Single-patient, adjustable expiratory resistance device that provides positive pressure (5 to 20 cm H2O) during expiration

Tracheobronchomalacia

Positive end expiratory pressure (PEEP) mask

nPEP (non-invasive positive expiratory pressure) mask

PEEP Mask for TBM-Induced Cough

The primary objective is to determine if use of the nPEP device will change cough severity. Responses to the Cough-Visual Analog Scale range from 0-100 mm, with higher scores corresponding to worse outcomes.

The objective is to determine if use of the nPEP device will change cough-related quality of life. Responses to the Cough-Specific Quality-of-Life Questionnaire range from 28-112, with higher scores corresponding to worse outcomes.

The objective is to determine if use of the nPEP device will change cough-related quality of life. Responses to the Leicester Cough Questionnaire range from 19-133, with lower scores corresponding to worse outcomes.

The secondary objective is to determine if use of the nPEP device changes airway physiology, specifically proximal airway resistance, as assessed by impulse oscillometry.

Duke University

Eligible patients will have 6-Minute Walk Test (6-MWT) on self ventilation and on CPAP

Those patients who improve their 6-MWT by more than 30 meters will then be randomised to either:
Treatment arm - Patients will be setup onto portable CPAP during the day

Those patients who improve their 6-MWT by more than 30 meters will then be randomised to either:
Control Arm - Standard care arm.

Excessive Dynamic Airway Collapse

Participants will be established on portable CPAP during the day with nasal pillows as an interface and requested to use it at least 8 hours/day.

Experimental: Treatment

Participants will undergo a run-in phase during which they will undergo baseline assessments. If they tolerate the portable CPAP and if their 6-MWT improves by more than 30m when performed on CPAP, they will be randomised into the trial.

Experimental: Run In Phase

No change will be made to participants care

Sham Comparator: Stand Care Arm

Guys and St Thomas NHS Foundation

Symptomatic Treatment of Excessive Dynamic Airway Collapse Using Daytime Portable Continuous Positive Airway Pressure

Daytime activity assessed by an accelerometer. Participants will be assessed at baseline and at 4 weeks in the control arm and in the treatment arm with participants on portable CPAP to see if there is any change between the time frames and between the groups on daytime activity measured by accelerometers that all participants randomised into the trial will wear from baseline to follow up at 4 weeks.

Is there a change in exercise capacity measured by 6-MWT for all patients in the study from baseline to 4 weeks. All walk tests will be performed on portable Continuous Positive Airway Pressure (CPAP)

Is there a change in quality of life from baseline to 4 weeks measured by Severe Respiratory Insufficiency Questionnaire

Is there a change in quality of life from baseline to 4 weeks measured by St George's Respiratory Questionnaire.

Is there a change in neural respiratory drive measured by parasternal electromyography both at rest and whilst using portable CPAP at baseline and at 4 weeks

Is there a change in lung homogeneity in participants from baseline to 4 weeks. Measured by electrical impedence tomography whilst all participants are using portable CPAP

Is there a change in the area of the quadriceps rectus femoris in participants from baseline to 4 weeks. Measured using ultrasound which will be performed on all participants

tracheobronchomalacia/cough

PEEP Mask for TBM-Induced Cough

Symptomatic Treatment of Excessive Dynamic Airway Collapse Using Daytime Portable Continuous Positive Airway Pressure

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