REAL-WORLD OUTCOMES IN VETERANS USING HIGH FREQUENCY CHEST WALL OSCILLATION FOR AIRWAY CLEARANCE

Abstract

TOPIC: Obstructive Lung Diseases TYPE: Original Investigations PURPOSE: Veterans have a high COPD prevalence compared to the civilian population. In COPD, excess sputum production and accumulation in the lungs is a commonly reported symptom. Several neuromuscular disorders are also known to present the clinician with airway clearance management challenges. High Frequency Chest Wall Oscillation (HFCWO) therapy is a noninvasive airway clearance therapy that directly addresses the issues associated with excess sputum production. There is limited information regarding outcomes of HFCWO therapy within the veteran population. To address this evidence gap, we established an ongoing VA outcomes program to better understand patient-reported outcomes in the veteran population receiving HFCWO therapy. METHODS: Self-reported hospitalization patterns and metrics of airway clearance from veterans were assessed before and after initiation of HFCWO therapy in a data set drawn from the HFCWO Outcomes Registry (HFCWO-OR). Variables collected included demographics, hospitalizations, and respiratory symptoms. The study was comprised of patients with a blended mix of diagnoses (e.g., COPD, bronchiectasis, and various neuromuscular disorders) who received the Philips InCourage vest therapy system. RESULTS: 323 veterans met inclusion criteria in this retrospective analysis. In the 12-month interval prior to initiating HFCWO therapy, the number of patients who reported zero hospitalizations was 46.4% (149/321), compared with 75.0% (21/28) of patients who reported zero hospitalizations in the subsequent 12 months (p=0.005). Conversely, 20.9% (67/321) of patients reported three or more hospitalizations in the prior 12 months, compared with only 3.6% (1/28) in the subsequent 12 months (p=0.001). There was an overall 66.3% reduction in the annualized hospitalization rate after 12 months (0.357 hospitalizations/patient/year at 12 months, compared to 1.059 hospitalizations/patient/year prior to initiating vest therapy) (p=0.001). Those patients who subjectively rated their "overall respiratory health" as good, very good, or excellent increased from 10.5% (34/323) upon initiation of therapy to 60.7% (17/28) within 12 months (p=0.0002). Those who rated the "ability to clear your lungs" as good, very good, or excellent increased from 8.4% (27/322) to 67.9% (19/28) within 12 months. (p<.0001). CONCLUSIONS: Our analysis indicates that outcomes in a veteran population, as measured by the number of self-reported hospitalizations, respiratory health, and the ability to clear secretions, improved substantially after the initiation of HFCWO therapy. These improvements were sustained for at least one year and provide valuable insights into the value of HFCWO in the population served by the VA health system. CLINICAL IMPLICATIONS: In a veteran population, positive outcomes are associated with the use of high frequency chest wall oscillation. DISCLOSURES: Consultant relationship with Respirtech Technologies Please note: $5001 - $20000 by Tara Barto, source=Web Response, value=Consulting fee No relevant relationships by Sarah Daignault, source=Web Response Employee relationship with RespirTech Please note: 2015-Present Added 04/16/2021 by Gary Hansen, source=Web Response, value=Salary Employee relationship with RespirTech, A Philips Company Please note: 2019 - present Added 04/16/2021 by PRITESH PANDYA, source=Web Response, value=Salary No relevant relationships by Frederic Seifer, source=Web Response