, and disposition, also showed no significant differences between the groups.
- Mild, self-resolving side effects were reported in a small number of patients receiving PEP therapy.
Conclusions:
- A single, brief administration of PEP therapy following first-line treatments does not improve clinical severity in pediatric patients with acute asthma presenting to the emergency department.
- PEP therapy, in this specific protocol, did not demonstrate a benefit in reducing the need for further interventions or shortening ED stays.
- Further research may be needed to explore different protocols or patient populations for PEP therapy in acute asthma management.
Objectives:
To evaluate the efficacy of brief, single administration of positive expiratory pressure (PEP) therapy in reducing clinical severity and need for additional second-line therapies and hospitalization in children presenting to the emergency department (ED) with acute asthma.
Study Design:
This was a prospective randomized controlled trial of children 2-18 years of age presenting to a tertiary-care academic pediatric ED with moderate-to-severe asthma exacerbations from December 2014 to June 2016. Children who continued to have moderate asthma severity after completion of initial therapies (albuterol/ipratropium bromide and corticosteroids) were randomized to receive PEP therapy or standard of care. The primary outcome was change in pulmonary asthma score before and after intervention, as assessed by a blinded physician. Secondary outcomes included need for additional therapies, ED length of stay, and disposition.
Results:
A total of 52 patients were randomized to receive either PEP (n?=?26) or standard therapy (n?=?26). Study groups were similar in demographics and baseline characteristics. There was no significant difference in primary outcome between groups with a mean change in Pulmonary Asthma Score of 0.92 (±1.2) in the PEP group and 0.40 (±1.2) in the standard group (P?=?.12). There also was no significant difference in need for additional therapies, ED length of stay, and disposition. Mild, self-resolving side effects were observed in 3 subjects receiving PEP therapy.
Conclusion:
Single, brief, administration of PEP therapy after completion of first-line therapies does not improve clinical severity in children presenting to the ED with acute asthma.
Trial Registration:
ClinicalTrials.gov: NCT02494076.
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