EFFECT OF TREATMENT WITH POSITIVE AIRWAY PRESSURE IN BRONCHIAL HYPER RESPONSIVENESS IN ASTHMATIC CHILDREN / ADOLESCENTS. RANDOMIZED CONTROLLED DOUBLE-BLIND CLINICAL TRIAL

Costa D.¹, David M.C.¹, Carvalho-Mello M.¹, Dantas Gomes E.L.²

¹Nove de Julho University, São Paulo, Brazil, ²Nove de Julho University, Post Graduation Science Rehabilitation, São Paulo, Brazil

Background: Asthma is characterized by airway hyper reactivity, which is primarily treated with anti-inflammatory agents and β adrenergic bronchodilators. However, mechanical strain during breathing is an important modulator of airway responsiveness demonstrated in asthmatic adults and animal models that continuous positive airway pressure (CPAP) resulted in lower airway reactivity.
In studies conducted with adults showed that patients who used the bilevel pressure were less time in intensive care than those who received the standard pharmacological treatment and used lowest dose and time of bronchodilators. However we need more information about the treatment and clinical control for new non pharmacological tools in the management of asthma whereas that the exercise-induced bronchospasm is a limiting symptom for a large proportion of asthmatics patients, especially children and adolescents.

Purpose: The aim was evaluate the effect of outpatient treatment by CPAP and bilevel pressure in asthmatic children and adolescents on bronchial hyper responsiveness evaluated for bronchial provocation test by exercise.

Methods: Randomized, double-blind controlled trial, in which 68 asthmatic children and adolescents were evaluated aged 6 to 16 years, 64 patients were treated: 22 were with bilevel pressure IPAP and EPAP 12 of 8; 22 with CPAP to 8 cmH2O and 20, as the control group, with respiratory muscle training (RMT) with 40% of the maximum inspiratory pressure. All were treated for 10 sessions with duration of 1 hour. The evaluation consisted of spirometry, bronchial provocation test by exercise, maximum respiratory pressure measurement, lung inflammation (FeNO) clinical control (ACQ6) and anthropometric measurements. Clinical Trials (NCT- 02939625).

Results: There were no differences between groups in any of the baseline variables. The average age of the bilevel group was 10.36 ± 2.8 in RMT group was 11 ± 3.3 and the CPAP group of 9.0 ± 3.4. According to the Z-score (-2 to +2) for anthropometric variables the groups were considered eutrophic and with proper stature. The 3 groups presented clinical difference regarding the control of asthma, from partial to full control control ( 0.75 with variation in score > or = 0.5). The maximum inspiratory pressure showed significant increase in 3 groups,being on top in the other RMT group. The bilevel group there was a significant improvement in lung function (FEV1, FEV1/FVC), FeNO reduction of 17.4 ppb with effect size = 2.43 in the bronchial responsiveness provocation test before treatment showed reduction in the fifth to the twentieth minute and post treatment of the fifth to tenth only. In the CPAP group there was improvement in FeNO 15.7 ppb with effect size of 2.46 and reduction in bronchial responsiveness that before treatment showed significant reduction of FEV1 from fifth to tenth and post-treatment just in the fifth. The RMT group showed no differences.

Conclusion(s): Positive pressure therapy has proved to be effective in reducing the bronchial responsiveness, lung inflammation and improves clinical asthma control.

Implications: With the results of this study the possibility of a non-pharmacological treatment with clinical and control impact on pulmonary function in addition to enable another function to positive airway pressure.

Funding acknowledgements: CNPq, CAPES and FAPESP

Topic: Paediatrics

Ethics approval: Nove de Julho University Board, (1487225/2016)

All authors, affiliations and abstracts have been published as submitted.