Comparison of High-Frequency Chest Wall Oscillation With Differing Waveforms for Airway Clearance in Cystic Fibrosis.

Background: High-frequency chest wall oscillation (HFCWO) is commonly used by cystic fibrosis (CF) patients for airway clearance. The primary objective of this study was to determine whether the use of a newer HFCWO device that generates oscillations with a triangular waveform results in greater sputum production than a commonly used device that generates oscillations with a sine waveform. Methods: This was a controlled, randomized, double-blind, crossover study. Fifteen clinically stable, adult CF patients participated. Patients performed airway clearance with each device once and at matched oscillation frequencies and pressures. All sputum produced during each session was collected. Patients completed pulmonary function tests before and after each session, and rated the comfort of the two devices. Results: Mean sputum wet and dry weight produced during sine waveform and triangular waveform HFCWO sessions did not differ (p = 0.11 and p = 0.2, respectively). Mean changes in FEV1 and FVC following HFCWO therapy were also comparable (p = 0.21 and p = 0.56, respectively). However, there was a significant reduction in air trapping by residual volume/ total lung capacity ratio following triangular waveform HFCWO (p = 0.01). In addition, in vitro cough transportability was 10.6% greater following therapy with the triangular waveform device (p = 0.05). Patients perceived the two devices as equally comfortable (p = 0.8). Conclusions: Single-session sputum production is comparable with sine and triangular waveform HFCWO devices. Longer term comparisons are needed to determine whether sustained use of the devices results in clinically important differences in outcomes.

COMMENTARY

Airway clearance techniques (ACT) are a mainstay of cystic fibrosis treatment, however, very little evidence for its effectiveness exists. This study utilized a carefully controlled and blinded cross-over trial to compare two modes of ACT using high-frequency chest wall oscillation. The findings of no significant difference between the modalities in sputum production, ease of cough, or comfort indicate that both are effective and well tolerated. This is important to practitioners who must choose which methods of ACT to recommend to patients with cystic fibrosis.

Reprinted with permission from Chest. [C] 2007 American College of Chest Physicians.

Abstract commentaries submitted by Anne K. Swisher PT, PhD, CCS