Oscillatory positive expiratory pressure device may preserve lung function in children

Use of an oscillatory positive expiratory pressure device alone or with additional airway clearance improved lung function among children with cystic fibrosis, according to data presented at the North American Cystic Fibrosis Conference.

“Airway clearance therapy is a cornerstone of cystic fibrosis care,” Elizabeth H. Baker, PhD, associate professor in the department of sociology at the University of Alabama at Birmingham, and colleague wrote. “Multiple airway clearance therapy modalities are available, but there is little evidence to support the use of one over another.”

In a retrospective longitudinal analysis, Baker and colleagues assessed 146 patients with cystic fibrosis (CF) aged 7 to 20 years from one cystic fibrosis center to observe lung function changes over 5 years when using an oscillatory positive expiratory pressure (OPEP) device (Aerobika, Monaghan), according to the study abstract.

Researchers stratified patients based on OPEP use, and they controlled for several sociodemographic and clinical covariates including, race, sex, parental education, smoke exposure and CF genotype.

Researchers reported lung function as percentage predicted FEV₁ and measured this, as well as age, at each clinical encounter.

Of the total cohort, 58 (39.7%) patients used OPEP as their main form of airway clearance therapy or in combination with a high-frequency chest wall oscillation vest.

Researchers observed that these patients had a higher likelihood of having the F508del homozygous CF genotype and were less likely to have smoke exposure and Pseudomonas aeruginosa.

After adjusting for all covariates, researchers found that over 5 years, users of OPEP had a 6.6 higher percentage predicted FEV₁ (P = .03) than nonusers. Further, OPEP users with parents who did not have a college degree had a 12.7 higher percentage predicted FEV₁ (93.5% vs. 80.8%; P = .004), which the researchers wrote indicates the device may be particularly helpful for children of lower socioeconomic status.

Researchers additionally reported that both OPEP users and nonusers had a yearly lung function decline of 1.5% (P < .001).

“The clinical efficacy of the device should be evaluated in a randomized controlled trial,” Baker and colleagues wrote. “Future research should also identify the most appropriate age for introducing the device. Because OPEP use appears to be especially beneficial to the most vulnerable individuals, it should be explored as a way to reduce disparities in lung function.”