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Comparison of Intermittent Positive Pressure Breathing (IPPB) and Temporary Positive Expiratory Pressure (TPEP) in Patients With Severe Chronic Obstructive Pulmonary Disease FREE TO VIEW

Antonello Nicolini, MD; Bruna Grecchi, CPFT
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Respiratory Diseases Unit, Sestri Levante, Italy

Chest. 2013;144(4_MeetingAbstracts):831A. doi:10.1378/chest.1690867
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SESSION TITLE: Physiology/PFTs/Rehabilitation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: TPEP is a technique which produces a 1 cmH2O increase in airway pressure along the respiratory cycle until immediately before the expiration.IPPB is a technique used to provide short-term or intermittent mechanical ventilation for the purpose of augmenting lung expansion, delivering aerosol medication, or assisting ventilation. We test the hypothesis that adding TPEP or IPPB to standard pharmacological therapy may provide additional clinical benefit over pharmacological therapy only in patients with GOLD 3 and 4 severity of airflow limitation and GROUP D combined COPD assessment.

METHODS: Thirty patients were randomized in three groups: a group was treated with IPPB,a group was treated with TPEP and a group with pharmacological therapy alone ( control group ). Both treatments lasted 30 minutes per session and were given twice daily ( morning and late afternoon ).The duration of each treatment was fifteen days and the treatment was administered five days per week. Primary outcome measures included dyspnea, cough, and sputum scales, as well as daily life activity evaluations (MRC,CAT,BCSS). Secondary outcome measures were respiratory function testing (FVC, FEV1, TLC, RV, DLCO, MIP, MEP), arterial blood gas analysis (paO2, paCO2, pH), and hematological examinations (white and red cells count, C reactive protein, γ-globulins).

RESULTS: Both patients in the IPPB group and in the TPEP group showed a significant improvement in two of three test of quality of life assessment (MRC,CAT) compared to the control group.However,in the group comparison analysis for the same variables between IPPB group and TPEP group we observed a significant improvement in the IPPB group ( p≤0.05 for MRC and p≤0.01 for CAT ).

CONCLUSIONS: The difference of action of the two techniques are evident in the results of pulmonary function testing: IPPB increases CVF, FEV1, and MIP; this reflects its capacity to increase lung volume and enhance effectiveness of the cough, but does not decreased total lung capacity and residual volume. Also TPEP increases CVF and FEV1 (less than IPPB), but increases MEP, while decreasing total lung capacity (TLC) and residual volume (RV).

CLINICAL IMPLICATIONS: The two techniques (IPPB and TPEP) improves quality of life and lung function in patients with severe COPD.IPPB demonstrated a significant greatest effectiveness to improve dyspnea and quality of life tools ( MRC,CAT ) than TPEP.

DISCLOSURE: The following authors have nothing to disclose: Antonello Nicolini, Bruna Grecchi

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