Laboratory Investigation into the Performance of four Oscillating Positive Expiratory Pressure (OPEP) Devices set at the Target Pressure Level

Introduction: OPEP devices are crucial for airway clearance in patients with excessive excess mucus production, including those with bronchiectasis, cystic fibrosis (CF) and COPD. This laboratory study compared the performance of four different OPEP devices, each utilizing distinct different mechanisms to generate oscillatory pressure. Flow oscillation amplitude (the magnitude of pulse), was determined at an average positive pressure of 15 cm H₂O², a midpoint within the therapeutic range of 10–20 cm H2O typically targeted for OPEP devices [1]. Higher oscillation amplitudes may create stronger shear forces, reducing the viscoelastic properties of bronchial secretions [1] and enhancing mobilization and clearance [2].

Methods: Four OPEP devices; Aerobika*(Trudell Medical International), Acapella Choice Blue (ICU Medical), GeloMuc (Pohl Boskamp), and RC Cornet Plus (Cegla) were assessed at their mid resistance setting(s) using a flow generator (Resmed VPAP III), flow meter (TSI 4000) and pressure sensor for data collection and analysis. The average flow oscillation amplitude was measured for each device when the positive pressure was set at 15 cm H₂O [2].

Results /Discussion: The devices exhibited varying performance, with Aerobika*achieving the highest flow pulse amplitude, followed by Acapella, GeloMuc, and RC Cornet Plus. Notably, the RC Cornet Plus demonstrated inconsistent oscillations at its higher mid-resistance setting due to inadequate flow rates, with more reliable results at the lower mid-resistance setting.

Discussion And Conclusions: The Aerobika*OPEP device performed the best overall, demonstrating the highest average flow pulse amplitudes at the target pressure setting. Limitations of the study include recognition that the clinical impact of such differences in flow amplitudes should be proven in patients and that patients may not always operate their OPEP devices at the target 15 cm H₂O² positive pressure. When selecting an OPEP device, it is crucial to consider not only the clinical evidence supporting its efficacy and patient preferences but also the variations in mechanical mode of operation that can influence device performance.

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Publication History

Article published online:
18 March 2025

• References

• 1 Coppolo D. et al Pulm Ther. 2021
• 2 Van Fleet H. et al Respiratory Care 2017; 62 (04) 451-458