Effect of High-Frequency Chest Wall Oscillation on the Central and Peripheral Distribution of Aerosolized Diethylene Triamine Penta-acetic Acid as Compared to Standard Chest Physiotherapy in Cystic Fibrosis

Effect of High-Frequency Chest Wall Oscillation on the Central and Peripheral Distribution of Aerosolized Diethylene Triamine Penta-acetic Acid as Compared to Standard Chest Physiotherapy in Cystic FibrosisCIystic fibrosis (CF), a disease of chronic bronchial infection, airway obstruction, progressive loss of lung function. Daily health maintenance consists of airway clearance therapy (ACT), antibiotics, dornase alfa, and bronchodilators, and can be very time consuming for CF patients. More than 50% of patients at our institution reported spending > 1 h/d administering ACT and aerosolized medications. Nearly all patients admitted noncompliance with ACT, with the most frequent reason cited for missing treatments being “too busy.”
Standard chest physiotherapy (SCPT), also called percussion and postural drainage, refers to the use of a number of positions and utilization of gravity to drain secretions from the lungs. Positioning is commonly combined with percussion or vibration over the area of the lung being drained. SCPT has been part of the standard care regimen in CF patients for > 50 years. A number of studies-2 support the effectiveness of this therapy; however, it is typically quite time consuming, requiring the use of a number of positions to achieve effective therapy.
Newer techniques may improve compliance by providing more convenient ways of administering ACT. Products such as oscillatory positive expiratory pressure devices (eg, the flutter valve) are more portable. High-frequency chest wall oscillation (HFCWO) allows for self-administration of therapy, providing patients more independence by removing the need for a caregiver to administer ACT. These newer modalities have been shown to be as effective as traditional chest percussion.
HFCWO, marketed in the United States as The Vest airway clearance system (Hill-Rom; Charleston, SC), consists of an inflatable vest and an air-pulse generator. This system is a mechanical high-frequency chest wall oscillator capable of superimposing oscillatory airflow over a patient’s inspiratory and expiratory efforts. During HFCWO, pressure pulses within the vest oscillate the thoracic wall and generate transient increases in airflow within the lung. The result is high oscillatory volumes at the mouth and high peak expiratory flow rates similar to that seen during a cough. These cough-like shear forces have been shown to alter the consistency of secretions.

This entry was posted in Cystic Fibrosis and tagged aerosol, airway clearance, central to peripheral deposition ratio, chest physiotherapy, cystic fibrosis, high-frequency chest wall oscillation, pulmonary, Xe.