Abstract
Introduction: Dynamic hyperinflation is an important target in the treatment of COPD. There is increasing evidence that positive expiratory pressure (PEP) could reduce dynamic hyperinflation during exercise. PEP application through a nasal mask and a flow resistance device might have the potential to be used during daily physical activities as an auxiliary strategy of ventilatory assistance. The aim of this study was to determine the effects of nasal PEP on lung volumes during physical exercise in patients with COPD.
Methods: 20 subjects (mean age 69.4 ± 6.4 years) with stable, mild-to-severe COPD were randomized to undergo physical exercise with nasal PEP breathing, followed by physical exercise with habitual breathing, or vice versa. Physical exercise was induced by a standard six-minute walk test (6MWT) protocol. PEP was applied by means of a silicone nasal mask loaded with a fixed-orifice flow resistor. Body plethysmography was performed immediately pre- and post-exercise.
Results: Differences in mean pre- to post-exercise changes in TLC (-0.63 ± 0.80 L; p = 0.002), FRC (-0.48 ± 0.86 L; p = 0.021), RV (-0.56 ± 0.75 L; p = 0.004), SpO2(-1.7 ± 3.4 %; p = 0.041) and 6MWT distance (-30.8 ± 30.0 m; p = 0.001) were statistically significant between the experimental and the control interventions.
Conclusions: The use of flow-dependent expiratory pressure, applied with a nasal mask and a PEP device, might promote significant reduction of dynamic hyperinflation during walking exercise. Further studies are warranted addressing improvements in endurance performance under regular application of nasal PEP during physical activities.
- Airway Resistance
- Chronic Obstructive Pulmonary Disease
- Dyspnea
- Lung Capacities
- Positive-Pressure Respiration
- Respiration
Footnotes
- Corresponding author Dr. Thomas Wibmer University Hospital of Ulm Dept. Internal Medicine II Albert-Einstein-Allee 23 89081 Ulm, Germany Tel.: +49 731500-45022; fax: +49 731500-45023. E-mail: thomas.wibmer{at}uniklinik-ulm.de
T.W., W.R. and C.S. conceived the study. Acquisition and interpretation of data was done by T.W., S.R., C.H., C.K., I.B. and K.M.S. All authors contributed to data analysis, literature search, drafting the manuscript, and approved the final version.
The authors certify that there is no conflict of interest and that there was no financial or non-finacial support.
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