Efficacy of bottle positive expiratory pressure (Bottle-PEP) therapy as adjunct to bronchodilators in stable COPD patients

<bold>Background:</bold> The adjunctive role of Bottle-PEP therapy to inhaled bronchodilators in stable COPD is unknown. <bold>Aims and Objectives:</bold> Our study was a single-blind RCT designed to find out whether the use of bottle PEP therapy with huff-cough as an adjunct to bronchodilators in stable COPD patients resulted in additional decrease in Breathlessness Cough Sputum Scale (BCSS) and COPD Assessment Test score (CAT) as compared to control. <bold>Methods:</bold> Baseline scores were measured. Stable COPD patients (GOLD Groups: B, C, D) were randomised into two arms. Intervention arm: Performed twice-daily five sets of ten exhalations through a 10-cm water column of Bottle-PEP followed by huff-cough and a 2-minute interval between sets. This was followed by inhaled bronchodilator therapy. Control arm: huff-cough followed by inhaled bronchodilators. Study duration was three months. The assessor was blind to the allocation arms. <bold>Results:</bold> At the end of three-months, the intervention & control arm had 41 & 39 patients, respectively. The decrease in mean CAT score from baseline in the intervention arm was 6.05 +/- 4.04 points, compared to 4 +/- 3.87 in the control arm. The mean BCSS score decreased by 1.93 +/- 1.66 in the intervention arm compared to 1.13 +/- 1.44 in the control arm. The decrease in CAT scores was significantly more in the intervention arm (t test -2.314, 95% CI = -3.81 to -0.28, p=0.02). Similarly, BCSS was significantly more reduced in the intervention arm (t test -2.293, 95% CI = -1.49 to -0.10, p=0.025). <bold>Conclusion:</bold> Significant intra group changes were observed in both arms, with the intervention arm showing a significantly greater decrease in CAT and BCSS scores.