Conical-PEP is safe, reduces lung hyperinflation and contributes to improved exercise endurance in patients with COPD: a randomised cross-over trial

Question: Does a new positive expiratory pressure device (conical-PEP) decrease lung hyperinflation during exercise in patients with chronic obstructive pulmonary disease compared to normal breathing? Does it increase the duration of exercise? Design: A randomised, cross-over trial with concealed allocation. Participants: Thirteen patients with moderate to severe chronic obstructive pulmonary disease (mean FEV1 61% predicted). Intervention: The experimental intervention was conical-PEP breathing with a positive expiratory pressure of 4-20 cmH(2)O during 30% of 1 RM alternate knee extension exercise at 70% age-predicted HRmax to fatigue. The control intervention was normal breathing. Outcome measures: Total lung capacity (inspiratory capacity and slow vital capacity), breathlessness, and leg discomfort were measured pre and post exercise. Cardiorespiratory function was measured pre and during the last 30 s of exercise. Duration of exercise was recorded. Results: After the experimental intervention, inspiratory capacity increased 200 ml (95% Cl 0 to 400) and slow vital capacity increased 200 ml (95% Cl 0 to 400) more than the control intervention. Participants exercised for 107 s (95% Cl -23 to 238) more during the experimental intervention than the control intervention. Conical-PEP breathing during exercise resulted in 6.1 fewer breaths/min (95% Cl 1.4 to 10.8) than normal breathing; it did not have any adverse effects on CO2 retention or oxygen saturation. Conclusion: The novel conical-PEP device decreases lung hyperinflation, is safe to use, and tends to increase the duration of exercise. Trial registration: NCT00741832. [Padkao T, Boonsawat W, Jones CU (2010) Conical-PEP is safe, reduces lung hyperinflation and contributes to improved exercise endurance in patients with COPD: a randomised cross-over trial. Journal of Physiotherapy 56: 33-39]