Vibratory PEP Device and Hospital Length of Stay for Acute Exacerbation of COPD

Not Applicable

Completed

Brief Summary: This study is evaluating the use of a respiratory device, the Acapella Vibratory Positive Expiratory Pressure (PEP) Therapy device, in patients admitted to the hospital with a chronic obstructive pulmonary disease (COPD) exacerbation.

Detailed Description: The investigators hypothesize that the PEP-FV used as adjunctive therapy in patients hospitalized for an acute exacerbation of COPD will result in decreased hospital length of stay and improvement of overall COPD-related health outcomes.

Recruitment & Eligibility

Inclusion Criteria

Admitted with COPD exacerbation as a primary diagnosis
Subjectively produces more than 1 tablespoon (15 ml) / day of sputum
Has the subjective feeling that he/she cannot cough up or clear her secretions
Physical respiratory system exam by the physician with evidence of course ronchi suggestive of impacted secretions
> 10 pack-year smoking history

Exclusion Criteria

Cannot use the flutter device or unable to follow commands
Altered mental status
Known active malignancy
Known systolic congestive heart failure (CHF) with ejection fraction (EF) < 40% or clinically in acute CHF exacerbation as documented by cardiologist or primary diagnosis other than COPD
Pregnancy
Patients in severe exacerbation (Intubated, Continuous use of NIPPV, Unable to speak full sentences)
Intracranial pressure (ICP) >20 mmHg
Hemodynamic instability (requiring vasopressor support)
Recent facial, oral, or skull surgery or trauma.
Acute sinusitis.
Epistaxis.
Esophageal surgery.
Active Hemoptysis (More than 2 tablespoons of frank blood per day)
Nausea.
Severe earache or discharge from ear. (Known or suspected tympanic membrane rupture or other middle ear pathology)
Untreated pneumothorax.

Primary Outcome Measures

Name	Time	Method
Length of Stay	Up to 2 weeks	Time of admission to time of discharge from hospital

Secondary Outcome Measures

Name	Time	Method
Difference in Bedside Spirometry	Day 5	Degree of airflow obstruction (FEV1/FVC)
Analysis of Change in Daily Sputum Production	Up to 5 days	Sputum production in a 24 hour period in mL volume
Dyspnea on the Borg Scale	Up to 5 days	Scale is used to rate the difficulty of breathing. It starts at 0 where the breathing is causing no difficulty at all and progresses through to number 10 where the breathing difficulty is maximal.
Dyspnea on the MMRC Scale	Up to 5 days	The Modified Medical Research Council (MMRC) dyspnea scale is used to assess an individual's shortness of breath. It starts at 0 where the shortness of breath occurs during strenuous exercise and progresses through to number 4 where the shortness of breath is maximal.
In Hospital Mortality	Up to 2 weeks	Death at the time of discharge
Change in 6MWT Test	Day 1 and Day 5	A six-minute walk test (6MWT) measures the distance that an individual can walk on a flat, hard surface in a period of six minutes. This is used to assess the exercise tolerance measured by the difference in meters between the tests.