Mechanical airway clearance with HFCWO may reduce mucus plugging and improve outcomes of patients hospitalized with acute asthma or COPD. The primary objective of this pilot study was to assess whether treatment of acute asthma or COPD with HFCWO, in addition to standard care, is tolerated. The secondary objective was to evaluate its effects on outcomes.
Randomized, double-masked, controlled, multicenter clinical trial comparing active and sham HFCWO (4 treatments; 15 minutes/treatment, 3 treatments/day) initiated within 24 hours of hospitalization. Patients age ≥ 18 years, physician-diagnosis of acute asthma or COPD, and airflow obstruction were eligible. Medical therapy was standardized across treatment groups. Primary outcomes were assessed after 4 treatments: adherence to HFCWO (minutes used/prescribed X 100%), and patient-reported comfort and perceived benefit. Secondary outcomes: change in FEV1 % predicted (follow-up –pre-treatment), spontaneously expectorated sputum volume, and change in Borg dyspnea score.
52 participants (N = 25 HFCWO, N = 27 sham) were enrolled in 4 academic hospitals. Baseline characteristics were similar between treatment groups: mean age 49 years, 62% female, 64% African-American, 60% admitted for acute asthma, median [Q1, Q3] FEV1 = 42 [32, 56]% predicted, and median dyspnea score = 3 [2, 5]. Mean adherence to HFCWO was high in both groups (HFCWO vs. sham: 91% vs. 93%; p = 0.70). Comfort and perceived benefit were similarly high in both treatment groups (e.g., feel safe [100 vs. 96%], feel comfortable [88 vs. 92%], feel better [80 vs. 85%]; all p-values = NS). Median change in FEV1% predicted (0 vs. 2%; p = 0.69) and median sputum volume (10 vs. 11 mL; p = 0.44) were similar, but dyspnea score improved significantly more with HFCWO (−1.5 vs. 0.0; p = 0.04).
Treatment with HFCWO is well tolerated in adults hospitalized for acute asthma or COPD and significantly improves dyspnea.
HFCWO may be beneficial in patients hospitalized for acute asthma or COPD. Larger-scale multi-center studies are needed to more definitively evaluate clinical benefits of HFCWO in this population.
Jerry Krishnan, Grant monies (from sources other than industry) American Thoracic Society, AHRQ, NHLBI, Bowman Lingle Trust; Grant monies (from industry related sources) Hill-Rom, Inc.; No Product/Research Disclosure Information