ResMed revs up CPAP

SAN DIEGO - ResMed, two years after Respironics rocked the CPAP world with the debut of its wildly popular C-Flex device, has finally answered the challenge with a similar form of therapy, called EPR. The new therapy is available on the Elite and Vantage flow generators, two of the four next generation S8 CPAP models that ResMed debuted at Medtrade. In general, the company's new line is smaller, lighter and consumer-driven, heralding an era of commoditization when CPAPs may actually come equipped with MP3 players and alarm clocks. Suppliers, charmed by the sleek new look, the smart card, the auto-mask reminder and EPR, are high on the new line but question whether the new therapy packs enough punch to take on C-Flex since the Respironics therapy is now a standard feature while EPR is a premium option. "Will the bells and whistles save money and improve patient compliance, specifically for DMEs," said Larry Loewen, director of sales and marketing at Mitchell Home Medical in Ypsilanti, Mich. "That's the question." Like C-Flex, EPR decreases pressure at the beginning of each expiration and offers three comfort settings. "Other than that, they are very different," said John Goodman, president of Health Management Services in Houston, who has identified a suite of differences: While C-Flex decreases the pressure at the beginning of the breath, EPR keeps the pressure down all the way through exhalation. Secondly, the C-Flex reductions are tied into the patient's exhalation strength while EPR cuts the pressure by one, two or three centimeters. This lets the "clinician pick an expiratory setting like 1-3 cm and know the machine is not cycling at more or less of the set numbers," said Ron Richard, senior vice president of strategic marketing initiatives at ResMed. Thirdly, EPR is suspended in the event of a disordered breathing event. Since the C-Flex pressure drop is so short, clinicians don't believe there's any negative impact during an event. EPR works in a separate mode, unlike C-Flex which is always on the auto-mode, and EPR can be limited to work as a ramp function. Goodman, for one, still questions how a therapy like EPR is really any different from bi-level since you're actually controlling the pressure reductions by one, two or three cm. The FDA and CMS clearly distinguish between bi-level and the new therapy modes and have approved the devices as CPAP, not bi-level. For Richard, too, there's a clear difference. "Bilevel devices like BiPAP or VPAP increase pressure during the inspiratory phase of the breath, thus increasing tidal volume and gas exchange," he said. "They drop pressure during exhalation, typically to a level of pressure which is thought to splint the airway open, like CPAP." EPR is not available on ResMed's S8 Compact model, an entry-level grade of CPAP that does include ramp but not a smart card or DC voltage. Nor is it available on the Escape model, which does have the smart card and the DC voltage and comes standard with the carrying case.