Oscillating Positive Expiratory Pressure Therapy May Be Performed Poorly by Children With Cystic Fibrosis

Area of Science:

• Pulmonary Medicine
• Pediatric Respiratory Care
• Medical Device Performance

Background:

• Oscillating positive expiratory pressure (OPEP) devices assist secretion removal and reduce gas trapping in hypersecretory lung diseases like cystic fibrosis.
• OPEP therapy involves exhaling against a resistor, creating positive airway pressure with fluctuations to enhance mucus clearance.
• Effective OPEP use requires achieving specific intrapulmonary pressure targets (10-20 cm H2O) with adequate expiratory flow.

Purpose of the Study:

• To evaluate the adherence to target therapeutic pressures during oscillating positive expiratory pressure therapy in pediatric cystic fibrosis patients.
• To assess the performance and technique variability of OPEP device use in a pediatric cystic fibrosis cohort.

Main Methods:

• Twenty-one pediatric cystic fibrosis patients with prior OPEP training were recruited.
• Performance was measured using an in-line flow and pressure sensor during participants' routine expirations.
• Standardized training and instruction were provided by a specialist physiotherapist prior to evaluation.

Main Results:

• No participants achieved the target therapeutic pressure ranges during OPEP use.
• The mean generated pressure was 16.2 ± 6.8 cm H2O, with a mean flow of 31.3 ± 8.9 L/min.
• The average expiration length was 2.5 ± 1.4 seconds, indicating potential technique limitations.

Conclusions:

• Significant variability in OPEP technique was observed among pediatric cystic fibrosis patients, despite standardized instruction.
• Poor patient technique compromised the effectiveness of airway clearance, potentially limiting the therapeutic benefits of OPEP.
• Further interventions may be needed to improve OPEP technique and optimize airway clearance in this population.