Comparison of Lung flute and Threshold PEP for airway clearance in Chronic Obstructive Pulmonary Disease patients: A Randomized Clinical Trial

Chronic Obstructive Pulmonary Disease (COPD) is characterizedby mucus hypersecretion and impaired mucociliary clearance, and significantly contributesto the morbidity and mortality of this disease.According to WorldHealth Organization, 5% of all deaths globally occurred due to COPD in 2005 andit is estimated to be the third leading cause of death by 2030. In this condition,patients complain of chronic symptoms of cough, sputum production, shortness ofbreath, and/or wheezing.

Currently available mucolytics andexpectorants are not proven to be effective in COPD.The availableevidence indicates that Active Breathing Techniques such as Active Cycle of BreathingTechniques (ACBT), Autogenic Drainage and Forced Expiration, can be effective intreatment of COPD. The Passive Techniques such as Postural Drainage, Percussionas well as Supporting Techniques such as Intrapulmonary Percussive Ventilation,PEP and Non-Invasive Ventilation have little evidence due to the small numberof studies.

The Lung Flute is a new, Food andDrug Administration (FDA) approved Oscillatory Positive Expiratory Pressure(OPEP) device which has been shown to be effective in inducing sputum when usedonce. It produces a low frequency acoustic wave with an exhalation vigorous enoughto make the reed oscillate thereby increasing mucociliary clearance. ThresholdPEP has a flow independent one way valve, ensuring consistent resistancethrough adjustable specific pressure settings (in cm H2O) set by healthcareprofessionals. When patients exhale through it, the resistive load createspositive pressure that helps open the airways and allows mucus to be expelledduring “huff†coughing (Forced Expiratory Technique) thus helping in airwayclearance, bronchial hygiene and can be used as an alternate to Chest PhysicalTherapy.

             Current choices for treatment ofmucus hypersecretion are few with limited data to support their effectivenessin COPD. Although Lung Flute and Threshold PEP have found to be effective inairway clearance in COPD patients, no previous studies have been done comparingthe two devices to know which is more effective for airway clearance in thisdisease. Hence there is a need of this study to compare the two devices.