A pilot study of the impact of high-frequency chest wall oscillation in chronic obstructive pulmonary disease patients with mucus hypersecretion

Abstract

IntroductionChronic obstructive pulmonary disease (COPD) patients with mucus hypersecretion tend to demonstrate increased frequency of infective exacerbations and a steeper slope of decline in lung function. Enhanced mucociliary clearance with high-frequency chest wall oscillation (HFCWO) devices previously used in cystic fibrosis and bronchiectasis patients may offer the opportunity for community-based, self-managed therapy to improve quality of life and lung function.Study design and methodsA randomized controlled crossover pilot study of HFCWO compared with conventional treatment was conducted in 22 patients with moderate to severe COPD and mucus hypersecretion. Patients spent 4 weeks using an HFCWO (SmartVest®) device and 4 weeks in a conventional phase with a 2-week washout. Eleven patients started with HFCWO and changed to conventional treatment, whereas the other eleven patients started conventional treatment and crossed over to HFCWO.ResultsThe patients were elderly with a mean age of 71 (standard deviation [SD] 10) years and were at the upper end of the normal range of body mass index (25 [SD 4.2] kg/m2). The majority of patients had moderate to severe COPD with a mean percentage predicted forced expiratory volume in 1 second of 41 (SD 15.6) and percentage predicted forced vital capacity of 73 (SD 17.7). Baseline sputum production was negatively correlated to lung function and positively to St George’s Respiratory Questionnaire. Symptom scores and St George’s Respiratory Questionnaire symptom dimension improved significantly (−8, P < 0.05). Sputum production showed a declining trend in the HFCWO phase, although not reaching statistical significance. The HFCWO device was well tolerated with good reported compliance.ConclusionThis pilot study demonstrated that patients with advanced COPD and mucus hypersecretion at increased risk of declining lung function tolerated the HFCWO treatment well, leading to improvement in quality of life and reduced symptoms.

Utility of vest high frequency chest wall oscillation device versus flutter device in acute exacerbation of chronic obstructive pulmonary disease

“…4,6,12,23 Our results also coincide with pilot study carried out by Chakravorty et al whom reported that patients with AECOPD and mucus hypersecretion are at increased risk of declining lung function, tolerated the HFCWO treatment well, leading to improvement in CAT-score and quality of life and reduced symptoms. 7 Moreover; our result is consistent with Mahajan et al, who stated that HFCWO is well tolerated in adults hospitalized for AECOPD or acute asthma and significantly improves dyspnea, also reported that patient with AECOPD use fewer antibiotics, due to fewer respiratory infections with less hospitalization. 23 In order to evaluates the tolerance to exertion as an equivalent to physical fitness, we used therapeutic effects of vest HFCWO and Flutter groups on the BODE index and its components, there was significant improvement of BODE index, 6-MWD, MMRC scale in HFCWO and Flutter groups, while BMI did not show any significant difference in both groups.…”

“…4 Conversely, Chakravorty et al, found no significant change in baseline spirometricindices (FEV1 or FVC) with HFCWO versus postintervention ones. 7 Mahajan et al, and Holland et al, reported that the vest HFCWO device was well tolerated with improvement in ventilatory functions. 23,28 The patients often feel better because they don't have to struggle to breathe and feel less fatigued, so improving quality of life.…”

“…HFCWO devices generate either positive or negative trans-respiratory pressure excursions to creates high velocity, low amplitude oscillatory airflows when applied through a pneumatic vest worn over the thorax, results in transient cephalad bias airflow spikes in the airways to loosen and moves trapped secretions from the peripheral to proximal airways, which can be removed through coughing or suctioning. 7 The chronic obstructive pulmonary disease assessment test (CAT) is designed for assessment of COPD impact on health status, it is simple questionnaires that cover daily symptoms; It include three parts (symptoms, activities and affection). [8][9][10][11][12] Identified items of CAT score include dyspnea, cough, expectoration and wheeze, also; systemic symptoms of fatigue and sleep disturbance.…”

Integrated Therapeutic Strategy During Noninvasive Ventilation in a Patient With End-Stage Respiratory Disease

“…8 To reduce the rate of treatment failure, different integrated strategies have been successfully implemented during NIV in expert RICU and ICU settings, such as careful pharmacologic sedation to improve a patient's cooperation, 9 early fiberoptic bronchoscopy, and/or high-frequency chest wall compressions (HFCWC) to promptly remove the excessive burden of secretion in COPD subjects with respiratory muscle fatigue and ineffective cough. 10,11 Extracorporeal CO 2 removal, which developed from the traditional extracorporeal membrane oxygenation, 12,13 has been recently proposed as an alternative or an integrated therapeutic option in patients with acute hypercapnic acidotic respiratory failure who are non-responders to an NIV trial. 14,15 Although extracorporeal membrane oxygenation is a total extracorporeal support that is able to oxygenate severely hypoxemic patients and remove up to 50% of the total body CO 2 production, extracorporeal CO 2 removal works as a partial extracorporeal support capable of removing lower amounts of CO 2 without substantial effects on oxygenation.…”

Expiratory Reserve Volume During Slow Expiration With Glottis Opened in Infralateral Decubitus Position (ELTGOL) in Chronic Pulmonary Disease: Technique Description and Reproducibility

“…Several techniques have been described to improve the expiratory phase and avoid premature airway closure in obstructive subjects; 6,[17][18][19][20] one such technique is ELTGOL. The slow expiration with open glottis performed during ELTGOL increases expiratory time.…”