{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T14:55:51Z","timestamp":1784904951194,"version":"3.55.0"},"reference-count":27,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T00:00:00Z","timestamp":1736208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, characterized by chronic mucus hypersecretion (CMH) that exacerbates airway obstruction and accelerates disease progression. Effective airway clearance techniques are essential to improve respiratory function and reduce exacerbations. Temporary Positive Expiratory Pressure (T-PEP) is a novel airway clearance device that has shown promise in managing COPD. Objectives: This meta-analysis aimed to evaluate the efficacy of T-PEP in a standard pulmonary rehabilitation program. Methods: Following PRISMA guidelines, a comprehensive search of randomized controlled trials (RCTs) was conducted in the MEDLINE and PEDro databases. Data from 162 subjects, including those with severe COPD and bronchiectasis, were analyzed. Key outcomes assessed were changes in lung function (FVC, FEV1, TLC), inspiratory and expiratory pressures (MIP, MEP), gas exchange (PaO2, PaCO2), exercise capacity (6MWT), symptom severity (mMRC, CAT, BCSS), and exacerbation rates. Results: T-PEP significantly improved FVC, FEV1, TLC, MIP, MEP, and DLCO compared to baseline, with heterogeneity noted across studies. Improvements in gas exchange and physical capacity were observed, with PaO2 increasing and PaCO2 decreasing. T-PEP also reduced symptoms of cough and dyspnea, improving quality-of-life scores. Additionally, a notable reduction in acute exacerbations of COPD was seen after one month and three months of treatment. Conclusions: T-PEP therapy shows substantial benefits in improving lung function, exercise capacity, and quality of life while reducing exacerbation rates in COPD patients. Although promising, these findings require further confirmation through randomized clinical trials to establish the optimal application of T-PEP in various clinical settings and patient phenotypes.<\/jats:p>","DOI":"10.3390\/jcm14020320","type":"journal-article","created":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T08:40:12Z","timestamp":1736239212000},"page":"320","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Systematic Review and Meta-Analysis of the Application of T-PEP in the Therapeutic Management of COPD Patients"],"prefix":"10.3390","volume":"14","author":[{"given":"Arianna","family":"Sepiacci","sequence":"first","affiliation":[{"name":"Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Starc","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossella","family":"Laitano","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franco","family":"Pasqua","sequence":"additional","affiliation":[{"name":"Pulmonary Rehabilitation Unit, Clinical Rehabilitation Institute of IRCCS San Raffaele, 00163 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7801-5040","authenticated-orcid":false,"given":"Paola","family":"Rogliani","sequence":"additional","affiliation":[{"name":"Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"},{"name":"Division of Respiratory Medicine, University Hospital Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9877-7851","authenticated-orcid":false,"given":"Josuel","family":"Ora","sequence":"additional","affiliation":[{"name":"Division of Respiratory Medicine, University Hospital Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,7]]},"reference":[{"key":"ref_1","unstructured":"(2024, October 01). GOLD Report 2024. Available online: https:\/\/goldcopd.org\/2024-gold-report\/."},{"key":"ref_2","unstructured":"World Health Organization (2024, October 01). The Top 10 Causes of Death. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/the-top-10-causes-of-death."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1378\/chest.09-2029","article-title":"Increased risk of myocardial infarction and stroke following exacerbation of COPD","volume":"137","author":"Donaldson","year":"2010","journal-title":"Chest"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1007\/s40265-014-0235-3","article-title":"Targeting mucus hypersecretion: New therapeutic opportunities for COPD?","volume":"74","author":"Martin","year":"2014","journal-title":"Drugs"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1164\/rccm.202006-2248OC","article-title":"Mucus Plugs and Emphysema in the Pathophysiology of Airflow Obstruction and Hypoxemia in Smokers","volume":"203","author":"Dunican","year":"2021","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"312","DOI":"10.2478\/jtim-2023-0094","article-title":"Mucus hypersecretion in chronic obstructive pulmonary disease: From molecular mechanisms to treatment","volume":"11","author":"Yang","year":"2023","journal-title":"J. Transl. Int. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1136\/thorax.57.9.759","article-title":"Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations","volume":"57","author":"Patel","year":"2002","journal-title":"Thorax"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"8840594","DOI":"10.1155\/2023\/8840594","article-title":"Mucus Hypersecretion in Chronic Obstructive Pulmonary Disease and Its Treatment","volume":"2023","author":"Shah","year":"2023","journal-title":"Mediat. Inflamm."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e13","DOI":"10.1164\/rccm.201309-1634ST","article-title":"An Official American Thoracic Society\/European Respiratory Society Statement: Key Concepts and Advances in Pulmonary Rehabilitation","volume":"188","author":"Spruit","year":"2013","journal-title":"Am. J. Respir. Crit Care Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1183\/13993003.02151-2015","article-title":"Increasing implementation and delivery of pulmonary rehabilitation: Key messages from the new ATS\/ERS policy statement","volume":"47","author":"Vogiatzis","year":"2016","journal-title":"Eur. Respir. J."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Belli, S., Prince, I., Savio, G., Paracchini, E., Cattaneo, D., Bianchi, M., Masocco, F., Teresa Bellanti, M., and Balbi, B. (2021). Airway Clearance Techniques: The Right Choice for the Right Patient. Front. Med., 8, Available online: https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.544826\/full.","DOI":"10.3389\/fmed.2021.544826"},{"key":"ref_12","first-page":"CD008328","article-title":"Airway clearance techniques for chronic obstructive pulmonary disease","volume":"2012","author":"Osadnik","year":"2012","journal-title":"Cochrane Database Syst Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/j.rmed.2014.11.003","article-title":"Positive expiratory pressure-Common clinical applications and physiological effects","volume":"109","author":"Lannefors","year":"2015","journal-title":"Respir. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"366","DOI":"10.4187\/respcare.11039","article-title":"The Impact of Positive Expiratory Pressure Therapy on Hyperinflation in Patients With COPD","volume":"69","author":"Santos","year":"2024","journal-title":"Respir. Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2895","DOI":"10.21037\/jtd.2016.10.69","article-title":"Effectiveness of temporary positive expiratory pressure (T-PEP) at home and at hospital in patients with severe chronic obstructive pulmonary disease","volume":"8","author":"Mascardi","year":"2016","journal-title":"J. Thorac. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1111\/crj.12661","article-title":"Comparison of effectiveness of temporary positive expiratory pressure versus oscillatory positive expiratory pressure in severe COPD patients","volume":"12","author":"Nicolini","year":"2018","journal-title":"Clin. Respir. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.arbres.2013.07.019","article-title":"Comparison of intermittent positive pressure breathing and temporary positive expiratory pressure in patients with severe chronic obstructive pulmonary disease","volume":"50","author":"Nicolini","year":"2014","journal-title":"Arch. Bronconeumol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1177\/0269215512458940","article-title":"Efficacy of temporary positive expiratory pressure (TPEP) in patients with lung diseases and chronic mucus hypersecretion. The UNIKO\u00ae project: A multicentre randomized controlled trial","volume":"27","author":"Venturelli","year":"2013","journal-title":"Clin. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation","volume":"169","author":"Tricco","year":"2018","journal-title":"Ann. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.physio.2015.07.005","article-title":"Short-term effects of three slow expiratory airway clearance techniques in patients with bronchiectasis: A randomised crossover trial","volume":"102","author":"Torres","year":"2016","journal-title":"Physiotherapy"},{"key":"ref_22","first-page":"1308","article-title":"Positive expiratory pressure and oscillatory positive expiratory pressure therapies","volume":"52","author":"Myers","year":"2007","journal-title":"Respir. Care"},{"key":"ref_23","unstructured":"Ora, J., Prendi, E., Attin\u00e0, M.L., Cazzola, M., Calzetta, L., and Rogliani, P. (2022). Efficacy of respiratory tele-rehabilitation in COPD patients: Systematic review and meta-analysis. Monaldi Arch. Chest Dis., 92, Available online: https:\/\/www.scopus.com\/inward\/record.uri?eid=2-s2.0-85137091998&doi=10.4081%2fmonaldi.2022.2105&partnerID=40&md5=3b08ca815f0859e4f41e42725d5a504a."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1941","DOI":"10.1056\/NEJMra1813799","article-title":"Muco-Obstructive Lung Diseases","volume":"380","author":"Boucher","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.1001\/jama.2023.2065","article-title":"Airway-Occluding Mucus Plugs and Mortality in Patients with Chronic Obstructive Pulmonary Disease","volume":"329","author":"Diaz","year":"2023","journal-title":"JAMA"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.bjpt.2016.12.001","article-title":"Comparing airways clearance techniques in chronic obstructive pulmonary disease and bronchiectasis: Positive expiratory pressure or temporary positive expiratory pressure? A retrospective study","volume":"21","author":"Garabelli","year":"2017","journal-title":"Braz. J. Phys. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/320\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:24:29Z","timestamp":1759919069000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/320"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,7]]},"references-count":27,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["jcm14020320"],"URL":"https:\/\/doi.org\/10.3390\/jcm14020320","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,7]]}}}