The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

THE EFFECTS OF AIRWAY CLEARANCE TREATMENTS (ACTs) WITH EXERCISE TRAINING ON SPUTUM EXPECTORATION, FORCED EXPIRATORY VOLUME IN ONE SECOND (FEV1), AND PEAK EXPIRATORY FLOW (PEF) ON CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) PATIENTS ENROLLED IN A PULMONARY REHABILITATION (PR) PROGRAM.

Michele L. McCarroll, PhD *‡; Timoth E. Kirby, PhD *; Phil D. Hoberty, RRT EdD †; Janet Buckworth, PhD*; & David M. Berzon, MD‡. *The Ohio State University Department of Exercise Science, The Ohio State University Department of Respiratory Therapy†, and ‡The Cleveland Clinic Health System Eastern Region Department of Cardiopulmonary Rehabilitation



BACKGROUND: Since chronic obstructive pulmonary disease (COPD) is often complicated by excess airway mucus, providing airway clearance treatments (ACTs) for patients during pulmonary rehabilitation (PR) may substantially improve their prognosis. The role of exercise to enhance airway clearing of sputum in the COPD population has not been sufficiently investigated for practitioners to implement in a daily bronchial hygiene plan.

OBJECTIVE: Apply bronchial hygiene models investigated in cystic fibrosis population and administer ACTs before and after exercise training on COPD patients participating in PR.

METHODS: Thirty-five patients with COPD from three PR centers were randomly assigned to either: 1) usual care group, (PR - Exercise Training), n=12, 2) usual care plus high-frequency chest wall oscillation (HFCWO, The Vest™) n=11, or 3) usual care plus vibratory positive expiratory pressure (VPEP, The Acapella®), n=12. Airway clearance therapy (HFCWO or VPEP) was performed before & after exercise for PR patients assigned to those treatment arms. Assessments of sputum production were collected before exercise, during exercise training, and after exercise. The secretions were weighed wet at each interval, then dried, and weighed again. Forced Expiratory Volume in one second (FEV1) and Peak Expiratory Flow (PEF) were measured at baseline and completion of PR.

RESULTS: Thirty-five patients were studied. The mean wet sputum weights at each time interval between treatment arms were not significant (p> 0.05). The mean FEV1 and PEF were not significant between the three groups (p> 0.05). However, the training effect for the entire group was significant (p< 0.05) for FEV1, PEF, and total wet sputum (table).

CONCLUSIONS: Sputum expectoration did not differ significantly between groups of exercise, VPEP + exercise, and HFCWO + exercise. The entire group significantly improved lung function in the entire group, although no additional effects were noted by adding ACTs. According to these results, exercise should be emphasized as an inexpensive ACT for improving lung function and sputum clearance. On the same note, exercise should be further encouraged among practitioners as a means of disease management and airway clearing for improved lung function.

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