To evaluate the utility of a short-term therapy trial to assess individual use and potential benefit of HFCWO in patients with COPD prior to extending therapy for long-term use.
Consenting patients with COPD, FEV1%<70%, retained secretions, dyspnea and reduced physical functioning were trained to use an HFCWO airway clearance device twice daily at home (N=94, 3 centers). Medical history, physical exam, spirometry, dyspnea, functional capacity, and quality of life (QOL) assessments were taken at baseline and after 90-days of therapy. Periodic symptom assessments and treatment satisfaction/adherence data were also collected.
Patients with moderate to severe COPD that completed the trial demonstrated improvements in symptoms, 6-min walk distance (6-MWD, p<0.001) and role-physical domain (SF-36, p<0.004). Analysis of inter-group differences between patients who continued or discontinued HFCWO after trial completion indicated a higher, sustained level of treatment satisfaction and adherence within the group that continued HFCWO long-term. Improvements in dyspnea (Borg, p<0.009; BDI/TDI, p<0.003), 6-MWD (p<0.001) and QOL (general health, vitality and physical functioning, p<0.05) were also significantly higher. Compared to baseline, a clinically significant improvement in 6-MWD (182±34 ft further) was demonstrated. Patients with moderate COPD demonstrated greater improvements in functional capacity after 90 days of HFCWO therapy than those with severe disease. Baseline predictors of success for specific outcomes are being assessed.
In this prospective, cohort study, COPD patients completing a 90-day trial of HFCWO demonstrated improvements in symptoms, functional capacity and QOL. Patients who did not perceive treatment benefit were less adherent and more likely to discontinue. Patients who reported a higher level of treatment tolerance and effectiveness within the first week were more likely to demonstrate significant improvements after 90 days of therapy.
Select patients with COPD adhere well to daily HFCWO therapy and may benefit from regular airway clearance therapy. A HFCWO therapy trial can help identify patients who are more likely to be adherent and satisfied with this therapy. Improvements in functional capacity and QOL may warrant consideration for long-term use.
Diane Kachel, None.