Mohamed Shamakh, Nagwa Badr, Mohamed El-Batanouny, Mohamed Shendy‎‎

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease that needs a multidisciplinary approach with an increasing emphasis on self-management. Physiotherapists utilize numerous airway clearance techniques in COPD management like Acapella and positive expiratory pressure (PEP). Objective: To find any difference between Acapella and hand-held positive expiratory pressure in the management of moderate COPD. Study design: a single-blinded randomized controlled trial. Methods: 60 patients were recruited from Cairo University Hospitals, Egypt, from August 2016 to February 2019. They were randomly classified into three equal groups. Group A patients received routine treatment: Active cycle of breathing technique (ACBT). Groups B and C received ACBT and either PEP or Acapella, respectively. Outcome measures were measured after an acute exacerbation and after six months of self-management at home. Results: FEV1 improved in all groups; A: 2.64%, B: 8.92%, and C: 10.49%. There was no significant difference between groups B and C (P=0.619). FEV1/FVC improved in all groups; A: 3.71%, B: 7.73%, and C: 8.52%. There was no significant difference between groups B and C (P=0.286). Walking distance in the six-minute walk test increased in all groups; A: 3%, B: 12.95%, and C: 20.09%. There was no significant difference between groups B and C (P=0.659). Quality of life using COPD assessment test scores revealed improvements in the three groups. All groups’ test scores decreased; A: 4.36%, B: 22.85%, and C: 22.99%. There was no significant difference between groups B and C (P=0.010). Conclusion: PEP and Acapella improved moderate COPD pulmonary functions. ACBT alone showed improvements but to a lesser extent than Acapella and PEP‎.