TY - JOUR T1 - Is There an Optimal Level of Positive Expiratory Pressure (PEP) to Improve Walking Tolerance in Patients With Severe COPD? JO - Archivos de Bronconeumología T2 - AU - Russo,Davide AU - Simonelli,Carla AU - Paneroni,Mara AU - Saleri,Manuela AU - Piroddi,Ines Maria Grazia AU - Cardinale,Francesco AU - Vitacca,Michele AU - Nicolini,Antonello SN - 15792129 M3 - 10.1016/j.arbr.2016.02.017 DO - 10.1016/j.arbr.2016.02.017 UR - https://www.archbronconeumol.org/en-is-there-an-optimal-level-articulo-S1579212916000689 AB - BackgroundThe application of positive expiratory pressure (PEP) devices during exercise had been proposed in order to counteract the pulmonary hyperinflation, reduce the dyspnea and thus increase the exercise tolerance in patients with severe chronic obstructive pulmonary disease (COPD). This randomized controlled crossover trial investigated the effect of two different levels of PEP (1cmH2O and 10cmH2O) on distance covered at 6min walk test (6MWT) in patients with severe COPD. Secondary outcomes were the evaluation of PEP effects on physiological and pulmonary function variables. MethodsSeventy-two severe COPD patients, referred to our hospitals as in and out patients, were recruited. A basal 6MWT without devices was performed on the first day, and then repeated with PEP 1cmH2O (PEP1) and 10cmH2O (PEP10), with a randomized crossover design. Slow and forced spirometries, including the inspiratory capacity measure, were repeated before and after each 6MWT. Results50 patients (average age 69.92 year, mean FEV1 41.42% of predicted) concluded the trial. The 6MWT improved significantly among both PEP levels and baseline (323.8mt at baseline vs 337.8 PEP1 and 341.8 PEP10; P<.002 and P<.018, respectively). The difference between PEP10 and PEP1 did not reach the significance. No improvements were found in pulmonary function, symptoms and physiological variables after the 6MWT. ConclusionsIn patients with severe COPD, the application of 1cmH2O of PEP seems to improve the exercise tolerance as 10cmH2O, with similar dyspnea. Further studies should investigate the effects of low levels of PEP on aerobic training programs. ER -