High frequency chest wall oscillation for asthma and chronic obstructive pulmonary disease exacerbations: a randomized sham-controlled clinical trial

Abstract

BackgroundHigh frequency chest wall oscillation (HFCWO) is used for airway mucus clearance. The objective of this study was to evaluate the use of HFCWO early in the treatment of adults hospitalized for acute asthma or chronic obstructive pulmonary disease (COPD).MethodsRandomized, multi-center, double-masked phase II clinical trial of active or sham treatment initiated within 24 hours of hospital admission for acute asthma or COPD at four academic medical centers. Patients received active or sham treatment for 15 minutes three times a day for four treatments. Medical management was standardized across groups. The primary outcomes were patient adherence to therapy after four treatments (minutes used/60 minutes prescribed) and satisfaction. Secondary outcomes included change in Borg dyspnea score (≥ 1 unit indicates a clinically significant change), spontaneously expectorated sputum volume, and forced expired volume in 1 second.ResultsFifty-two participants were randomized to active (n = 25) or sham (n = 27) treatment. Patient adherence was similarly high in both groups (91% vs. 93%; p = 0.70). Patient satisfaction was also similarly high in both groups. After four treatments, a higher proportion of patients in the active treatment group had a clinically significant improvement in dyspnea (70.8% vs. 42.3%, p = 0.04). There were no significant differences in other secondary outcomes.ConclusionsHFCWO is well tolerated in adults hospitalized for acute asthma or COPD and significantly improves dyspnea. The high levels of patient satisfaction in both treatment groups justify the need for sham controls when evaluating the use of HFCWO on patient-reported outcomes. Additional studies are needed to more fully evaluate the role of HFCWO in improving in-hospital and post-discharge outcomes in this population.Trial RegistrationClinicalTrials.gov: NCT00181285

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.…”

“…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. On the other hand, all these variables did not differ in control group (Table 3).…”

“…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.…”

“…5,22,23 The patient was positioned in a relaxed and comfortable position either sitting upright or lying down, as no special position is recommended. No sessions immediately after a meal.…”

“…The total CAT score was calculated by summing the points of each variable, the higher scores represent worse health. [8][9][10][11][12] It was classified into four categorizes; low (< 10), medium (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), high (21)(22)(23)(24)(25)(26)(27)(28)(29)(30) and very high (> 30). (FEV1% pred = predicted amount as a percentage of the forced expiratory lung volume in one second; 6MWD = six minute walking distance; MMRC = modified medical research council dyspnea scale; BMI = body mass index.…”