Intrapulmonary percussion ventilation on functional respiratory imaging endpoints in COPD patients

<bold>Background:</bold> Intrapulmonary percussion ventilation (IPV) is an airway clearance technique which results in an increased mucus clearance and potential promotion of alveolar recruitment (Riffard et al., 2013). <bold>The aim of this study</bold> is to investigate the impact of treatment with intrapulmonary percussive ventilation (IPV) MODEL IPV-2C (Sentec) on functional respiratory imaging (FRI) endpoints in COPD patients. <bold>Methods:</bold> COPD patients receive IPV session, 3 times a week for 30-minutes during 4 weeks. At baseline and at the end of the intervention period, HRCT scans are taken at Total Lung Capacity (TLC) and Functional Residual Capacity (FRC). FRI endpoints are volume fraction of intrapulmonary vessels with cross-sectional area 1.5 to 5 mm² (BV5%) and lobe volumes (iVlobe) at TLC and FRC. <bold>Results:</bold> 9 COPD (5M/4F) patients of 70(7) years with FEV1 37(14)% predicted were enrolled. iVlobe at TLC decreased significantly(p=.003) and significantly increased at FRC (p=.003). BFV5% decreased significantly (p=.044). <bold>Conclusions:</bold> One month treatment with IPV in patients with severe to very severe COPD led to decrease of hyperinflation, given by significant decrease in iVlobe at TLC. Furthermore, the significant increase of iVlobe at FRC reflects a recruitment of alveoli. Both changes lead to increased intra-alveolar perfusion (IAP). In hyperinflated alveoli, the higher pressure on intra-alveolar vessels (IAV) will shift the blood to larger postcapillary vessels, measured by BV5%. Significant decrease of BV5% is an indicator of better IAP by decline in hyperinflation (less pressure on IAV) and recruitment of alveoli, creating more IAV with shifting less blood to BV5.