Manometry Optimized Positive Expiratory Pressure (MOPEP) in Excessive Dynamic Airway Collapse (EDAC)

Area of Science:

• Respiratory Medicine
• Pulmonology
• Medical Devices

Background:

• Obstructive lung diseases often involve positive expiratory pressure (PEP) breathing, but quantifying airway pressures (AP) for efficacy is challenging.
• Excessive dynamic airway collapse (EDAC) causes significant dyspnea and reduced quality of life (QoL), with limited treatment options.

Purpose of the Study:

• To measure AP and exertional dyspnea in EDAC patients using various PEP modalities during rest and exercise.
• To evaluate the efficacy of pursed-lip breathing (PLB), nasal PEP (nPEP), and oral PEP (oPEP) in managing EDAC symptoms.

Main Methods:

• EDAC patients performed bicycle ergometry with normal breathing, PLB, nPEP, and oPEP.
• Airway pressures were measured using continuous topographic upper airway manometry.
• Dyspnea (BORG scores) and QoL (St. George's Respiratory Questionnaire - SGRQ-C) were assessed pre- and post-intervention.

Main Results:

• Expiratory laryngopharyngeal APs varied significantly across different PEP techniques and patients.
• Pursed-lip breathing (PLB) and oral PEP (oPEP) demonstrated the greatest reduction in BORG dyspnea scores for different patients.
• A 17-point decline in mean SGRQ-C scores was observed after one week of prescribed PEP therapy.

Conclusions:

• Upper airway manometry accurately measures laryngopharyngeal pressures during rest and exercise in EDAC patients.
• This technique aids in selecting and optimizing PEP breathing strategies to alleviate respiratory symptoms.
• PEP modalities, when properly selected, can significantly improve QoL in individuals with EDAC.