PURPOSE: Traditional asthma therapy includes anti-inflammatory medication and bronchodilators, but little attention has been given to airway mucociliary clearance. High frequency chest wall oscillation (HFCWO) uses a specialized vest that oscillates, mobilizing secretions from peripheral to central airways. HFCWO is effective in cystic fibrosis and neuromuscular disease, but has not been assessed in pediatric patients with acute asthma exacerbation. We hypothesized that HFCWO would increase mucociliary clearance and ultimately improve acute asthma exacerbation management.
METHODS: We conducted a randomized, controlled, double-blind study in pediatric patients 18 months to 18 years with a diagnosis of asthma. Patients received either HFCWO therapy via the VESTTM or standard asthma care. The primary endpoint was time to readiness for discharge. Secondary endpoints included total hospital length of stay (LOS), change in clinical score and assessment of safety.
RESULTS: 43 patients (22 males, average age 8.2 years) were recruited over 12 months (intervention group, n=19). Patients receiving HFCWO were ready for discharge in 1.74 days compared to 1.75 days in control patients (p=0.9). There were no differences in total LOS or clinical score. Of the 19 HFCWO patients, one patient complained of discomfort, but otherwise there were no adverse events. On post hoc analysis, we evaluated the 11 patients admitted to the PICU (intervention group, n=6) and found that the HFCWO group averaged 1.4 days in the PICU vs. 2.1 days for the control group (p=0.14).
CONCLUSION: HFCWO therapy was found to be safe in asthmatic children. No difference in time to readiness for hospital discharge was demonstrated in our overall study results. However, in 11 patients admitted directly to the PICU, there was a notable difference in the number of intensive care days favoring the intervention.
CLINICAL IMPLICATIONS: We continue to study HFCWO in PICU patients. Achieving enhanced mucociliary clearance may benefit patients with severe exacerbations. HFCWO did not contribute to bronchospasm, and treatments were safe in our population.
DISCLOSURE: Jon Roberts, No Financial Disclosure Information; No Product/Research Disclosure Information