Effectiveness of treatment with high-frequency chest wall oscillation in patients with bronchiectasis

BMC Pulmonary Medicine

Cornelius Barlascini¹  Maura Ferrari-Bravo⁴  Sergio Lanata²  Norma Landucci³  Federica Cardini³  Antonello Nicolini³ 

[1] Forensic Medicine, Chiavari, Italy;Histopathology Unit, General Hospital of Sestri Levante, Genoa, Italy;Respiratory Diseases Unit,General Hospital of Sestri Levante, Genoa, Italy;Department of Public Health and Preventive Medicine, Chiavari, Italy

关键词: Dyspnea scales;    Sputum cell count;    Lung function;    Chest physiotherapy;    High frequency chest wall oscillation;    Bronchiectasis;   

Others  :  1122363
DOI  :  10.1186/1471-2466-13-21

 received in 2012-08-13, accepted in 2013-03-13,  发布年份 2013

【 摘 要 】

Background

High-frequency airway clearance (HFCWC) assist devices generate either positive or negative trans-respiratory pressure excursions to produce high-frequency, small-volume oscillations in the airways.

HFCWC can lead to changes in volume of 15–57 ml and in flow up to 1.6 L/s, which generate minimal coughing to mobilize secretions. The typical treatment lasts 20–30 minutes, and consists of short periods of compression at different frequencies, separated by coughing.

The aim of this study was to find the more efficacious treatment in patients with bronchiectasis: traditional techniques of chest physiotherapy (CPT) versus high frequency oscillation of the chest wall in patients with bronchiectasis.

Methods

37 patients were enrolled. Seven of them were excluded. Computer randomization divided the patients into three groups:

– 10 patients treated with HFCWO by using the Vest® Airway Clearance System;

– 10 patients treated with traditional techniques of air way clearance (PEP bottle, PEP mask, ELTGOL, vibratory positive expiratory pressure);

– 10 patients received medical therapy only (control group).

To be eligible for enrollment, participants had to be between 18 and 85 years old and have a diagnosis of bronchiectasis, confirmed on high resolution computed tomography. Exclusion criteria: lack of informed consent, signs of exacerbation, cystic fibrosis. Before the treatment, each patient had blood tests, sputum volume and cell count, pulmonary function tests and on the quality of life inventories (MMRC, CAT, BCSS). The results were processed through the covariance analysis, performed with the R-Project statistical program. It has been considered a positive result p <005.

Results

Both treatments (traditional CPT and HFCWO) showed a significant improvement in some biochemical and functional respiratory tests as well as in the quality of life compared to the control group. The use of HFCWO compared to CPT also produced a significant improvement in blood inflammation parameter C-RP (p ≤0.019), parameters of lung functionality associated with bronchial obstruction (FVC, FEV1) (p ≤0.006 and p ≤0.001), and in the dyspnea. Improvement in quality of life scales was noted. (BCSS, CAT) (both p ≤0.001). No significant changes of total cell counts in sputum samples were observed in the two groups. In the HFCWO group a significant reduction of neutrophils percentage (p≤0.002) and a significant increase of macrophages percentage (p ≤0.012).

Conclusions

The HFCWO technique provides an improvement both in pulmonary function and quality of life related parameters in patients with chronic hypersecretive disease. Since those patients need daily airway clearance, this treatment should be included among the principal options in chest physiotherapy. The study was registered as ChiCTR-TRC-12002134 at http://www.chictr.org webcite.

【 授权许可】

   
2013 Nicolini et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Barker AF: Bronchiectasis. N Engl J Med 2002, 346:1383-1393.
• [2]Eyuboglu FO, Ugurlu AO, Habesoglu MA: Clinical, radiologic, and functional evaluation of 304 patients with bronchiectasis. Ann Thor Med 2011, 6(3):131-136.
• [3]Alzeer AH, Al-Mobeirek AF, Al-Otair HA, Elzamzamy UA, Shaffy AS, Joherjy IA: Right and left ventricular function and pulmonary artery pressure in patients with bronchiectasis. Chest 2008, 133:468-473.
• [4]King PT, Holdsworth SR, Freezer NJ, Villanueva E, Gallagher M, Holmes PW: Outcome in adult bronchiectasis patients. COPD 2005, 2:27-34.
• [5]Alzeer AH, Masood M, Basha SJ, Shaik SA: Survival of bronchiectatic patients with respiratory failure in ICU. BMC Pulm Med 2007, 7:17. BioMed Central Full Text
• [6]Paneroni M, Clini E, Simonelli C, Bianchi L, Degli Antoni F, Vitacca M: Safety and efficacy of short-term intrapulmonary percussive ventilation in patients with bronchiectasis. Resp Care 2011, 56(7):984-988.
• [7]Martinez Garcia MA, Carro LM, Serra PC: Treatment of non-cystic fibrosis bronchiectasis. Arch Broncopneumol 2011, 47(12):599-609.
• [8]Ilowite J, Spiegler P, Chawla S: Bronchiectasis: new findings in the pathogenesis and treatment of this disease. Curr opin infect Dis 2008, 21(2):163-167.
• [9]O’Donnel AE: Bronchiectasis. Chest 2008, 134(4):815-823.
• [10]Metersky ML: New treatment options for bronchiectasis. Ther Adv Respir Dis 2010, 4(2):93-99.
• [11]Daviskas E, Anderson SD, Gomes K, Briffa P, Cochrane B, Chan HK: Inhaled mannitol for the treatment of mucociliary dysfunction in patients with bronchiectasis:effect on lung function, health status and sputum. Respirology 2005, 10:46-56.
• [12]Yalcin E, Kiper N, Ozcelik U, Dogru D, Firat P, Sahin A: Effects of clarithromycin on inflammatory parameters and clinical conditions in children with bronchiectasis. J Clin Pharm ther 2006, 31:49-55.
• [13]Nogrady SG, Evans WV, Davies BH: Reversibility of airways obstructions in bronchiectasis. Thorax 1978, 33:635-637.
• [14]Pryor JA: Physical therapy for adults with bronchiectasis. Clin Pulm Med 2004, 11:201-209.
• [15]McCool FD, Rosen MJ: Non pharmacological airway clearance therapies.ACCP evidence-based clinical practice guidelines. Chest 2006, 129(1):S250-S259.
• [16]Eaton T, Young P, Zeng I, Kolbe J: A randomized evaluation of the acute efficacy, acceptability and tolerability of flutter and active cycle of breathing with and without postural drainage in non-cystic fibrotic bronchiectasis. Chron Resp Dis 2007, 2007(4):23-30.
• [17]Mutalithas K, Watkin G, Willing B, Wardlaw A, Pavord ID, Birring SS: Improvement in health status following bronchopulmonary hygiene physical therapy in patients with bronchiectasis. Resp Med 2008, 102(8):1140-1144.
• [18]Patterson JE, Bradley JM, Elborn JS: Airways clearance in bronchiectasis:a randomized crossover trial of active cycle of breathing techniques (incorporating Postural drainage and vibration) versus test of incremental respiratory endurance. Chronic Resp Dis 2004, 1(3):127-130.
• [19]Bott J, Blumenthal S, Buxton M, Ellum S, Falconer C, Garrod R: British Thoracic Society Physiotherapy guideline development Group. Guidelines for the physiotherapy management of the adult,medical,spontaneously breathing patients. Thorax 2009, 64(1):1-51.
• [20]Rowe SM, Clancy JP: Advances in cystic fibrosis therapies. Curr Opin Pediatr 2006, 18:604-613.
• [21]Osman LP, Roughton M, Hodson ME, Pryor JA: Short-term comparative study of high frequency chest wall oscillation and European airway clearance techniques in patients with cystic fibrosis. Thorax 2010, 65:196-200.
• [22]Chakravorty I, Chahal K, Austin G: A pilot study of the impact of high-frequency chest wall oscillation in chronic obstructive pulmonary disease patients with mucus hypersecretion. Int j COPD 2011, 6:693-699.
• [23]Mahajan AK, Dietta GB, Hatipoglu U, Bilderback S, Ridge A, Walker Harris V: High frequency chest wall oscillation for asthma and chronic obstructive pulmonary disease exacerbations: a randomized sham-controlled clinical trial. Resp Res 2011, 12:120. BioMed Central Full Text
• [24]Guimares FS, Moco VJR, Menezes SLS, Diaz CM, Alles REB, Lopes AJ: Effects of Eltgoland flutter VRPI on the dynamic and static pulmonary volumes and on the other secretion clearance of patients with bronchiectasis. Rev Bras Fisioter 2012, 16(2):108-113.
• [25]West K, Wallen M, Follett J: Acapella vs. PEP mask therapy: a randomised trial in children with cystic fibrosis during respiratory exacerbation. Physiother Theory Pract 2010, 26(3):143-149.
• [26]Sehling M, Ohberg F, Johansson MS, Winso O: Physiological responses to positive expiratory pressure breathing:a comparison of the PEP bottle and the PEP mask. Resp Care 2007, 52(8):1000-1005.
• [27]Santos AP, Guimarães RC, De Carvalho EM, Gastaldi AC: Mechanical behaviors of Flutter VRP1, Shaker, and Acapella Devices. Resp Care 2013, 58(2):298-304. in press
• [28]Leidy NK, Rennard S, Schmier J, Jones K, Goldman M: The breathlessness,cough,and sputum scale.The development of empirically based guidelines for interpretation. Chest 2182, 124:2182-2191.
• [29]Dodd JW, Hogg L, Nolan J, Jefford H, Grant A, Lord VM: The COPD assessment test (CAT): response to pulmonary rehabilitation. A multicentre prospective study. Thorax 2011, 66(5):425-429.
• [30]Lee BY, Lee S, Lee JS, Song JW, Lee SD, Jang SH: Validity and reliability of CAT and Dyspnea-12 in bronchiectasis and tubercolous destroyed lung. Tuberc Respir Dis 2012, 72:467-474.
• [31]Pizzichini E, Pizzichini MM, Efthimiadis A, Evans S, Morris MM, Squillace D: Indices of airway inflammation in induced sputum:reproducibility and validity of cell and fluid-phase measurement. AmJ Resp Crit Care Med 1996, 154:308-317.
• [32]Moritz P, Marquez Steidle LJ, Felisbino MB, Kleveston T, Pizzichini MM, Pizzichini E: Determination of the inflammatory component of airway diseases by induced sputum cell counts: use in clinical practice. J Bras Pneumolo 2008, 34(11):913-921.
• [33]VareKojis SM, Douce FH, Flucke RL, Filburn DA, Tice JS, McCoy KS: A comparison of the therapeutic effectiveness of and preference for postural drainage and percussion, intrapulmonary percussive ventilation, and high-frequency chest wall compression in hospitalized cystic fibrosis patients. Resp Care 2003, 48:24-28.
• [34]Miller MR, Hankinson J, Brusaco V, Burgos F, Casaburi R, Coates A, Crapo R: Standadization of spirometry. Eur Resp J 2005, 26(2):319-338.
• [35]Pryor JA: Physiotherapy for airway clearance in adults. Eur Resp J 1999, 14:1418-1424.
• [36]Anderson CA, Palmer CA, Ney AL, Becker B, Schaffel B, Quickel RR: Evaluation of the Safety of high-frequency chest wall oscillation (HFCWO) therapy in blunt thoracic patients. J trauma Manag Outcomes 2008, 2:8-14. BioMed Central Full Text
• [37]Braveman J, Nozzarella M: High-frequency chest compression advanced therapy for obstructive lung disease. Resp Therapy 2007, 2:48-51.
• [38]Warwick WJ, Hansen LG: The long-term effect of high-frequency chest compression therapy on pulmonary complications of cystic fibrosis. Pediatr Pulmonol 1991, 11:265-271.
• [39]Kempainen RR, Milla C, Dunitz J, Savik K, Hazelwood A, Williams C: Comparison of settings used for high-frequency chest wall compression in cystic fibrosis. Respir Care 2010, 55:695-701.
• [40]Darbee JC, Kanga JF, OHtake PJ: Physiologic evidence for high-frequency chest wall oscillation and positive expiratory pressure breathing in hospitalized subjects with cystic fibrosis. Phys Ther 2005, 85:1278-1289.
• [41]Fainardi V, Longo F, Faverzani S, Tripodi MC, Chetta A, Pisi G: Short-term effects of high- Frequency chest compression and positive expiratory pressure in patients with cystic fibrosis. J Clin Med Rese 2011, 3(6):279-284.
• [42]Arens R, Gozal A, Omlin KJ, Vega J, Boyd KP, Keens G: Comparison of high frequency chest compression and conventional chest physiotherapy in hospitalized patients with cystic fibrosis. Am J Resp Crit Care Med 1994, 150:1154-1157.
• [43]Kempainen RR, Williams CB, Hazelwood A, Rubin BK, Milla CE: Comparison of high-Frequency chest wall oscillation with differing waveforms for airway clearance in cystic Fibrosis. Chest 2007, 132:1227-1232.
• [44]Isabey D, Harf A, Chang HK: Alveolar ventilation during high-frequency oscillation: core dead space concept. J Appl Physiol 1984, 56:700-707.
• [45]Jones RL, Lester RT, Brown NE: Effects of high-frequency chest compression on respiratory system mechanics in normal subjects and cystic fibrosis patients. Can Resp J 1995, 2:40-46.
• [46]Bradley JM: High frequency chest wall oscillation in cystic fibrosis. Thorax 2010, 65(3):189-190.
• [47]Oermann CM, Sockrider MM, Giles D, Sontag MK, Accuso FJ, Castile RG: Comparison of high-frequency chest wall oscillation and oscillating positive expiratory pressure in the home management of cystic fibrosis:a pilot study. Pediatr Pulmonol 2001, 32:372-377.
• [48]Spanevello A, Confalonieri M, Sulotto F, Romano F, Balzano G, Migliori GB: Induced sputum cellularity, Reference values and distribution in normal volunterees. Am J Resp Crit Care Med 2000, 162:1172-1174.