Comparison of positive expiratory pressure device versus non-invasive ventilation on outcomes in acute exacerbation of chronic obstructive pulmonary disease in the emergency department

Comprehensive Summary

This randomized, controlled study evaluated EzPAP®, a portable positive expiratory pressure device, for acute chronic obstructive pulmonary disease (COPD) exacerbation in the Emergency Department. The study also compared the efficacy of EzPAP® to non-invasive ventilation (NIV) via Bilevel Positive Airway Pressure (BPAP). 103 patients 18 years and older with a confirmed diagnosis of COPD were included in the study once they required systemic corticosteroid therapy and NIV. Blood gas values, vital signs, and spirometry measurements were recorded before and after treatment. Eligible patients were randomized to two hours of BPAP or EzPAP®. Hospital admission rate occurred in 93% of BPAP patients, compared to only 75% in of EzPAP® patients (p = 0.004). There was no statistically significant difference in mortality rates between the two groups (p = 0.981). Changes in PaCO2, SpO2, pH, and PaO2 were similar between groups (all p> 0.3). By applying positive pressure during expiration to augment lung volume and the amount of ambient air inflow, EzPAP® improved spirometry indices and oxygenation compared with BPAP.

Outcomes and Implications

COPD exacerbations are a frequent cause of ED visits and hospitalizations. The portability of EzPAP® eliminates the need for patient transport, simplifying the treatment process. EzPAP® only requires an oxygen source, while BPAP relies on mechanical ventilators or advanced oxygen systems reliant on electrical framework. EzPAP® may serve as an effective alternative for COPD exacerbation in EDs experiencing NIV resource strain.