High-frequency Chest Wall Oscillation Therapy Research Articles

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

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

OUTCOMES WITH HIGH-FREQUENCY CHEST WALL OSCILLATION AMONG PATIENTS WITH COPD USING A LARGE CLAIMS DATABASE

SESSION TITLE: Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: High-Frequency Chest Wall Oscillation (HFCWO) is increasingly used for airway clearance therapy in patients with bronchiectasis and chronic obstructive pulmonary disease (COPD). Limited evidence currently exists on the relationship between HFCWO therapy and clinical/economic outcomes in patients with COPD who do not have bronchiectasis. Several studies have evaluated the impact of HFCWO but have yielded variable evidence. Without larger and more robust studies, there exists a clinical concern that some patients with COPD and chronic bronchitis are receiving suboptimal therapy. METHODS: A retrospective pre/post-cohort design and data from the Optum healthcare claims repository were employed. The study population included all patients having at least one medical claim with HCPCS code E0483 for the use of air-powered HFCWO devices on or between January 1, 2008 and April 30, 2018. Of these, the cohort was limited to those with >= 12 months pre- and >=12 months post-index continuous medical insurance eligibility from the first usage of HFCWO therapy; no major comorbidities indicating end of life; patients with a COPD diagnosis and no record of bronchiectasis; and patients >= age 18. Statistical comparisons were made using a paired-samples t-test of the 12-month pre and 12-month post periods, examining both respiratory-related and all-cause hospitalizations.A retrospective pre/post-cohort design and data from the Optum healthcare claims repository were employed. The study population included all patients having at least one medical claim with HCPCS code E0483 for the use of air-powered HFCWO devices on or between January 1, 2008 and April 30, 2018. Of these, the cohort was limited to those with >= 12 months pre- and >=12 months post-index continuous medical insurance eligibility from the first usage of HFCWO therapy; no major comorbidities indicating end of life; patients with a COPD diagnosis and no record of bronchiectasis; and patients >= age 18. Statistical comparisons were made using a paired-samples t-test of the 12-month pre and 12-month post periods, examining both respiratory-related and all-cause hospitalizations. RESULTS: The study population included 1172 patients with COPD-only who had initiated HFCWO therapy during the study period. Of these, 62% were female; age distribution was 4% age <40, 14% age 40-59, 61% age 60-79, 21% age 80 and over; and the mean Charlson Comorbidity Index was 2.78 + 1.9. Comparing pre and post periods, mean respiratory-related and all-cause hospitalization rates were lowered by 17.1% (0.495 vs. 0.410, p=0.025) and 13.6% (0.873 vs. 0.754, p=0.031) respectively. CONCLUSIONS: For patients with COPD in the absence of bronchiectasis, hospital utilization improved during the 12-month period following initiation of HFCWO therapy. CLINICAL IMPLICATIONS: HFCWO is associated with reduced hospitalizations in patients with COPD-only. DISCLOSURES: Employee relationship with RespirTech Please note: >$100000 Added 04/06/2020 by Gary Hansen, source=Web Response, value=Salary Scientific Medical Advisor relationship with Respirtech a Philips Company Please note: $5001 - $20000 Added 04/10/2020 by Charlene McEvoy, source=Web Response, value=Grant/Research Support Employee relationship with RespirTech, A Philips Company Please note: >$100000 Added 04/08/2020 by PRITESH PANDYA, source=Web Response, value=Salary Consultant relationship with RespirTech, A Philips Company Please note: $1001 - $5000 Added 04/08/2020 by Derek Weycker, source=Web Response, value=Grant/Research Support

CLINICAL OUTCOMES AND HEALTHCARE RESOURCE UTILIZATION IN ADULT HIGH-RISK PATIENTS WITH NONCYSTIC FIBROSIS BRONCHIECTASIS USING HIGH FREQUENCY CHEST WALL OSCILLATION AND POSITIVE EXPIRATORY PRESSURE THERAPY

SESSION TITLE: Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: In current clinical practice, airway clearance therapy is important in the overall management of patients with bronchiectasis. We aimed to compare healthcare resource utilization (HCRU) and costs among adults with high risk bronchiectasis after initiation of high frequency chest wall oscillation (HFCWO) and positive expiratory pressure (PEP) therapy. METHODS: A pre-post analysis of two mutually exclusive cohorts was conducted using the PharMetrics Health Plan Claims Database. Adult patients with Non-CF bronchiectasis, a high-risk Bronchiectasis Aetiology and Comorbidity Index (BACI) score of >6, and a claim for HFCWO or PEP between 2009 - 2018 were included. Clinical outcomes, HCRU and costs were measured in the 12-months pre- and post-index periods in each cohort. Comparisons to baseline data were conducted using McNemar’s test for categorical and Wilcoxon signed-rank test for continuous variables. RESULTS: In the HFCWO cohort (N=147), the mean age was 56.4 years (SD=14); 64% were females. COPD (88%) and asthma (72%) were common comorbidities. At one-year follow-up from initiation of HFCWO therapy, there was a statistically significant reduction in mean all-cause (22%, P=0.04) and disease-specific hospitalizations, (73%, P=0.01) compared to baseline. All-cause and disease-specific bronchoscopies reduced by 69% (P<0.0001) and 75% (P<0.001), respectively. Chest X-ray use reduced by 25% (P<0.001) and 38% (P=0.02), respectively. Disease-specific laboratory use decreased by 31% (P<0.01). Oral and IV antibiotics use reduced by 8% (P=0.03) and 63% (P=0.01), respectively. Pulmonologist visits reduced by 11% (P<0.01). Disease-specific ED visits trended down. All-cause inpatient costs decreased significantly from $23,774 to $12,028 (P<.01). In the PEP cohort (N=138), mean age was 63.7 years (SD=14); 59% were females. COPD (74%) and asthma (58%) were common comorbidities. At one-year follow-up from initiation of PEP therapy, mean all-cause and disease-specific hospitalizations trended up. Physician office visits increased by 17% (P=0.03). Use of hypertonic saline nebulization increased (P=0.01). Oral antibiotic use reduced by 11% (P=0.02) while IV antibiotic use did not change. All-cause and disease-specific bronchoscopies trended down. Disease-specific ED visits, chest X-ray, and laboratory use all trended up. Mean disease specific outpatient costs increased (P=0.04). Median disease-specific total costs increased significantly (P=0.04) CONCLUSIONS: In high risk bronchiectasis patients, HFCWO significantly improves clinical outcomes by reducing hospitalizations, antibiotics use and other health care resource utilization measures. High risk bronchiectasis patients started on PEP therapy had less favorable outcomes. CLINICAL IMPLICATIONS: In bronchiectasis patients with a high risk BACI score, HFCWO therapy should be considered for airway clearance as it has been shown to improve clinical and economic outcomes. DISCLOSURES: Advisory Board relationship with Insmed Please note: $1001 - $5000 by Ashwin Basavaraj, source=Web Response, value=Honoraria Consultant relationship with Hill-Rom Please note: $1001 - $5000 by Ashwin Basavaraj, source=Web Response, value=Consulting fee Employee relationship with Hill-Rom Company Inc. Please note: >$100000 Added 06/01/2020 by Brian Becker, source=Web Response, value=Salary Stock Ownership relationship with Hill-Rom Company Inc. Please note: $20001 - $100000 Added 06/01/2020 by Brian Becker, source=Web Response, value=Stock Ownership No relevant relationships by Mitch Dekoven, source=Web Response Employee relationship with Hillrom Please note: >$100000 Added 06/01/2020 by Angela Murray, source=Web Response, value=Salary No relevant relationships by Drishti Shah, source=Web Response Employee relationship with Hillrom Please note: >$100000 Added 06/01/2020 by Carlos Urrea, source=Web Response, value=Salary Employee relationship with Hill-Rom Inc Please note: >$100000 Added 05/31/2020 by Missy Wanjala, source=Web Response, value=Salary

A RETROSPECTIVE REAL-WORLD COHORT STUDY DEMONSTRATING THE IMPACT OF HIGH FREQUENCY CHEST WALL OSCILLATION THERAPY ON HEALTHCARE COSTS IN PATIENTS WITH NEUROMUSCULAR DISORDERS

SESSION TITLE: Respiratory Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The progressive muscle weakness caused by neuromuscular makes it challenging for patients to get mucus out of the lungs leading to either mucus plugging in the airways and/or chest congestion. Mucus secretion clearing and mobilization techniques play a critical role and can be helpful in maintaining well-being, to minimize breathing problems, and prevent further decay of health status. Currently, there is limited evidence on the relationship between utilization of high frequency chest wall oscillation (HFCWO) therapy with clinical and economic outcomes. To address this, the aim of this study was to characterize hospitalization rate data before and after initiation of HFCWO with air-powered vests. METHODS: A retrospective pre/post-cohort design and data from the Optum healthcare claims repository were employed. The study population included all patients at least one medical claim with HCPCS code E0483 for the use of air-powered HFCWO devices on or between January 1, 2008 and April 30, 2018. Of these, the cohort was limited to those with >= 12 months pre- and >=12 months post from the first usage of HFCWO therapy; no major comorbidities indicating end of life; patients with neuromuscular disorders (e.g., muscular dystrophies, cerebral palsy, and/or multiple sclerosis, and selected other conditions); and patients >= age 18. Statistical comparisons were made using a paired-samples t-test of the 12-month pre and 12-month post periods, examining both respiratory-related and all-cause hospitalizations. RESULTS: The study population included 1080 diagnosed with neuromuscular disorders. Of these, 62% were female; age distribution was 27% age 18-39, 15% age 40-59, 44% age 60-79, 14% age 80 and over; and the mean Charlson Comorbidity Index was 2.12 + 1.179. Our analysis comparing pre and post periods indicate a reduction in all-cause and respiratory-related hospitalization in the year after initiating HFCWO therapy. Specifically, the average all-cause hospitalization rates were reduced by 21.7% (1.008 vs. 0.790, p<0.005) while the respiratory-related hospitalizations were reduced by 24.7% (0.498 vs. 0.375, p<0.005). CONCLUSIONS: In a retrospective analysis of claims data, hospitalization rates were reduced for one year after initiation of HFCWO therapy in a blended group of patients with neuromuscular conditions. CLINICAL IMPLICATIONS: HFCWO is associated with reduced hospitalizations in patients with neuromuscular disorders. DISCLOSURES: Employee relationship with RespirTech Please note: >$100000 Added 04/06/2020 by Gary Hansen, source=Web Response, value=Salary Scientific Medical Advisor relationship with Respirtech a Philips Company Please note: $5001 - $20000 Added 04/10/2020 by Charlene McEvoy, source=Web Response, value=Grant/Research Support Employee relationship with RespirTech, A Philips Company Please note: >$100000 Added 04/08/2020 by PRITESH PANDYA, source=Web Response, value=Salary Consultant relationship with RespirTech, A Philips Company Please note: $1001 - $5000 Added 04/08/2020 by Derek Weycker, source=Web Response, value=Grant/Research Support

BASELINE CLINICAL CHARACTERISTICS OF ADULT NON-CYSTIC FIBROSIS BRONCHIECTASIS PATIENTS ON HIGH FREQUENCY CHEST WALL OSCILLATION AND OTHER AIRWAY CLEARANCE THERAPIES: ANALYSIS FROM THE UNITED STATES BRONCHIECTASIS RESEARCH REGISTRY

SESSION TITLE: Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Non-Cystic Fibrosis Bronchiectasis (NCFBE) is characterized by permanent dilatation of the airways and a vicious cycle of inflammation, leading to impaired mucous clearance, recurrent infection, and progressive airway damage. Use of Airway Clearance Therapies (ACTs) is part of clinical practice. In this study, we aimed to evaluate the characteristics of adults with NCFBE receiving High Frequency Chest Wall Oscillation (HFCWO) therapy and other ACTs, utilizing the U.S. Bronchiectasis Research Registry. METHODS: A retrospective cohort study was conducted. Adult patients seen clinically between 2008-2019 with NCFBE who were using ACTs were grouped into two mutually exclusive cohorts; HFCWO and other ACTs (positive expiratory pressure devices, chest percussion, postural drainage, directed cough, active cycle breathing, or others). Descriptive statistics of demographics and clinical characteristics were assessed in the 24-months prior to enrollment. RESULTS: A total of 992 patients met inclusion criteria. The mean age was 63.2 years (SD=14). Seventy-nine percent were female. The average BMI was 22.9 (SD=4). Of the total cohort, 266 (27%) were using HFCWO, while 726 (73%) were using other ACTs. Disease severity was based on the modified bronchiectasis severity index (BSI). Eighteen percent of patients using HFCWO had mild disease, vs. 26% in the other ACTs cohort. Thirty-six percent of patients in the HFCWO group had moderate disease, vs. 48% in the other ACTs group. Forty-six percent of patients using HFCWO had severe disease, vs. 25% in the other ACTs group. Eighty-four percent of patients in the HFCWO group had at least one exacerbation within the past two years, compared to 66% in the other ACTs group. In the HFCWO group, 29% of patients had one exacerbation, and 25% had more than three exacerbations in the prior two years. In the other ACTs group, 33% had one exacerbation, and 22% had more than three exacerbations. In the HFCWO group, 33% reported having at least one hospital admission within the past two years, vs. 19% in the other ACTs group. Fifty-eight percent of patients in the HFCWO group had one hospitalization, and 10% had more than three hospitalizations. In the other ACTs group, 64% had one hospitalization, while 4% had more than three hospitalizations. There was a statistically significant difference between the HFCWO and other ACT groups in severity of disease (p<.0001), incidence of acute exacerbations (p<.0001), and rate of hospitalizations (p<.0001). CONCLUSIONS: Patients with bronchiectasis using HFCWO had more severe disease than those using other ACTs, as characterized by higher BSI scores and a greater number of exacerbations and hospitalizations. Further analysis to control for potential confounders and to explore longitudinal trends is recommended. CLINICAL IMPLICATIONS: HFCWO therapy is more commonly used in bronchiectasis patients with moderate to severe disease. DISCLOSURES: No relevant relationships by Timothy Aksamit, source=Web Response Advisory Board relationship with Insmed Please note: $1001 - $5000 by Ashwin Basavaraj, source=Web Response, value=Honoraria Consultant relationship with Hill-Rom Please note: $1001 - $5000 by Ashwin Basavaraj, source=Web Response, value=Consulting fee Employee relationship with Hill-Rom Company Inc. Please note: >$100000 Added 06/01/2020 by Brian Becker, source=Web Response, value=Salary Stock Ownership relationship with Hill-Rom Company Inc. Please note: $20001 - $100000 Added 06/01/2020 by Brian Becker, source=Web Response, value=Stock Ownership No relevant relationships by Radmila Choate, source=Web Response Employee relationship with Hill-Rom Inc Please note: >$100000 Added 05/31/2020 by Missy Wanjala, source=Web Response, value=Salary

TWO YEAR CLINICAL OUTCOMES AND HEALTHCARE RESOURCE UTILIZATION IN ADULT PATIENTS WITH HIGH-RISK NONCYSTIC FIBROSIS BRONCHIECTASIS ON HIGH FREQUENCY CHEST WALL OSCILLATION

SESSION TITLE: Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: In current clinical practice, High Frequency Chest Wall Oscillation (HFCWO) is prescribed for patients with moderate to severe Non-CF bronchiectasis. This study aimed to evaluate the clinical and economic outcomes of adult bronchiectasis patients with a high five-year morbidity and mortality risk, using HFCWO for airway clearance. METHODS: A Pre-Post study was conducted using the PharMetrics Health Plan Claims Database. Adult patients with bronchiectasis and a claim for HFCWO in 2009 to 2018 were included in the study. High risk status was determined by a Bronchiectasis Aetiology and Comorbidity Index (BACI) score of >6. All-cause and disease-specific healthcare care resource utilization and costs, as well as clinical outcomes, were measured at one and two-year follow-up periods, and compared to baseline. McNemar’s test was used for categorical variables, while Wilcoxon signed-rank test was used for continuous variables. RESULTS: Eighty patients met inclusion criteria. The mean age was 58 [13] years; 66.3% were female. Fifty-one percent of patients were diagnosed by a pulmonologist, who also prescribed 31.3% of devices. The proportion of all-cause oral antibiotic use reduced by 13% (P=0.03) in year two compared to baseline. IV antibiotic use trended down. All cause ER visits reduced by 37% in the second year compared to baseline (P=0.01). Laboratory use reduced by 5% in both years (P=0.05). Use of chest X-ray reduced by 21% in one-year follow-up(P=0.02) and 24% in year two (P=0.01). Bronchoscopy use reduced by 63% in one-year follow-up (P<0.01) and 68% in year two (P<0.001). There was a downward trend in all-cause hospitalizations in both years, compared to baseline. The proportion of disease specific physician office visits reduced by 13% (P=0.02) in one-year follow-up and 21% (P<0.01) in year two, compared to baseline. Laboratory use reduced by 33% in one-year follow-up (P=0.02) and 60% (P<.0001) in year two. Radiology use reduced by 43% in one-year follow-up (P<0.01) and 31% in year two (P<0.01). Bronchoscopy use reduced by 82% in one-year follow-up (P<0.01) and 91% in year two (P<0.01). Ancillary services use increased in year one by 19% (P<0.01) but reduced in year two by 17% (P=0.04). There was a trend towards reduced disease-specific hospitalizations in both the first and second year, compared to baseline. A trend towards reduced total all-cause costs in one-year and two-year follow-up was seen, compared to baseline. Disease-specific costs increased from a baseline of $4,811 to $11,633 in the first year (P<0.0001), likely due to device costs, then reduced significantly in the second year to $2,793 (P=0.04). CONCLUSIONS: In patients with bronchiectasis at high risk of morbidity and mortality, initiation of HFCWO therapy results in improvement in clinical and economic outcomes. CLINICAL IMPLICATIONS: Our findings lend support to the routine use of HFCWO in high risk bronchiectasis patients. DISCLOSURES: Advisory Board relationship with Insmed Please note: $1001 - $5000 by Ashwin Basavaraj, source=Web Response, value=Honoraria Consultant relationship with Hill-Rom Please note: $1001 - $5000 by Ashwin Basavaraj, source=Web Response, value=Consulting fee Employee relationship with Hill-Rom Company Inc. Please note: >$100000 Added 06/01/2020 by Brian Becker, source=Web Response, value=Salary Stock Ownership relationship with Hill-Rom Company Inc. Please note: $20001 - $100000 Added 06/01/2020 by Brian Becker, source=Web Response, value=Stock Ownership No relevant relationships by Mitch Dekoven, source=Web Response Employee relationship with Hillrom Please note: >$100000 Added 06/01/2020 by Angela Murray, source=Web Response, value=Salary No relevant relationships by Drishti Shah, source=Web Response Employee relationship with Hillrom Please note: >$100000 Added 06/01/2020 by Carlos Urrea, source=Web Response, value=Salary Employee relationship with Hill-Rom Inc Please note: >$100000 Added 05/31/2020 by Missy Wanjala, source=Web Response, value=Salary

Real-life experience with high-frequency chest wall oscillation vest therapy in adults with non-cystic fibrosis bronchiectasis.

Background:High frequency chest wall oscillation (HFCWO) has long been used for airway clearance for patients with cystic fibrosis. Only limited research has evaluated this therapy in adult patients with non-cystic fibrosis bronchiectasis (NCFB).Methods:Data from 2596 patients from a registry of adult bronchiectasis patients using HFCWO therapy was used to evaluate hospitalization patterns before and after initiation of HFCWO therapy, as well as antibiotic use and self-reported metrics of quality of life. Self-reported outcomes were also reviewed by cross-checking with sampled patient charts and found to be consistent.Results:The number of patients who had at least one respiratory-related hospitalization decreased from 49.1% (192/391) in the year before to 24.0% (94/391) in the year after starting HFCWO therapy (p-value < 0.001). At the same time, the number of patients who required three or more hospitalizations dropped from 14.3% (56/391) to 5.6% (22/391). Patients currently taking oral antibiotics for respiratory conditions decreased from 57.7% upon initiation of therapy to 29.9% within 1 year (p < 0.001). Patients who subjectively rated their “overall respiratory health” as good to excellent increased from 13.6% upon initiation of therapy to 60.5% in 1 year (p < 0.001) and those who rated their “ability to clear your lungs” as good to excellent increased from 13.9% to 76.6% (p < 0.001).Conclusion:NCFB patients showed improved self-reported outcomes associated with the initiation of HFCWO therapy as measured by number of hospitalizations, antibiotic use, and the subjective experience of airway clearance. The improvement was observed early on after initiation of therapy and sustained for at least 1 year. The reviews of this paper are available via the supplemental material section.

OUTCOMES OF HIGH FREQUENCY CHEST WALL OSCILLATION (HFCWO) IN COPD PATIENTS WITHOUT BRONCHIECTASIS

SESSION TITLE: Tuesday Electronic Posters 4 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: High Frequency Chest Wall Oscillation (HFCWO) vests have long been used to assist in airway clearance for patients with cystic fibrosis (CF) and non-CF bronchiectasis (NCFB), but there is limited information on the outcomes of this therapy in COPD patients who are free of radiographic bronchiectasis. METHODS: The hospitalization patterns and self-reported metrics of subjective airway clearance experience were assessed before and after initiation of HFCWO therapy in a data set of COPD patients (ICD-9-CM 496 and ICD-10-CM J44.X) from the HFCWO Outcomes Registry (HFCWO-OR). Patients with evidence of bronchiectasis by high-resolution chest CT were excluded. Variables collected included demographics, radiographic findings, hospitalizations, and respiratory symptoms. RESULTS: 219 COPD patients met inclusion criteria (male/female 46%/54%, average age 65). In the 12-month interval prior to initiating HFCWO therapy, the number of patients with zero self-reported hospitalizations was 39.5% (64/162), compared with 64.4% (29/45) of patients who reported zero hospitalizations in the subsequent 12 months (p=0.005). Conversely, 29.0% (47/162) of patients reported three or more hospitalizations in the prior 12 months, compared with 8.9% (4/45) in the subsequent 12 months. (p=0.001). There was an overall 54.4% reduction in the annualized hospitalization rate after 12 months (0.60 hospitalizations/patient/year at 12 months, compared to 1.31 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 8.0% upon initiation of therapy to 50.0% within 12 months. (p=0.018). Those who rated the “ability to clear your lungs” as good, very good, or excellent increased from 9.5% upon initiation of therapy to 61.4% within 12 months. (p=0.137). CONCLUSIONS: This study shows that outcomes in COPD patients without bronchiectasis, as measured by number of hospitalizations, self-reported 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. CLINICAL IMPLICATIONS: Symptomatic patients with COPD who are free of radiographic bronchiectasis may benefit from the use of HFCWO therapy. DISCLOSURES: no disclosure on file for Tara Barto; No relevant relationships by Sarah Daignault, source=Web Response Employee $100000 Added 03/13/2019 by Gary Hansen, source=Web Response, value=Salary<br Consultant relationship with Sunovion Please note: $1001 - $5000 Added 11/28/2018 by Diego Maselli Caceres, source=Web Response, value=Consulting fee Consultant relationship with Sanofi Regeneron Please note: $5001 - $20000 Added 11/28/2018 by Diego Maselli Caceres, source=Web Response, value=Consulting fee Consultant relationship with AztraZeneca Please note: $1001 - $5000 Added 03/14/2019 by Diego Maselli Caceres, source=Web Response, value=Consulting fee Consultant relationship with Novartis Please note: $1001 - $5000 Added 03/14/2019 by Diego Maselli Caceres, source=Web Response, value=Consulting fee Consultant relationship with GSK Please note: $5001 - $20000 Added 03/14/2019 by Diego Maselli Caceres, source=Web Response, value=Consulting fee

The Impact of High-Frequency Chest Wall Oscillation on Healthcare Use in Patients with Neuromuscular Diseases.

People with neuromuscular disease frequently have difficulty clearing pulmonary secretions, which leads to pneumonia and respiratory failure. High-frequency chest wall oscillation (HFCWO) is one intervention used to facilitate secretion clearance. The objective of this study was to determine if HFCWO therapy leads to improved outcomes as measured by lower healthcare use for patients who have a chronic neuromuscular disease. We performed a cohort study comparing healthcare claims before and after initiation of HFCWO. Data were obtained from two large databases of commercial insurance claims. Study subjects were commercial insurance members with an International Classification of Diseases, Ninth Revision, code for a neuromuscular disease and a claim for HFCWO between 2007 and 2011. The study included both children and adults. There were 426 patients in this study. Their mean age was 29.9 ± 22 years. Total medical costs per member per month decreased by $1,949 (18.6%) after initiation of HFCWO (P = 0.002). Inpatient admission costs decreased by $2,392 (41.7%) (P = 0.001), and pneumonia costs decreased by $514 (18.1%) (P = 0.015). To account for the possibilities of misclassification based on diagnosis and bias due to loss to follow-up, we compared outcomes between those lost to follow-up and those not, and we found similar results. Total medical costs, hospitalizations, and pneumonia claims were less after than before initiation of HFCWO in a broad group of patients with neuromuscular disease. Subject to the limitations that administrative data did not capture how HFCWO was used and that HFCWO may be a marker of generally better care, our findings lend support to the routine use of this intervention in the care of patients with neuromuscular diseases.

Does high-frequency chest wall oscillation therapy have any impact on the infective exacerbations of chronic obstructive pulmonary disease? A randomized controlled single-blind study

Objective: To investigate the impact of high-frequency chest wall oscillation in chronic obstructive pulmonary disease patients with infective exacerbation. Design: Clinical randomized controlled trial. Setting: Patients received high-frequency chest wall oscillation therapy at the Department of Pulmonology. Subjects: Stage III-IV chronic obstructive pulmonary disease patients hospitalized with acute infective exacerbation who had received high-frequency chest wall oscillation therapy were studied. Interventions: Patients were randomized into two groups, which were classified as I and II. All patients have been treated with bronchodilators, antibiotics, if necessary oxygen and patient education, as part of acute chronic obstructive pulmonary disease exacerbation protocol. Group II patients received additional high-frequency chest wall oscillation therapy. Main measures: Body mass index (B), forced expiratory volume in the first second (O), modified Medical Research Council dyspnea scale (D) and 6-minute walking test (E) (BODE) index, forced expiratory volume in the first second, dyspnea, exercise capacity, oxygenation parameters and hospitalization of duration were recorded at baseline and at three-days and five-days follow-up. Results: From April 2009 to July 2011, a total of 99 patients were assessed for eligibility, 50 patients were enrolled and randomized into two groups. A total of 50 (100%) patients (25 in Group I and 25 in Group II) were followed up for five days. Application of high-frequency chest wall oscillation therapy resulted in no significant advantage in all outcomes (p > 0.05). Mean (SD) baseline BODE index value in Group I was 7.72 (1.76), in Group II was 7.72(1.89) (p = 0.55). On the fifth-day assessment, mean (SD) BODE index value in Group I was 7.24 (1.83), in group II was 6.44 (2.46) (p = 0.18). Conclusions: The application of high-frequency chest wall oscillation therapy offers no additional advantages on infective exacerbations in chronic obstructive pulmonary disease.

High-Frequency Chest Wall Oscillation Successful in Controlling Refractory Asthma

Introduction. High-frequency chest wall oscillation (HFCWO) has been traditionally implemented for airway secretion clearance in conditions such as cystic fibrosis (CF) and bronchiectasis. There have been few reports of its use in refractory asthma. Case report. A 36-year-old, non-smoker male presented with a lifelong history of poorly controlled asthma. Despite multiple controller medications, he reported daily chest congestion, copious phlegm, and frequent exacerbations. Imaging, blood work, and bronchoscopy ruled out atypical infections, immunodeficiency, CF, and other chronic conditions. Pulmonary function tests supported a diagnosis of asthma. Results. We initiated HFCWO therapy twice daily in addition to standard inhaled pharmacological therapy. After 2 months, the patient noted resolution of respiratory symptoms as well as improvement in lung function. He remained symptom-free at his 2-year follow-up. Conclusion. High-frequency chest oscillation may be useful in phenotypes of asthma characterized by prominent mucus hypersecretion.

Effect of high-frequency chest wall oscillation on pulmonary function after pulmonary lobectomy for non-small cell lung cancer*

We examined the feasibility of high-frequency chest wall oscillationtherapy in immediate postoperative lung recruitment after pulmonary lobectomy for non-small cell lung cancer compared to conventional chest physiotherapy. A prospective, single-blind, randomized trial was conducted at Samsung Medical Center between March 2010 and May 2010. Patients were randomized to either the high-frequency chest wall oscillation group or the conventional percussive physiotherapy (control) group. : Briefly, the eligibility criteria included 1) participants between the ages of 35 and 70 yrs, 2) candidates of lobectomy for non-small cell lung cancer, and 3) the first elective surgery of the day. Sixty-six patients were enrolled in the study. Patients in the control group had routine postoperative percussive chest physiotherapy four times a day. Participants in the high-frequency chest wall oscillation group received three sessions of high-frequency chest wall oscillation treatment every 8 hrs for 15 mins starting 4 hrs after surgery. All the treatments and measurements were performed by randomly assigned nursing staff who had received standardized education for respiratory care and who were not aware of the details of the study. The primary outcome was postoperative change of forced expiratory volume for 1 sec, and secondary outcomes were changes in arterial oxygen partial pressure and saturation. Safety outcomes and pain scores were also investigated. Patients in the high-frequency chest wall oscillation group experienced significantly improved recovery of pulmonary function as assessed by forced expiratory volume for 1 sec on the third and fifth postoperative days (p = .03) and improved oxygenation on the first postoperative day (p < .01). There were no significant differences in pain score or analgesic requirements. There were no unexpected complications, such as hemodynamic deterioration, postoperative bleeding or chest tube, and wound problems associated with the high-frequency chest wall oscillation therapy. High-frequency chest wall oscillation therapy after pulmonary lobectomy resulted in significantly improved immediate postoperative pulmonary function recovery compared to conventional physiotherapy, without any significant adverse effects. These results suggest that high-frequency chest wall oscillation therapy may be a valuable tool in the postoperative care of non-small cell lung cancer patients with lobectomy.

High-frequency Chest Wall Oscillation Therapy: Clinical Effectiveness in the Patients with Pulmonary Contusion

Background: Pulmonary contusion is the most common pulmonary parenchymal injury in blunt chest trauma and may constitute a life-threatening thoracic injury. In this study, we evaluated the usefulness of high-frequency chest wall oscillation (HFCWO) therapy in patients with pulmonary contusion. Methods: Patients with lung contusion either received HFCWO therapy using the Vest system (Vest group; n = 18) or received conventional chest physiotherapy (non-Vest group; n = 23). The physiological parameters of the patients, length of stay in hospital and ICU, and the duration of mechanical ventilation were compared between the two groups. Variables, including pulmonary contusion score, percentage of patients receiving mechanical ventilation therapy, and PaO2/FiO2 ratio, were also analyzed. Results: The pulmonary contusion score was higher in the Vest group (p < 0.01), and mechanical ventilation was used more frequently in the Vest group (p = 0.027). Improvement in the PaO2/FiO2 ratio over the first 48 h did not differ between the Vest and Non-Vest groups. No significant differences in the physiological parameters, hospital and ICU stays, and duration of mechanical ventilation were observed between the two groups. Conclusions: The therapeutic effect of the Vest system in patients with pulmonary contusion was similar to that of conventional chest physiotherapy. Therefore, the Vest system could be considered as an airway clearance technique in the management of patients with pulmonary contusion.

Comparison of High-Frequency Chest Wall Oscillation With Differing Waveforms for Airway Clearance in Cystic Fibrosis

High-frequency chest wall oscillation (HFCWO) is commonly used by cystic fibrosis (CF) patients for airway clearance. The primary objective of this study was to determine whether the use of a newer HFCWO device that generates oscillations with a triangular waveform results in greater sputum production than a commonly used device that generates oscillations with a sine waveform. This was a controlled, randomized, double-blind, crossover study. Fifteen clinically stable, adult CF patients participated. Patients performed airway clearance with each device once and at matched oscillation frequencies and pressures. All sputum produced during each session was collected. Patients completed pulmonary function tests before and after each session, and rated the comfort of the two devices. Mean sputum wet and dry weight produced during sine waveform and triangular waveform HFCWO sessions did not differ (p = 0.11 and p = 0.2, respectively). Mean changes in FEV(1) and FVC following HFCWO therapy were also comparable (p = 0.21 and p = 0.56, respectively). However, there was a significant reduction in air trapping by residual volume/total lung capacity ratio following triangular waveform HFCWO (p = 0.01). In addition, in vitro cough transportability was 10.6% greater following therapy with the triangular waveform device (p = 0.05). Patients perceived the two devices as equally comfortable (p = 0.8). Single-session sputum production is comparable with sine and triangular waveform HFCWO devices. Longer term comparisons are needed to determine whether sustained use of the devices results in clinically important differences in outcomes.

High-Frequency Chest Wall Oscillation Therapy in Amyotrophic Lateral Sclerosis

High-Frequency Chest Wall Oscillation Therapy in Amyotrophic Lateral Sclerosis

Assessing Efficacy of High-Frequency Chest Wall Oscillation in Patients With Familial Dysautonomia

To determine the benefits of daily use of high-frequency chest wall oscillation (HFCWO) in familial dysautonomia (FD) patients with lung disease. Pulmonary function tests, chest radiographs, and blood tests were performed on entry to the study. A retrospective chart review of 12 months prior to entry provided baseline data regarding respiratory illnesses, medications, doctor visits, hospitalizations, and absenteeism. Daily logs provided prospective data on these parameters as well as HFCWO usage. Evaluations were performed at 1, 3, 6, 9, and 12 months for pulse oximetry, spirometry, and log review. At the exit evaluation, blood tests and chest radiographs were repeated. Fifteen FD patients with history of lung disease requiring daily inhalation therapy (7 female and 8 male; age range, 11 to 33 years) were enrolled in a 1-year clinical trial of HFCWO therapy. Two subjects withdrew after 3 months and 6 months, respectively. Each individual served as his/her own control. Oxygen saturation improved by 1 month (median, 97.5%; interquartile range [IQR], 96 to 98%; vs median, 94%; IQR, 89 to 96%) and was sustained at exit evaluation (median, 98%; IQR, 98 to 98%) [p = 0.004]. Median FVC and peak expiratory flow rate (PEFR) were the pulmonary function measures with sustained improvement from baseline to exit (p = 0.02 and p = 0.03, respectively). When retrospective and prospective data were compared, all measured health outcomes improved significantly, including pneumonias (p = 0.0156), hospitalizations (p = 0.0161), antibiotic courses (p = 0.0005), antibiotic days (p = 0.0002), doctor visits (p = 0.0005), and absenteeism (p = 0.0002). In this limited study of FD patients, HFCWO effected significant improvements in all measured health outcomes and oxygen saturation; FVC and PEFR were the pulmonary function measures demonstrating sustained improvement.

High-Frequency Chest Wall Oscillation Improves Pulmonary Health Outcomes and Function in Patients With Familial Dysautonomi

PURPOSE: Aspiration pneumonia in familial dysautonomia (FD) patients is common and causes increased secretions. Hypotonia, poorly coordinated breathing, and spine curvature impede effective clearance of secretions and increase risk for chronic lung disease. Chest physiotherapy (CPT) has inherent complications due to concomitant labile blood pressures and gastroesophageal reflux. High-frequency chest wall oscillation (HFCWO) therapy (administered via an inflatable vest) creates airflow within the lungs that loosens and mobilizes secretions cephalad. Although HFCWO is used in a variety of patients, outcomes in FD have not been reported. We hypothesized that HFCWO therapy would reduce respiratory problems and medical interventions and improve lung function.

The Utility of High-Frequency Chest Wall Oscillation Therapy in the Post-Operative Management of Thoracic Surgical Patient

The Utility of High-Frequency Chest Wall Oscillation Therapy in the Post-Operative Management of Thoracic Surgical Patient