Comparison of high-frequency chest wall oscillation and oscillating positive expiratory pressure in the home management of cystic fibrosis: A pilot study

Enhanced airway clearance is thought to result in better-maintained pulmona ry function in cystic fibrosis (CF). Postural drainage, percussion, and vib ration (PDPV) have been the primary airway clearance technique (ACT) employ ed in CF for over 40 years. Two new airway clearance modalities are high-fr equency chest wall oscillation (HFCWO) and oscillating positive expiratory pressure (OPEP). This pilot study was undertaken to evaluate the efficacy o f these techniques during home use, assess patient satisfaction with them a s compared to PDPV, and assess the feasibility of performing a definitive c omparative trial. The prospective, randomized, multicenter crossover trial was conducted at three urban academic CF Care Centers. Twenty-nine CF patie nts, 9-39 years of age, participated. Subjects performed 4 weeks each of HF CWO and OPEP following 2-week lead-in/washout periods. Spirometry, lung vol umes, National Institutes of Health and Petty Scores, and a satisfaction su rvey were performed at baseline and after each treatment period. An ACT pre ference survey was completed at the conclusion of the study. Twenty-four subjects completed both therapies. There were no statistically significant differences between therapies for spirometry, lung volumes, or clinical scores. No significant safety issues arose during the study period . Compliance between therapies was similar. Significant differences among t herapies existed in patient satisfaction. Given a choice of therapy, 50% of subjects chose HFCWO, 37% OPEP, and 13% PDPV. This study suggests that HFCWO and OPEP are safe and as effective as patien ts' routine therapies when used for airway clearance in a home setting. Pat ient satisfaction and preference differ among ACTs and should be considered when prescribing home therapy. A definitive, multi-center, comparative stu dy evaluating long-term efficacy of these techniques is feasible. (C) 2001 Wiley-Liss, Inc.