OPEP device added to chest physiotherapy improves adherence but not clinical outcomes in children with bronchiectasis

BACKGROUND: Airway clearance is major part of care for children with bronchiectasis (BE) and oscillatory positive pressure (OPEP) devices are widely used, yet their added value beyond a multicomponent chest physiotherapy (CPT) program remains unclear and device access often entails out of pocket costs. Aim of this study was to evaluate whether adding an OPEP device to a multicomponent CPT program provides additional benefits in exercise capacity and dynamic ventilatory responses in children with BE. METHODS: A randomized trial involving 42 children with non-cystic fibrosis BE was conducted. Children were allocated to either CPT or CPT + OPEP group. Both groups trained at home twice daily for 8 weeks. 6-min walk test (6MWT) with Spiropalm® device, spirometry, quadriceps strength measurement and Leicester Cough Questionnaire (LCQ) were applied at baseline and after training. RESULTS: 6MWT distance, change in inspiratory capacity during exertion (ΔIC), lowest SpO, the time spent with a drop of ≥ %4 in SpO [T (dSpO ≥ %4)], FVC%, FEV%, PEF%, significantly improved in both groups, with no between-groups difference. Program adherence (%) was significantly higher in CPT + OPEP group (85 ± 15) compared to CPT group (74 ± 18) (p < 0.05). CONCLUSION: In children with BE, a multicomponent CPT program improved exercise capacity, dynamic ventilatory responses and spirometry, while adding an OPEP device primarily increased adherence and conferred no additional benefit. The decision to add an OPEP device may be individualized to address engagement or feasibility rather than further clinical benefit. TRIAL REGISTRATION: The study was prospectively registered to ClinicalTrials. gov on September 1, 2021, under the registration number NCT05034900.