• Paulo de Tarso Müller, Gustavo Christofoletti, Rodrigo Koch, João Henrique Zardetti Nogueira, Luiz Armando Pereira Patusco, and Gaspar Rogério Chiappa.
• Federal University of Mato Grosso do Sul (UFMS)/Maria Aparecida Pedrossian Hospital (HUMAP), Laboratory of Respiratory Pathophysiology (LAFIR)/Division of Respiratory Medicine, Campo Grande, Mato Grosso do Sul, MS, Brazil.
• Clin Respir J. 2018 Apr 1; 12 (4): 1598-1606.

IntroductionLung hyperinflation is associated with inspiratory muscle strength reduction, nocturnal desaturation, dyspnea, altered cardiac function and poor exercise capacity in advanced COPD.ObjectivesWe investigated the responses of inspiratory capacity (IC) and inspiratory muscle strength (PImax), comparing continuous positive airway pressure (CPAP) and expiratory positive airway pressure (EPAP) with the main hypothesis that there would be similar effects on lung deflation.MethodsEligible patients were submitted to 10 cmH2 O CPAP and EPAP on different days, under careful ECG (HR) and peripheral oxygen saturation (SpO2 ) monitoring.ResultsTwenty-one eligible COPD patients were studied (13 male/8 female, FEV1 % predicted of 36.5 ± 9.8). Both CPAP and EPAP demonstrated significant post-pre (Δ) changes for IC and PImax, with mean ΔIC for CPAP and EPAP of 200 ± 100 mL and 170 ± 105 mL (P = .001 for both) in 13 and 12 patients (responders) respectively. There were similar changes in % predicted IC and PImax (∼7%, P = .001 for both) for responders and poor responder/non-responder agreement depending on CPAP/EPAP mode (Kappa = .113, P = .604). There were no differences in CPAP and EPAP regarding intensity of lung deflation (P =.254) and no difference was measured regarding HR (P = .235) or SpO2 (P = .111). CONCLUSIONS: Both CPAP and EPAP presented a similar effect on lung deflation, without guaranteeing that the response to one modality would be predictive of the response to the other.© 2017 John Wiley & Sons Ltd.

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