Respiratory Therapy in COPD Exacerbations

NCT ID: NCT02125747

Last Updated: 2017-01-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

35 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-12-31

Study Completion Date

2012-11-30

Brief Summary

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The purpose of this study is to determine effectiveness, feasibility and safety/tolerance of Respiratory Therapy in hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease.

Detailed Description

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Acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) is defined as an event in the natural course of the disease characterized by a change in the patient's usual symptoms (dyspnea, cough and/or sputum) that may not be explained by the daily variations and requires a change in regular medication.

Because AE-COPD result in impairment of both pulmonary and respiratory muscle functions, as well as an increasing impact on costs, priority should be given to interventions to slow the progression of the disease, prevention of exacerbations and reduce the risk of comorbidity.

Chest physiotherapy is often used in hospitalized patients with AE-COPD with the aim of favoring the removal of secretions and thus to improve the ventilation perfusion (V/Q), and therefore the function lung. The limited scientific evidence has determined that their use is controversial and not routinely recommended in clinical practice guidelines. Current clinical guidelines in the treatment of COPD are unable to rule on the application of respiratory therapy during exacerbations, since there is little scientific evidence of its benefits in the short and long term.

Conditions

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Obstructive Chronic Bronchitis With Acute Exacerbation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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No Respiratory Therapy

Patients with acute exacerbation of chronic obstructive pulmonary disease. Patients received conventional treatment.

Group Type OTHER

No Respiratory Therapy

Intervention Type OTHER

Patients received conventional treatment.

Respiratory therapy

Patients with acute exacerbation of chronic obstructive pulmonary disease. Patients received conventional treatment and Respiratory Therapy

Group Type EXPERIMENTAL

Respiratory Therapy

Intervention Type OTHER

Respiratory Therapy consists of postural drainage, positive expiratory pressure (PEP) and vibropercussion (it is a postural drainage method, which uses chest clapping with a flexible wrist and cupped hands or a mechanical vibrator to loosen and mobilize retained secretions that can then be expectorated or drained). Postural drainage is an airways clearance technique in which patient's body is positioned so that the trachea is inclined downward and below the affected chest area.

The PEP consists of expiratory cycles through a system generating a positive pressure of 10-20 cc (cubic centimeter) water. Vibropercussion is applied by the use of a mechanical system following rib movement during expiration to enhance clearance of secretions.

Intervention group received 30-minute-sessions twice a day, 7 days per week, during hospitalization period.

Interventions

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No Respiratory Therapy

Patients received conventional treatment.

Intervention Type OTHER

Respiratory Therapy

Respiratory Therapy consists of postural drainage, positive expiratory pressure (PEP) and vibropercussion (it is a postural drainage method, which uses chest clapping with a flexible wrist and cupped hands or a mechanical vibrator to loosen and mobilize retained secretions that can then be expectorated or drained). Postural drainage is an airways clearance technique in which patient's body is positioned so that the trachea is inclined downward and below the affected chest area.

The PEP consists of expiratory cycles through a system generating a positive pressure of 10-20 cc (cubic centimeter) water. Vibropercussion is applied by the use of a mechanical system following rib movement during expiration to enhance clearance of secretions.

Intervention group received 30-minute-sessions twice a day, 7 days per week, during hospitalization period.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* age over 18 years,
* hospitalized patients and
* acute exacerbation of COPD.

Exclusion Criteria

* Previous history of any chronic respiratory disease and
* not to have performed any kind of general or respiratory training in the previous 3 months.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Parc de Salut Mar

OTHER

Sponsor Role lead

Responsible Party

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Esther Marco Navarro

PhD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mauricio Orozco-Levi, MD, PhD

Role: STUDY_DIRECTOR

Biomedical Research Network for Respiratory Diseases (CIBERES), ISCIII, Ministerio de Ciencia y Tecnología, Spain; Respiratory Department, Hospital del Mar, Spain; Respiratory Department, Centro de Investigaciones, Fundación Cardiovascular de Colombia

Locations

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Departments of Respiratory Medicine and Rehabilitation. Parc de Salut Mar, Hospital del Mar

Barcelona, Barcelona, Spain

Site Status

Countries

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Spain

References

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Jones AP, Rowe BH. Bronchopulmonary hygiene physical therapy for chronic obstructive pulmonary disease and bronchiectasis. Cochrane Database Syst Rev. 2000;(2):CD000045. doi: 10.1002/14651858.CD000045.

Reference Type BACKGROUND
PMID: 10796474 (View on PubMed)

Sivasothy P, Brown L, Smith IE, Shneerson JM. Effect of manually assisted cough and mechanical insufflation on cough flow of normal subjects, patients with chronic obstructive pulmonary disease (COPD), and patients with respiratory muscle weakness. Thorax. 2001 Jun;56(6):438-44. doi: 10.1136/thorax.56.6.438.

Reference Type BACKGROUND
PMID: 11359958 (View on PubMed)

Gulsvik A. The global burden and impact of chronic obstructive pulmonary disease worldwide. Monaldi Arch Chest Dis. 2001 Jun;56(3):261-4.

Reference Type BACKGROUND
PMID: 11665507 (View on PubMed)

Elkins MR, Jones A, van der Schans C. Positive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD003147. doi: 10.1002/14651858.CD003147.pub3.

Reference Type BACKGROUND
PMID: 16625571 (View on PubMed)

Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Thoracic Society. Am J Respir Crit Care Med. 1995 Nov;152(5 Pt 2):S77-121. No abstract available.

Reference Type BACKGROUND
PMID: 7582322 (View on PubMed)

Puhan MA, Scharplatz M, Troosters T, Steurer J. Respiratory rehabilitation after acute exacerbation of COPD may reduce risk for readmission and mortality -- a systematic review. Respir Res. 2005 Jun 8;6(1):54. doi: 10.1186/1465-9921-6-54.

Reference Type BACKGROUND
PMID: 15943867 (View on PubMed)

Olseni L, Midgren B, Hornblad Y, Wollmer P. Chest physiotherapy in chronic obstructive pulmonary disease: forced expiratory technique combined with either postural drainage or positive expiratory pressure breathing. Respir Med. 1994 Jul;88(6):435-40. doi: 10.1016/s0954-6111(05)80046-0.

Reference Type BACKGROUND
PMID: 7938794 (View on PubMed)

Hill K, Patman S, Brooks D. Effect of airway clearance techniques in patients experiencing an acute exacerbation of chronic obstructive pulmonary disease: a systematic review. Chron Respir Dis. 2010;7(1):9-17. doi: 10.1177/1479972309348659. Epub 2009 Oct 9.

Reference Type BACKGROUND
PMID: 19819912 (View on PubMed)

Mohsenifar Z, Rosenberg N, Goldberg HS, Koerner SK. Mechanical vibration and conventional chest physiotherapy in outpatients with stable chronic obstructive lung disease. Chest. 1985 Apr;87(4):483-5. doi: 10.1378/chest.87.4.483.

Reference Type BACKGROUND
PMID: 3884288 (View on PubMed)

Miravitlles M, Ferrer M, Pont A, Zalacain R, Alvarez-Sala JL, Masa F, Verea H, Murio C, Ros F, Vidal R; IMPAC Study Group. Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study. Thorax. 2004 May;59(5):387-95. doi: 10.1136/thx.2003.008730.

Reference Type BACKGROUND
PMID: 15115864 (View on PubMed)

Newton DA, Stephenson A. Effect of physiotherapy on pulmonary function. A laboratory study. Lancet. 1978 Jul 29;2(8083):228-9. doi: 10.1016/s0140-6736(78)91742-7.

Reference Type BACKGROUND
PMID: 79027 (View on PubMed)

Garrod R, Lasserson T. Role of physiotherapy in the management of chronic lung diseases: an overview of systematic reviews. Respir Med. 2007 Dec;101(12):2429-36. doi: 10.1016/j.rmed.2007.06.007. Epub 2007 Sep 17.

Reference Type BACKGROUND
PMID: 17870457 (View on PubMed)

Tang CY, Taylor NF, Blackstock FC. Chest physiotherapy for patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease (COPD): a systematic review. Physiotherapy. 2010 Mar;96(1):1-13. doi: 10.1016/j.physio.2009.06.008. Epub 2009 Sep 22.

Reference Type BACKGROUND
PMID: 20113757 (View on PubMed)

Lange P, Nyboe J, Appleyard M, Jensen G, Schnohr P. Relation of ventilatory impairment and of chronic mucus hypersecretion to mortality from obstructive lung disease and from all causes. Thorax. 1990 Aug;45(8):579-85. doi: 10.1136/thx.45.8.579.

Reference Type BACKGROUND
PMID: 2402719 (View on PubMed)

Opdekamp C, Sergysels R. [Respiratory physiotherapy in lung diseases]. Rev Med Brux. 2003 Sep;24(4):A231-5. French.

Reference Type BACKGROUND
PMID: 14606285 (View on PubMed)

Wolkove N, Kamel H, Rotaple M, Baltzan MA Jr. Use of a mucus clearance device enhances the bronchodilator response in patients with stable COPD. Chest. 2002 Mar;121(3):702-7. doi: 10.1378/chest.121.3.702.

Reference Type BACKGROUND
PMID: 11888949 (View on PubMed)

Ides K, Vissers D, De Backer L, Leemans G, De Backer W. Airway clearance in COPD: need for a breath of fresh air? A systematic review. COPD. 2011 Jun;8(3):196-205. doi: 10.3109/15412555.2011.560582. Epub 2011 Apr 22.

Reference Type BACKGROUND
PMID: 21513439 (View on PubMed)

van der Schans CP. Conventional chest physical therapy for obstructive lung disease. Respir Care. 2007 Sep;52(9):1198-206; discussion 1206-9.

Reference Type BACKGROUND
PMID: 17716386 (View on PubMed)

Osadnik CR, McDonald CF, Jones AP, Holland AE. Airway clearance techniques for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2012 Mar 14;2012(3):CD008328. doi: 10.1002/14651858.CD008328.pub2.

Reference Type BACKGROUND
PMID: 22419331 (View on PubMed)

Other Identifiers

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PSM/RHB/CR/05

Identifier Type: -

Identifier Source: org_study_id

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