One year of vest therapy with high frequency chest wall oscillation (HFCWO) can reduce the risk of hospitalization and the use of antibiotics, while improving self-reported respiratory health in people with non-cystic fibrosis bronchiectasis (NCFB), according to a study based on patient registry data.
The study, “Real-life experience with high-frequency chest wall oscillation vest therapy in adults with non-cystic fibrosis bronchiectasis,” was published in the journal Therapeutic Advances in Respiratory Disease. A research grant supporting this study was given by RespirTech (a Phillips company), which markets a system for HFCWO.
HFCWO is a technique for clearing airway mucus, which involves a specially engineered vest to deliver external chest wall oscillations. The approach is commonly used in conditions characterized by excessive mucus accumulation, typically if other airway clearance techniques or devices have been ineffective.
While its efficacy for cystic fibrosis has been validated extensively, less is known about benefits in people with in NCFB.
A seven-person team that included two RespirTech researchers analyzed clinical and demographic data collected before and after individuals were started on HFCWO with the company’s InCourage system. Collected data were mostly self-reported, and successfully validated using hospital records.
Information was gathered on 2,596 adults with NCFB (average age of 70, range 21 to 101) in the HFCWO-Outcomes Registry of patients prescribed the InCourage system. Registry data, collected here from September 2013 to November 2015, come from phone surveys at HFCWO start, and at one month, three months, six months, 12 months, and at six month intervals thereafter.
Patients were asked how many hospitalizations they had due to respiratory causes since before and after starting therapy. In addition, participants also provided information on the number of antibiotic treatments taken for respiratory purposes, and rated their respiratory health and ability to clear secretions using a five-point scale.
More data were available for earlier time points (first months after starting HFCWO) than at later time points.
In the year after starting HFCWO, the proportion of people with at least one respiratory-related hospitalization fell from 49.1% to 24%, or from 192 of 391 patients to 94. Over the same period, the proportion of people requiring three or more hospitalizations dropped from 14.3% to 5.6%, or from 56 to 22 of the 391 people who answered “yes” to being hospitalized before and since starting with this vest therapy.
The overall rate of hospitalizations was reduced by 54.5%: from 0.887 to 0.404 admissions per person.
Likewise, the proportion of people who were using antibiotics decreased after a year of HFCWO use, from 57.7% 29.9%.
When asked, “How would you rate your overall respiratory health,” the proportion of people who answered “good,” “very good,” or “excellent” increased from 13.6% to 60.5% after one year of HFCWO. Likewise, the proportion who gave positive answers to the question, “How would you rate your ability to clear your lungs,” increased from 13.9% to 76.6%.
“The majority of the improvement for both questions was seen within the first month and sustained for at least 1 year,” the researchers wrote.
“This study shows positive results that HFCWO therapy delivered by the InCourage system, coupled with RespirTech’s patient-centered service model, can help to reduce hospitalizations and antibiotic use for chronic respiratory patients, while also improving their overall quality of life,” Gary Hansen, director of scientific affairs at RespirTech, said in a press release.
A study participant, identified as William S., added: “I couldn’t walk across the room, take a shower or get dressed without losing my breath before I used this system. I [now] use the system three times a day for 30 minutes. [It has] eliminated the need for antibiotics for constant lung infections. It has been 1.5 years since my last lung infection. It used to be every two months.”
Among the study’s limitations, the team mentioned that patients likely received treatments other than HFCWO, which may have affected the results. Also, the study did not assess the severity of bronchiectasis, or account for milder health events that may not require hospitalization.
“More research is necessary to further clarify the impact of HFCWO on NCFB, particularly for important outcomes like hospitalization rates and when best to initiate this therapy in the course of the disease,” the scientists added. “Long-term outcomes studies are needed to elucidate whether there are sustained benefits with this treatment modality.”