(272) Effect of Aerobika®, an Oscillatory Positive Expiratory Pressure (OPEP) Device, on Lung Function Change in Pediatric Patients with Cystic Fibrosis

Thursday, November 3, 2022

12:00 PM – 12:40 PM ET

Presenting Author(s)

Elizabeth H. Baker, PhD (she/her/hers)

Associate Professor
University of Alabama at Birmingham
Birmingham, Alabama, United States

Co-Author(s)

HG

Hector H. Gutierrez, M.D.

Professor and Director
University of Alabama at Birmingham, United States
SG

Stephanie Gamble, MPH,RRT,RCP

RRT
Children's of Alabama, United States
Gabriela R. Oates, PhD

Associate Professor
University of Alabama at Birmingham
Birmingham, Alabama, United States

Background: Airway clearance therapy (ACT) is a cornerstone of CF care. Multiple ACT modalities are available, but little evidence exists to support the use of one over another. We assessed the effect of an Aerobika®, an Oscillatory Positive Expiratory Pressure (OPEP) device, on changes in lung function over a 5-year period.

Methods: We conducted a retrospective longitudinal analysis of lung function in pediatric patients, age 7 years or older, at a single CF Center from 2016 to 2021, stratified by Aerobika® use. Patient socio-demographic characteristics (sex, age, race/ethnicity, parental education, smoke exposure) and CF genotype (F508del homozygous/heterozygous/ other) were measured at baseline; P. aeruginosa (yes/no) and CFTR modulator use (yes/no) were recorded for the study period. Lung function (ppFEV₁) and age were obtained for each clinical encounter during the study period. Longitudinal analysis used hierarchical linear mixed modeling, which estimates ppFEV₁ trajectory as a function of both fixed and random effects. The intercept and the slope of lung function were measured as random effects and account for the dependence of errors introduced from repeated observations.

Results: The sample included 146 participants, age 7-20 years. Between 2016 and 2021, 39.7% (N=58) used Aerobika®, either as a main method of ACT or concurrently with a High Frequency Chest Wall Oscillation (HFCWO) vest. Aerobika® users were more likely to be F508del homozygous and less likely to be exposed to smoke and have P. aeruginosa. Longitudinal mixed models adjusted for all socio-demographic and clinical covariates showed that Aerobika® use was associated with a 6.6-point higher ppFEV₁(p=0.028) over the study period (Figure 1). Additional analyses demonstrated that Aerobika® is particularly beneficial to children of lower socioeconomic status. Among patients whose parents did not have a college degree, Aerobika® use was associated with 12.7 higher ppFEV₁ (93.5 vs 80.8; p=0.004) after controlling for all covariates. Annual lung function decline was 1.5% in both groups (p< 0.001).

Conclusions: Aerobika®, used alone or concurrently with a HFCWO vest, shows a potential for improved preservation of lung function in pediatric patients with CF, especially among patients with lower socioeconomic status. The clinical efficacy of the device should be evaluated in a randomized controlled trial. Future research should also identify the most appropriate age for introducing the device. As Aerobika® use appears to be especially beneficial to the most vulnerable individuals, it should be explored as a way to reduce disparities in lung function.

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