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Adjuncts for sputum clearance in COPD: clinical consensus versus actual use
Ruth Barker1, Anthony A Laverty2, Nicholas S Hopkinson1
1NIHR Respiratory Disease, Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK.
BMJ Open Respiratory Research
|October 27, 2017
Summary
Prescribing data shows a 100-fold difference between carbocisteine and Oscillatory Positive Pressure devices (OPEP) for COPD. Physiotherapist attitudes vary, indicating a need for research on OPEP effectiveness in specific COPD patient groups.
Area of Science:
- Respiratory Medicine
- Pulmonology
- Clinical Practice
Background:
- Oscillatory Positive Pressure devices (OPEP) are adjuncts for sputum clearance in COPD, but evidence is incomplete.
- Physiotherapist attitudes towards OPEP in COPD care and device utilization versus medication prescription remain unstudied.
Purpose of the Study:
- To investigate the utilization of OPEP devices compared to prescribed medications for COPD.
- To explore physiotherapists' awareness, treatment thresholds, and preferences for OPEP devices.
Main Methods:
- Analysis of English prescribing data (2013-2015) from OpenPrescribing.net.
- Online survey of physiotherapists regarding OPEP device awareness, treatment criteria, and preferences (Acapella, Flutter, PEP mask).
Main Results:
- Carbocisteine and tiotropium were widely prescribed for COPD, while OPEP devices saw limited use (4989 prescribed).
- Survey revealed varied physiotherapist thresholds for OPEP use, with Acapella preferred (69%) over Flutter (24%) and PEP mask (6%).
Conclusions:
- A significant disparity exists in the prescription rates of carbocisteine versus OPEP devices for COPD.
- Varied physiotherapist perspectives on treatment thresholds underscore the need for research into OPEP efficacy in specific COPD patient phenotypes.
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