High Frequency Chest Wall Oscillation May Decrease Moderate Exacerbations in Subjects With Bronchiectasis, COPD, Asthma, or Overlap

Background: Mucus clearance to prevent mucus plugging can be difficult in subjects with obstructive pulmonary disease. This may lead to an increase in exacerbations that may require antibiotic and/or prednisone use; in severe exacerbations, can lead to ED visits or hospitalizations. Standard airway clearance therapy includes exercise, huff cough, and pulmonary hygiene therapy such as high frequency chest wall oscillation (HFCWO). Our aim is to evaluate the use of HFCWO in adult subjects with bronchiectasis, COPD, asthma, or an overlap of any of these diseases and its impact on rates of exacerbations, ED visits, or hospitalizations. Methods: This study is a retrospective analysis of UC Davis Health adult ambulatory care subjects who were ordered home HFCWO, due to failure of other forms of pulmonary hygiene, between January 2019 - December 2023. Subject diagnoses include bronchiectasis, COPD, asthma, or an overlap of any of these. We compared data 6 months pre- to 6 months post-HFCWO ordered. Pre- and post-HFCWO analyzed for moderate exacerbation rates requiring antibiotic and/or prednisone use. Pre- and post-HFCWO analyzed for severe exacerbation rates that required ED visits or hospitalization. Excel t-Test: Two-Sample Assuming Equal Variances used for statistical analyses. Study deemed not research by UC Davis IRB # 2173468-1. Results: Authors included n = 114 subjects for variable comparisons. Moderate exacerbations requiring antibiotic and/or prednisone use, P = .040; severe exacerbations requiring ED visits, P = .38, hospitalizations, P > .99. Descriptive data: Mean age 69.5 y, mean BMI 27.2, female 65%, diagnosed with GERD 42%. Conclusions: Statistical significance was reached when comparing rates of moderate exacerbations requiring the use of antibiotics and/or prednisone 6 months before and after HFCWO was ordered. No statistical significance was reached when comparing rates of severe exacerbations requiring ED visits or hospitalizations. HFCWO use may decrease moderate exacerbations requiring antibiotic and/or prednisone in subjects with bronchiectasis, COPD, asthma, or any overlap of these.