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Dyspnea is a major factor delaying post-exercise recovery in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the effectiveness of positive expiratory pressure (PEP) breathing on dyspnea recovery in COPD patients. A randomized cross-over trial was conducted with 12 stable COPD patients with an average age of 58.9±6.7 years. The participants exercised with spot brisk marching until moderate to severe dyspnea. Then immediately after the end of exercise, they were exhaled for 6 breaths through PEP device with an expiratory load of 5 cmH2O in the Experimental and 0 cmH2O in the Sham condition. Ratings of dyspnea with Borg’s scale, respiratory rate (RR), pulse oxygen saturation (SpO2), and end-tidal carbon dioxide pressure (PETCO2) were measured before and every minute during exercise and 10 minutes of recovery period. The results show that the recovery rate of dyspnea was twice as fast following the Experimental compared to the Sham condition (1.31±0.36 vs 0.70±0.09 units/min; p < 0.001). Dyspnea returned to baseline in 3 minutes in the Experimental compared to 5 minutes in the Sham condition. SpO2, and PETCO2 were not different between the two conditions at any time point. RR was not different between condition at rest or during exercise, but was lower in the recovery period following use of PEP (p < 0.05). We concluded that PEP breathing at least 5 cmH2O accelerates the rate of dyspnea recovery and decreases recovery time after exercise in COPD.
2. O'Donnell DE. Breathlessness in patients with chronic airflow limitation. Mechanisms and management. Chest. 1994;106(3):904-12.
3. O' Donnel DE, Webb KA. The major limitation to exercise performance in COPD is dynamic hyperinflation. J Appl Physiol. 2008;105:753-5.
4. O'Donnell DE, Banzett RB, Carrieri-Kohlman V, Casaburi R, Davenport PW, Gandevia SC, et al. Pathophysiology of dyspnea in chronic obstructive pulmonary disease: a roundtable. Proc Am Thorac Soc. 2007;4(2):145-68.
5. Marin JM, Carrizo SJ, Gascon M, Sanchez A, Gallego B, Celli BR. Inspiratory capacity, dynamic hyperinflation, breathlessness, and exercise performance during the 6-minute-walk test in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;163(6):1395-9.
6. Jolley CJ, Luo YM, Steier J, Reilly C, Seymour J, Lunt A, et al. Neural respiratory drive in healthy subjects and in COPD. Eur Respir J. 2009;33(2):289-97.
7. Jolley CJ, Moxham J. A physiological model of patient-reported breathlessness during daily activities in COPD. Eur Respir Rev. 2009;18(112):66-79.
8. Puente-Maestu L, Stringer WW. Hyperinflation and its management in COPD. Int J Chron Obstruct Pulmon Dis. 2006;1(4):381-400.
9. Wouters EFM. Non pharmacological modulation of dynamic hyperinflation. Eur Respir Rev. 2006;15:90-6.
10. Padkao T, Boonsawat W, Jones CU. Conical-PEP is safe, reduces lung hyperinflation and contributes to improved exercise endurance in patients with COPD: a randomised cross-over trial. J Physiother. 2010;56(1):33-9.
11. Monteiro MB, Berton DC, Moreira MA, Menna-Barreto SS, Teixeira PJ. Effects of expiratory positive airway pressure on dynamic hyperinflation during exercise in patients with COPD. Respir Care. 2012;57(9):1405-12.
12. Nicolini A, Merliak F, Barlascini C. Use of positive expiratory pressure during six minute walk test: results in patients with moderate to severe chronic obstructive pulmonary disease. Multidisciplinary Respiratory Medicine. 2013;8(1):19.
13. Martin AD, Davenport PW. Extrinsic Threshold PEEP Reduces Post-exercise Dyspnea in COPD Patients: A Placebo-controlled, Double-blind Cross-over Study. Cardiopulm Phys Ther J. 2011;22(3):5-10.
14. National institutes of health NH, Lung,and BloodInstitute. Global Initiativefor Chronic ObstructiveLung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease NHLBI/WHO workshop report:. 2015.
15. Antoniu S. Descriptors of dyspnea in obstructive lung diseases. Multidisciplinary Respiratory Medicine. 2010;5(3):216-9.
16. Stendardi L, Binazzi B, Scano G. Exercise dyspnea in patients with COPD. International Journal of Chronic Obstructive Pulmonary Disease. 2007;2(4):429-39.
17. McKeough ZJ, Alison JA, Bye PT. Arm positioning alters lung volumes in subjects with COPD and healthy subjects. Aust J Physiother. 2003;49(2):133-7.
18. McKeough ZJ, Alison JA, Bye PT. Arm exercise capacity and dyspnea ratings in subjects with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2003;23(3):218-25.
19. Gigliotti F, Coli C, Bianchi R, Grazzini M, Stendardi L, Castellani C, et al. Arm exercise and hyperinflation in patients with COPD: effect of arm training. Chest. 2005;128(3):1225-32.
20. Hannink JD, Van Helvoort HA, Dekhuijzen PN, Heijdra YF. Similar dynamic hyperinflation during arm and leg exercise at similar ventilation in chronic obstructive pulmonary disease. Med Sci Sports Exerc. 2011;43(6):996-1001.
21. Martin AD, Davenport PW. Extrinsic threshold PEEP reduces post-exercise dyspnea in COPD patients: a placebo-controlled double-blind cross-over study. Cardiopulm Phys Ther J. 2011;22(3):5-10.
22. Benhamou D, Cuvelier A, Muir JF, Leclerc V, Le Gros V, Kottakis J, et al. Rapid onset of bronchodilation in COPD: a placebo-controlled study comparing formoterol (Foradil Aerolizer) with salbutamol (Ventodisk). Respir Med. 2001;95(10):817-21.
23. Matera MG, Cazzola M, Vinciguerra A, Di Perna F, Calderaro F, Caputi M, et al. A comparison of the bronchodilating effects of salmeterol, salbutamol and ipratropium bromide in patients with chronic obstructive pulmonary disease. Pulm Pharmacol. 8. England1995. p. 267-71.