• Saeed M Alghamdi, Ruth Emily Barker, Abdullah S S Alsulayyim, Ali M Alasmari, BanyaWinston A SWASNational Heart and Lung Institute, Imperial College London, London, UK.Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK., Michael I Polkey, Surinder S Birring, and Nicholas S Hopkinson.
• National Heart and Lung Institute, Imperial College London, London, UK.
• Thorax. 2020 Oct 1; 75 (10): 855-863.

IntroductionOscillating positive expiratory pressure (OPEP) devices are intended to facilitate sputum clearance in chronic obstructive pulmonary disease (COPD), but there is uncertainty as to their place in treatment pathways. We aimed to review the existing literature to establish the evidence base for their use.MethodsA systematic search of records up to March 2020 was performed on PubMed, CINAHL, Medline (Ovid), Cochrane and Embase to retrieve clinical trials that evaluated the efficacy of OPEP devices in patients with COPD. Two independent reviewers retrieved the titles, abstracts and full texts, and completed the data extraction.ResultsFollowing full-text review of 77 articles, eight (six randomised control trials and 2 cross-over studies) were eligible for inclusion. Pooled analysis showed low-grade evidence that the use of OPEP devices was associated with decreased COPD symptoms and exacerbations (OR 0.37, 95% CI 0.19 to 0.72), and enhanced exercise capacity; 6 min walk distance (mean difference (95% CI), 49.8 m (14.2 m to 85.5 m); p=0.009]). However, studies were mostly short term with the majority having a high risk of bias. The average acceptance, completion and drop-out rates were 82%, 91% and 8%, respectively.ConclusionThe use of OPEP devices can have a positive impact in COPD, but confidence in effect sizes is low and there is a need for further, higher quality studies to examine their long-term efficacy in COPD as well as to identify specific patient phenotypes that are more likely to respond.Prospero Registration NumberCRD 42016041835.© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

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