Effectiveness of treatment with high-frequency chest wall oscillation in patients with bronchiectasis

Abstract

BackgroundHigh-frequency airway clearance (HFCWC) assist devices generate either positive or negative trans-respiratory pressure excursions to produce high-frequency, small-volume oscillations in the airways.HFCWC can lead to changes in volume of 15–57 ml and in flow up to 1.6 L/s, which generate minimal coughing to mobilize secretions. The typical treatment lasts 20–30 minutes, and consists of short periods of compression at different frequencies, separated by coughing.The aim of this study was to find the more efficacious treatment in patients with bronchiectasis: traditional techniques of chest physiotherapy (CPT) versus high frequency oscillation of the chest wall in patients with bronchiectasis.Methods37 patients were enrolled. Seven of them were excluded. Computer randomization divided the patients into three groups:– 10 patients treated with HFCWO by using the Vest® Airway Clearance System;– 10 patients treated with traditional techniques of air way clearance (PEP bottle, PEP mask, ELTGOL, vibratory positive expiratory pressure);– 10 patients received medical therapy only (control group).To be eligible for enrollment, participants had to be between 18 and 85 years old and have a diagnosis of bronchiectasis, confirmed on high resolution computed tomography. Exclusion criteria: lack of informed consent, signs of exacerbation, cystic fibrosis. Before the treatment, each patient had blood tests, sputum volume and cell count, pulmonary function tests and on the quality of life inventories (MMRC, CAT, BCSS). The results were processed through the covariance analysis, performed with the R-Project statistical program. It has been considered a positive result p <005.ResultsBoth treatments (traditional CPT and HFCWO) showed a significant improvement in some biochemical and functional respiratory tests as well as in the quality of life compared to the control group. The use of HFCWO compared to CPT also produced a significant improvement in blood inflammation parameter C-RP (p ≤0.019), parameters of lung functionality associated with bronchial obstruction (FVC, FEV1) (p ≤0.006 and p ≤0.001), and in the dyspnea. Improvement in quality of life scales was noted. (BCSS, CAT) (both p ≤0.001). No significant changes of total cell counts in sputum samples were observed in the two groups. In the HFCWO group a significant reduction of neutrophils percentage (p≤0.002) and a significant increase of macrophages percentage (p ≤0.012).ConclusionsThe HFCWO technique provides an improvement both in pulmonary function and quality of life related parameters in patients with chronic hypersecretive disease. Since those patients need daily airway clearance, this treatment should be included among the principal options in chest physiotherapy. The study was registered as ChiCTR-TRC-12002134 at http://www.chictr.org.

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

“…Numerous studies come in agreement with our results and concluded that the reduction in CAT-score detects early health status improvement and chest wall vibration reduces dyspnea in COPD patients. 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.…”

“…3 The improved spirometric-indices reported among our patients in HFCWO or Flutter with no improvement in control group (Table 3), was similar to the results reported by Nicolini et al, who concluded that, there was significant improvement in pulmonary function tests (FEV1 or FVC) in CPT and HFCWO treated patients in comparison to control group. 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.…”

Effect of Combination of Acapella Device and Breathing Exercises on Treatment of Pulmonary Complications After Upper Abdominal Surgeries

“…This treatment should be included among the principal options in chest physiotherapy [13]. There was a significant improvement of FVC and FEV1 also arterial oxygen pressure (PaO2), carbon dioxide pressure (PaCO2) improved after 4 weeks in patients with chronic obstructive pulmonary diseases (COPD) after upper abdominal surgery [14].…”

Response of Forced Expiratory Volume/Forced Vital Capacity Ratio to Acapella Device and Breathing Exercises After Upper Abdominal Surgeries

“…The OPEP provide an improvement both in pulmonary function tests (FVC, FEV1) and quality of life. This treatment should be included among the principal options in chest physiotherapy [13].…”