Document Detail

Upright Positive Expiratory Pressure Therapy and Exercise: Effects on Gastroesophageal Reflux in COPD And Bronchiectasis.
MedLine Citation:
PMID:  22348601     Owner:  NLM     Status:  Publisher    
BACKGROUND: Patients with COPD and patients with bronchiectasis undertake airway clearance therapy and exercise as part of management but the effect of these activities on gastroesophageal acid exposure is unknown. This study aimed to determine if positive expiratory pressure (PEP) therapy and standardised exercise tasks were associated with increased gastroesophageal reflux. METHODS: During dual-probe 24hr esophageal pH monitoring, all patients undertook a single session of PEP therapy, a measure of submaximal exercise capacity (six-minute walk test [6MWT]) and a functional upper limb task (Grocery Shelving Task [GST]). The number of reflux episodes (NRE) and fractional reflux time (reflux index [RI]) were recorded during each intervention and compared to equivalent background time (BGT). RESULTS: Fifty-seven patients (30 with bronchiectasis, 27 with COPD, mean (SD) age of 61(13) years, FEV₁ of 61.2(24.6) % predicted) completed the study. Episodes of isolated distal esophageal reflux occurred in 31% of patients during PEP therapy, 25% during the 6MWT and 31% during the GST. However, there was no significant difference in distal RI during 6MWT or PEP therapy compared to BGT (all p>.05). NRE were decreased compared to BGT during the GST (p=.001) and 6MWT (p=.001) but not during PEP therapy (p=.71). CONCLUSIONS: Episodes of gastroesophageal reflux may occur during physiotherapy tasks including airway clearance therapy using mouthpiece PEP, the 6MWT and a measure of upper limb movement. However, as these activities did not increase the frequency of these events, no modifications to these tasks to minimize the occurrence of gastroesophageal reflux are necessary.
Annemarie L Lee; Linda Denehy; John W Wilson; Stuart Roberts; Robert G Stirling; Ralf G Heine; Brenda M Button
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-17
Journal Detail:
Title:  Respiratory care     Volume:  -     ISSN:  0020-1324     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7510357     Medline TA:  Respir Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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