High frequency chest wall oscillation for asthma and chronic obstructive pulmonary disease exacerbations: a randomized sham-controlled clinical trial

Respiratory Research

Jerry A Krishnan⁴  Edward T Naureckas³  Jeff T Charbeneau⁴  Stephanie Lewis⁴  Sameer Badlani¹  Vijay Dalapathi³  Vanessa Walker Harris²  Alana Ridge²  Andrew Bilderback²  Umur Hatipoğlu⁵  Gregory B Diette²  Amit K Mahajan³ 

[1] Section of Hospital Medicine, University of Chicago, 5841 S. Maryland Ave, Chicago, Illinois, 60637, USA;Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E. Monument, 5th Floor, Baltimore, Maryland, 21205, USA;Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, 5841 S. Maryland Ave, Chicago, Illinois, 60637, USA;Department of Medicine, Section of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, 840 S. Wood Street, Chicago, Illinois 60612, USA;Respiratory Institute, Cleveland Clinic, MC A90, 9500 Euclid Avenue, Cleveland, OH 44195, USA

关键词: airway mucus clearance;    high frequency chest wall oscillation;    chronic obstructive pulmonary disease;    asthma;   

Others  :  796802
DOI  :  10.1186/1465-9921-12-120

 received in 2011-06-12, accepted in 2011-09-10,  发布年份 2011

【 摘 要 】

Background

High frequency chest wall oscillation (HFCWO) is used for airway mucus clearance. The objective of this study was to evaluate the use of HFCWO early in the treatment of adults hospitalized for acute asthma or chronic obstructive pulmonary disease (COPD).

Methods

Randomized, multi-center, double-masked phase II clinical trial of active or sham treatment initiated within 24 hours of hospital admission for acute asthma or COPD at four academic medical centers. Patients received active or sham treatment for 15 minutes three times a day for four treatments. Medical management was standardized across groups. The primary outcomes were patient adherence to therapy after four treatments (minutes used/60 minutes prescribed) and satisfaction. Secondary outcomes included change in Borg dyspnea score (≥ 1 unit indicates a clinically significant change), spontaneously expectorated sputum volume, and forced expired volume in 1 second.

Results

Fifty-two participants were randomized to active (n = 25) or sham (n = 27) treatment. Patient adherence was similarly high in both groups (91% vs. 93%; p = 0.70). Patient satisfaction was also similarly high in both groups. After four treatments, a higher proportion of patients in the active treatment group had a clinically significant improvement in dyspnea (70.8% vs. 42.3%, p = 0.04). There were no significant differences in other secondary outcomes.

Conclusions

HFCWO is well tolerated in adults hospitalized for acute asthma or COPD and significantly improves dyspnea. The high levels of patient satisfaction in both treatment groups justify the need for sham controls when evaluating the use of HFCWO on patient-reported outcomes. Additional studies are needed to more fully evaluate the role of HFCWO in improving in-hospital and post-discharge outcomes in this population.

Trial Registration

ClinicalTrials.gov: NCT00181285

【 授权许可】

   
2011 Mahajan et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Castro M, Zimmerman N, Crocker S, et al.: Asthma intervention program prevents readmission in high healthcare utilizers. Am J Respir Crit Care Med 2003, 168:1094-1099.
• [2]Bloomberg G, Trinkaus K, Fisher E Jr, et al.: Hospital readmission for childhood asthma: A 10-year metropolitan study. Am J Respir Crit Care Med 2003, 167:1068-1076.
• [3]Rowe B, Bota G, Fabris L, et al.: Inhaled budesonide in addition to oral corticosteroids to prevent asthma relapse following discharge from the emergency department. JAMA 1999, 281:2119-2126.
• [4]Niewoehner D, Erbland M, Deupree R, et al.: Effect of systemic glucocorticoids on exacerbations of chronic obstructive lung disease. N Engl J Med 1999, 340:1941-1947.
• [5]Garcia-Aymerich J, Farrero E, Felez M, et al.: Risk factors for readmission to hospital for a copd exacerbation: A prospective study. Thorax 2003, 58:100-105.
• [6]Mannino D, Homa D, Akinbami L, Ford E, Redd S: Chronic obstructive pulmonary disease surveillance - - - United States, 1971-2000. National Center of Health Statistics 2002.
• [7]Carroll N, Mutavdic S, James A: Increased mast cells and neutrophils in submucosal mucous glands and mucus plugging in patients with asthma. Thorax 2002, 47:5.
• [8]Kuyper L, Pare P, Hogg J, Lambert R, Ionescu D, Woods R, Bai T: Characterization of airway plugging in fatal asthma. Am J Med 2003, 115:6-11.
• [9]Tanizaki Y, Kitani H, Okazaki M, Mifune T, Mitsunobu F, Kimura I: Mucus hypersecretion and eosinophils in bronchoalveolar lavage fluid in patients with bronchial asthma. J Asthma 1993, 30:5.
• [10]Rogers D, Barnes P: Treatment of airway mucus hypersecretion. Annals of Medicine 2006, 38:9.
• [11]Linhartova A, Anderson A, Foraker A: Intraluminal exudates of nonrespiratory bronchioles in pulmonary emphysema. Human Pathology 1971, 2:3.
• [12]Arens R, Gozal D, Omlin K, Vega J, Boyd K, Keens T, Woo M: Comparison of high frequency chest compression and conventional chest physiotherapy in hospitalized patients with cystic fibrosis. Am J Respir Crit Care Med 1994, 150:1154-1157.
• [13]Fink J, Mahlmeister M: High-frequency oscillation of the airway and chest wall. Respir Care 2002, 47:797-807.
• [14]Hansen L, Warwick W: High-frequency chest compression system to aid in clearance of mucus from the lung. Biomed Instrum Technol 1990, 24:289-294.
• [15]Lange D, Lechtzin N, Davey C, David W, Heiman-Patteron T, Gelinas D, Becker B, Mitsumoto H: High-frequency chest wall oscillation in ALS: An exploratory randomized, controlled trial. Neurology 2006, 67:6.
• [16]Morrison L, Agnew J: Oscillation devices for airway clearance in people with cystic fibrosis. Cochran Database of Systemic Reviews 2009 2010, CD006842.
• [17]Krishnan JA, Ridge A, Walker Harris V, Lewis S, Ivy S, Dalapathi V, Bilderback A, Mazurek A, Charbeneau J, Hatipoglu U, Badlani S, Diette G: Treating exacerbations of asthma or chronic obstructive pulmonary disease (COPD) with high frequency chest wall oscillation (HFCWO) in hospitalized patients (Abstract 3869). [http:/ / www.ersnet.org/ learning_resources_player/ abstract_print_10/ files/ ERS2010_Abstract_final.pdf] webciteEur Respir J 2010, 690s. (accessed April 20, 2011)
• [18]National Heart Lung, Blood Institute: Guidelines for the diagnosis and management of asthma (EPR-3). [http://www.nhlbi.nih.gov/guidelines/asthma/] webcite (accessed April 21, 2011)
• [19]Global Initiative for Chronic Obstructive Lung Disease (GOLD) [http://www.goldcopd.com/] webcite (accessed April 21, 2011)
• [20]Ries AL: Minimally clinically important difference for the UCSD shortness of breath questionnaire, borg scale, and visual analog scale. COPD 2005, 2:105-110.
• [21]Sutherland ER: Sham procedure versus usual care as the control in clinical trials of devices. Proc Am Thorac 2007, 4:574-576.
• [22]Al-Mutairi S, Sharma P, Al-Alawi A, Al-Deen J: Impulse oscillometry: An alternative modality to the conventional pulmonary function test to categorise obstructive pulmonary disorders. Clin Exp Med 2007, 7:8.