Oscillating Positive Expiratory Pressure (OPEP) Therapy in Bronchiectasis and Chronic Obstructive Pulmonary Disease (COPD): A Narrative Review of Clinical Studies

Exacerbations associated with bronchiectasis with or without chronic obstructive pulmonary disease (COPD) are often associated with generation and accumulation of excessive mucus in the airways of the lungs. Not only can mucus plugs reduce the perfusion of oxygen to the alveolar gas exchange region but they also serve as a location for opportunistic bacterial/viral infection. Delivery of inhaled medications to treat receptors associated with the underlying COPD distal to the obstructed airways can be restricted or prevented altogether. This narrative review examines clinical evidence published mainly since 2004 for the use of oscillating positive expiratory pressure (OPEP) as a drug-free airway clearance therapy (ACT) for patients experiencing COPD with or without bronchiectasis. OPEP therapy is considered as a preventative measure in between exacerbations and to clear the airways during severe exacerbations. The review is intended to assist clinicians involved with COPD-bronchiectasis management, given the increased awareness of the advantages of OPEP therapy in clinical practice guidelines.