Treatment Algorithm Centered on Chest Physiotherapy May Minimize Lung Function Decline, Study Says

Treatment Algorithm Centered on Chest Physiotherapy May Minimize Lung Function Decline, Study Says

A treatment algorithm centered on the use of high-frequency chest wall oscillation (HFCWO) therapy may help minimize lung function decline, hospitalization rate, and the need for oral antibiotics among patients with bronchiectasis, a study says.

The findings of the study, “Employment of an algorithm of care including chest physiotherapy results in reduced hospitalizations and stability of lung function in bronchiectasis,” were published in the journal BMC Pulmonary Medicine.

Bronchiectasis is a medical condition characterized by irreversible scarring and inflammation of the bronchi (the lungs’ airways), leading to airway obstruction and impaired mucus clearance. It is often associated with other lung diseases, such as chronic obstructive respiratory disease (COPD) or cystic fibrosis (CF).

Long-term antibiotic therapy, often with tobramycin or azithromycin, has been shown to reduce the number of disease flare-ups, as well as the risk of bacterial lung infections. Using nebulized mucolytics like hypertonic saline — medications taken to soften mucus in the respiratory tract, so it can be coughed up more easily — has been shown to help in mucus clearance and improve patients’ quality of life.

In CF patients, the combination of HFCWO — an airway clearance therapy that uses inflatable vests to produce vibrations that help separate mucus from airway walls so that it can be expelled more easily — with long-term antibiotic therapy and nebulized mucolytics is known to lead to clinically meaningful improvements.

However, data is still very limited on the long-term effects of HFCWO treatment among people with bronchiectasis.

To learn more, a team led by researchers from the University of Alabama assessed the long-term effects of a treatment algorithm using HFCWO in combination with other therapies on patients’ lung function, antibiotic use, and rate of disease flare-ups.

The observational, retrospective cohort study recruited a total 65 participants from a database of patients with bronchiectasis. All had a confirmed diagnosis using high resolution computed tomography (CT) of the chest, and all experienced at least two disease flare-ups within the previous year. They also had symptoms warranting clinic admission.

Participants received a treatment algorithm which included a combination of nebulized bronchodilators, mucolytics (hypertonic saline or N-acetylcysteine) inhaled one or two times a day, antibiotics administered three times a week if needed, and HFCWO therapy (SmartVest) performed once or twice a day. Patients’ clinical outcomes were assessed after one year of treatment.

From the 65 patients receiving the treatment algorithm, 43 were eligible to be included in the final study analyses.

After one year of treatment, the forced expiratory volume (FEV1; a measure of lung function) remained stable (1.85 L before versus 1.89 L after treatment), while the number of disease flare-ups requiring patients’ hospitalization (1.3 before versus 0.46 after treatment) and antibiotic use (2.5 courses per year before versus 2.1 after treatment) were significantly reduced compared with the study’s start.

“[T]he data demonstrates the ability of this algorithm to help stabilize key lung function parameters and suggest reduction of the rate of decline of lung function. At the same time, the treatment algorithm was associated with significant reductions in the rate of exacerbations and hospitalizations which would also help slow the decline of lung function over time by preventing exacerbations,” the researchers said.

According to the team, further multicenter studies with larger sample sizes are still needed “to control and analyze the individual components of the algorithm. Smart technology could also be used to determine the level of use and adherence of the vest by the participant.”