| 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 enhance their PR outcomes. Objective. To assess the effect of 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(TM)) n = 11, or (3) usual care plus vibratory positive expiratory pressure (VPEP, The AcapellaRTM), n = 12. Airway clearance therapy (HFCWO or VPEP) was given for 10 min before and after the exercise for PR patients assigned to those treatment arms. Assessments of Pulmonary Function Status Scale (PFSS), Six-Minute Walk (SMW) test, Physical Activity Stage of Change Questionnaire (PASCQ), Forced Expiratory Volume in one second (FEV1) and Peak Expiratory Flow (PEF) were measured at baseline and completion of PR. Sputum quantity was measured before exercise, during exercise, and after exercise. Results. The entire group showed significant changes in the PFSS: pre 118 SD +/- 22.6 to post 123 SD +/- 21.9 (p < 0.5); SMW test pre 803.7ft SD +/- 383 to post 967.9ft SD +/- 386 (p < 0.5); PASCQ of precontemplation pre 8% to post 0%, contemplation pre 43% to post 0%, preparation pre 37% to post 14%, action pre 3% to post 66%, and maintenance pre 9% to post 20%; FEV1 0.90 L +/- 0.44 to 0.96 L +/- 0.56; and PEF 157 l/min +/- 96 to 180 l/min +/- 131 (p < 0.05). No significant differences were found in all the outcomes between the three treatment groups (p > 0.05). As well, the mean wet sputum weights at each time interval between treatment arms were not significant (p > 0.05). Conclusions. Based on the current findings, adding VPEP or HFCWO ten minutes before and after exercise training did not yield additional benefits in the outcomes collected. Exercise may be used as an inexpensive airway clearing treatment for improving lung function, exercise capacity, and sputum clearance. More research is needed to demonstrate quality initiatives to acquire better rehabilitation outcomes in caring for the growing COPD population. |
