PEP-flute selfcare in epidemic respiratory infectious diseases – high societal impact at low cost?

Background
The COVID-19 pandemic has led to worldwide increases in mortality and disrupted healthcare systems. The necessary countermeasures have adversely affected our lives, both mentally and economically. Home-based interventions to help individuals with early COVID-19 overcome the disease with fewer symptoms are needed. This study explored if self-care using positive expiratory pressure (PEP) as airway clearance is effective in reducing respiratory symptoms and, thus hypothetically prevent COVID-19 associated pneumonia.
Methods
This open-label, randomized trial (ClinicalTrials.gov:NCT04530435) recruited community dwelling adults from Capital Region and Region Zealand in Denmark from 6 Oct 2020 to 26 Feb 2021. Eligible participants (verified SARS-CoV-2 infection, COVID-19 symptoms, and able to perform self-care) were randomized to usual care or to PEP-flute self-care (PEP thrice daily) as an add-on to usual care. PEP-flutes were delivered by express mail and instructions given by video-links. The primary outcome was a change (analyzed by repeated measures mixed linear models) in self-reported symptom severity from baseline to day 30, as assessed by the COPD (chronic obstructive pulmonary disease) assessment test (CAT). Another outcome was the perceived effect of PEP-selfcare.
Results
The PEP self-care group (n = 190) had significantly lower symptom severity (group difference -1.2 points (95% confidence interval -2.1 to -0.2; p = 0.017)) at day 30 compared to the usual care group (n = 188). The PEP self-care group reported less chest tightness, less dyspnea, more vigor, and higher level of daily activity. When asked, “How do you describe the PEP-flute effect?”, 30% (n = 56) from the PEP group reported PEP-use to provoke coughing of phlegm. No serious adverse events were reported.
Conclusions
In early COVID-19, PEP-flute self-care was effective in reducing respiratory symptom severity among community dwelling adults and may have a future societal impact at a low cost.
Key messages
• We advocate for more research in self-care interventions to confirm if campaigns and handouts of PEP-flutes to mobilize the citizens’ selfcare are suitable public health responses to the next pandemic.

• More research is needed to establish efficacy of non-drug interventions like PEP-selfcare for airway clearance to prevent pneumonia.