Intermittent Positive Pressure Breathing Therapy of Chronic Obstructive Pulmonary Disease

doi:10.1059/0003-4819-99-5-612

Intermittent Positive Pressure Breathing Therapy of Chronic Obstructive Pulmonary Disease

A Clinical Trial

Abstract

A multicenter trial compared intermittent positive pressure breathing (IPPB) therapy with compressor nebulizer therapy in 985 ambulatory patients with chronic obstructive pulmonary disease. A bronchodilator aerosol solution was administered with both treatments, the only difference being the positive pressure applied by IPPB. Patients were randomly assigned to treatment and closely followed by monthly home and quarterly clinic visits for an average of 33 months. Compliance with treatment, lung function, and quality of life were evaluated at regular intervals during follow-up, and records were kept of hospitalizations and vital status. Treatment compliance was disappointing; only half of the patients used their devices the prescribed amount of time. There was no statistically significant difference between the treatment groups in mortality, rate and duration of hospitalizations, or change in lung function or life quality with time, overall or for clinically relevant subgroups. We saw no advantage of IPPB over compressor nebulizer therapy in this large group of patients, and conclude that, if an advantage exists, it must be marginal.

Article and Author Information

▸Participants in the Intermittent Positive Pressure Breathing Trial are listed in the Acknowledgments.
Participants in the Intermittent Positive Pressure Breathing Trial (an asterisk indicates a principal investigator) were the following:
Clinical Centers: Baylor College of Medicine, Houston, Texas: Paul Stevens, M. D.*; and Ruth Abeles, R.N.; Loma Linda University, Loma Linda, California: John E. Hodgkin, M.D.*; and Eileen G. Zorn, R.N., M.S.; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma: David C. Levin, M.D.*; Brenda N. Jaye, R.N., and Patricia K. Brannin, R.N., M.S.N., R.R.T.; University of California, San Francisco, California: Philip C. Hopewell, M.D.*; and Joan Turner, R.N., M.S.; and University of Manitoba, Winnipeg, Manitoba, Canada: Nicholas R. Anthonisen, M.D.*; and Lynda Mendella, R.N.
Data Coordinating Center: George Washington University Biostatistics Center, Bethesda, Maryland: Dean E. Krueger, M.S.*; Elizabeth C. Wright, M.P.H.; and Max Halperin, Ph.D.
Neuropsychology Center: University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma: George P. Prigatano, Ph.D.
Pathology Center: University of British Columbia, Vancouver, British Columbia, Canada: William M. Thurlbeck, M.D.
Advisory Board: Marvin A. Sackner, M.D. (Chairman); Stephen M. Ayres, M.D.; B. William Brown, Ph.D.; David DeMets, Ph.D.; Millicent Higgins, M.D.; Philip Kimbel, M.D.; Jeanne K. Malchon; Harold Menkes, M.D.; William F. Miller, M.D. and Louis Vachon, M.D.
National Heart, Lung, and Blood Institute: Lynn H. Blake, Ph.D.; David DeMets, Ph.D.; Suzanne Hurd, Ph.D.; Claude Lenfant, M.D.; Sydney Parker, Ph.D.; Hannah Peavy, M.D. and Richard Sohn, Ph.D.
The authors thank Boehringer Ingelheim, Ltd., Ridgefield, Connecticut, for the donation of metaproterenol solution, metaproterenol metered dose inhalers, and theophylline tablets; Breon Laboratories, Inc., New York, New York, for the donation of isoetharine solution and isoetharine metered dose inhalers; and Key Pharmaceuticals, Inc., Miami, Florida, and Roerig (Pfizer Pharmaceuticals), New York, New York, for the donation of theophylline tablets.
▸Requests for reprints should be addressed to the Division of Lung Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Westwood Building, Room 6Al2; Bethesda, MD 20205.