Mucus hypersecretion is a common feature among those suffering from COPD and asthma, often leading to frequent exacerbations despite optimal pharmaceutical treatment. HFCWO helps improve airway clearance by using positive and negative pressure changes to enhance peripheral lung secretion movement.
HFCWO therapy is safe and well tolerated in hospitalized patients requiring airway clearance therapy, with few adverse side effects reported by hospital staff or patients alike. Furthermore, its safer percussive ventilation approach than chest wall percussion does not dislodge lines, drains, catheters etc.
What is HFCWO?
High frequency chest wall oscillation (HFCWO) is an airway clearance therapy that utilizes vibrations to loosen and flush away mucus from your respiratory tract, making breathing easier while decreasing risk of exacerbations. HFCWO’s at-home treatment option utilizes a vest fitted around your chest which vibrates at a fixed frequency to facilitate secretion mobilization and clearance.
In a large, retrospective cohort study involving 2596 adults with non-cystic fibrosis bronchiectasis (NCFB), initiating mHFCWO was associated with significant improvements in hospitalization rates, antibiotic use and self-reported quality of life metrics such as respiratory symptoms and health-related quality of life metrics, particularly frequent exacerbator patients. Furthermore, improvements were immediate and sustained for up to 1 year post mHFCWO implementation.
Recent research compared spirometry results of NCFB patients treated with both an mHFCWO and sham device. FEV1, FVC and total lung capacity measurements were similar between groups; moreover, both reduced frequency of exacerbations due to spirometry-based measures.
mHFCWO was found to significantly decrease central and distal airway volumes as well as total lobe volumes in both proximal and distal lung areas. Furthermore, an increase in lung elasticity caused a shift of mucus in airways; an effect which likely contributed to this shift.
These findings demonstrate that mHFCWO can be an effective treatment option for NCFB, and should be included as part of existing therapies as an add-on therapy. Furthermore, it’s a safe and cost-effective treatment which may also form part of an overall plan to manage bronchiectasis including education and supportive care services.
How Does HFCWO Work?
HFCWO systems differ from OLE devices by employing external percussive wave forces to mobilize secretions through air bladders in an airway clearance vest, typically by Hillrom-Baxter’s Vest system, Tactile Medical’s AffloVest or Monarch (Hillrom-Baxter) or SmartVest (Electromed).
HFCWO therapy uses rapid compression and expansion motions on the chest wall to generate oscillatory pressure waves that disturb bronchial secretions, making them easier for coughing out. Vibrations also stimulate ciliary beating which changes their nature so they become thinner and more liquid, helping the body easily clear them out from within your lungs.
Airway clearance therapy is a noninvasive form of physical therapy used to help those living with chronic respiratory conditions breathe easier and live healthier lives. A consistent schedule of airway clearance therapy reduces symptoms like fatigue, shortness of breath and coughing while protecting against potentially life-threatening bacterial infections that could occur with chronic conditions like cystic fibrosis (CF).
Studies have demonstrated that HFCWO can significantly decrease pulmonary exacerbations among those living with cystic fibrosis or chronic obstructive pulmonary disease (COPD), while also improving their lung function and quality of life.
HFCWO works based on several theories. One is that its device increases shearing force on bronchial secretions during expiration, enabling them to flow more easily from lungs to large airways. Another possibility is that vibrations stimulate ciliary beats which changes their nature so they become thinner and clear more quickly when coughing occurs.
The SmartVest is the premier device for providing HFCWO therapy. With advanced features and personalized therapy that allow users to breathe easier and enjoy greater quality of life, those interested in including HFCWO as part of their daily life should consult with their doctor prior to beginning this form of treatment.
People already receiving this revolutionary treatment may participate in ongoing clinical trials to assess its efficacy. One such trial compares AffloVest with standard physiotherapy for 30 bronchiectasis patients; SmartVest will play a significant role in this trial with an estimated completion date in December 2020.
What is the Difference Between HFCWO and Compression?
HFCWO stands apart from compression therapy in how it generates and delivers its effects. Percussive waves vibrating the chest wall help loosen thick mucous with shearing forces, making coughing out easier for patients. Furthermore, these vibrations also reach into the lungs to promote secretion mobilization and elimination. There are various devices which provide percussive waves directly onto the chest wall like handheld percussion clapping or vest-based devices that deliver percussive waves directly.
HFCWO differs from hand-held devices by being worn comfortably while sitting. It consists of an inflatable vest that wraps fully around a patient and connects to an air pulse generator, equipped with air pockets that vibrate at a specific frequency and intensity selected by them, between 2Hz-25Hz depending on their comfort levels.
A randomized controlled trial was conducted to compare the effects of mobile HFCWO device (mHFCWO) with nonmobile device in individuals with cystic fibrosis who experienced difficulty clearing their sputum. Both devices were used for 30 min during one treatment session followed by two week break periods between each therapy session; Sputum collections, spirometry tests and Brody score assessments were done before and after every therapy session.
The results of the study demonstrated that mHFCWO outshone CPT at mobilizing and expectorating sputum, even when taking into account potential factors like practice effects and familiarity with CPT. This important finding demonstrated that mHFCWO can be as effective in people living with CF who struggle to cough than CPT alone.
Note that while this result may seem encouraging, not all micro HFCWO devices are created equal. Biphasic Cuirass Ventilation (BCV) devices offer true oscillation of the chest wall without inhibiting range of motion or interfering with FRC recruitment – unlike traditional vest-based therapies which often restrict chest movement or interfere with FRC recruitment; as a result it significantly enhances secretion clearance for those suffering from conditions like Cystic Fibrosis, Bronchiectasis disorder of diaphragm or neuromuscular diseases.
Why Should I Try HFCWO?
HFCWO therapy can provide significant improvements in lung function and quality of life for those living with cystic fibrosis, bronchiectasis or any other chronic respiratory conditions. HFCWO therapy serves as an effective mucus mobilization method, making home treatment possible with its portable device. Furthermore, it should be part of an airway clearance therapy regimen (ACT), alongside inhalers and nebulized medications to maximize outcomes and maximize results.
ACT can help break up and thin out thick mucus in the lungs that cannot be cleared by coughing or suction alone, making sputum easier for your body to clear away. Historically, chest physiotherapy, huff coughing and PEP devices were commonly used as forms of ACT therapies; more recently however mobile high frequency chest wall oscillation vests (mHFCWOs) with positive pressure air pulses are being introduced that use positive pressure air pulses to loosen secretions and promote natural coughing.
The mHFCWO is an advanced and user-friendly version of the original HFCWO device. The device consists of an inflatable vest connected to a power generator which quickly injects and withdraws air, creating vibrations similar to diaphragmatic movements. Setup or training aren’t required for using it and its rechargeable battery allows patients to bring it along on travel adventures for treatment while on the road.
Recent umbrella review of 12 systematic reviews provides support for the efficacy of HFCWO for improving sputum properties, lung function tests, dyspnea and quality of life in conditions like cystic fibrosis, bronchiectasis and chronic obstructive pulmonary disease (COPD). 8 studies had a high AMSTAR-2 confidence level while global interest in HFCWO has grown substantially since 2010.
RespirTech, a Philips company, conducted a retrospective patient registry study which demonstrated how HFCWO therapy with their mHFCWO device significantly reduced hospital admissions, antibiotic usage and improved health-related quality of life for chronic respiratory patients in just one year.1 Their results were published in PLOS ONE peer-reviewed journal.
