Abstract
Background: High frequency chest wall oscillation (HFCWO) is a form of airway clearance therapy that has been available since the mid-1990s and is routinely used by patients suffering from retained pulmonary secretions. Patients with cystic fibrosis (CF), neuromuscular disease (NMD), and other disorders, including bronchiectasis (BE) and COPD (without BE), are commonly prescribed this therapy. Limited evidence exists describing HFCWO use in the BE population, its impact on long-term management of disease, and the specific patient populations most likely to benefit from this therapy. This study sought to characterize the clinical characteristics of patients with BE who have documented use of HFCWO at baseline and 1-year follow-up. Methods: An analysis from a large national database registry of patients with BE was performed. Demographic and clinical characteristics of all patients receiving HFCWO therapy at baseline are reported. Patients were stratified into two groups based on continued or discontinued use of HFCWO therapy at 1-year follow-up. Results: Over half (54.8 %) of patients who reported using HFCWO therapy had a Modified Bronchiectasis Severity Index (m-BSI) classified as severe, and the majority (81.4 %) experienced an exacerbation in the prior two years. Of patients with 1-year follow-up data, 73 % reported continued use of HFCWO. Compared to patients who discontinued therapy, these patients were more severe at baseline and at follow-up suggesting that patients with more severe disease are more likely to continue HFCWO therapy. Conclusions: Patients who have more severe disease and continue to experience exacerbations and hospitalizations are more likely to continue HFCWO therapy. Clinical trial registration: NA.
| Original language | English |
|---|---|
| Article number | 107555 |
| Journal | Respiratory Medicine |
| Volume | 223 |
| DOIs | |
| State | Published - Mar 2024 |
Bibliographical note
Publisher Copyright:© 2024
Funding
Baxter provided financial support for editorial support of the manuscript and for the Bronchiectasis and NTM Research Registry but did not directly fund this study. This is a retrospective observational cohort study using data from the United States Bronchiectasis and NTM Research Registry (BRR) collected between 2008 and 2021. The BRR is a centralized database of patients with bronchiectasis and/or non-tuberculous mycobacteria (NTM) enrolled across 18 sites throughout the US and sponsored by the COPD Foundation. At the time of the current analysis, the BRR contained data from over 4000 patients with BE and/or NTM nationwide. Data collected includes basic demographic information, medical history related to the disease(s), comorbidities, respiratory symptoms, concomitant medications and other therapies; data on imaging, cultures, procedures and hospitalizations. The goal of the BRR is to support collaborative research for the treatment of BE and NTM lung disease.The current authors previously conducted a research study using data from the same national registry, investigating the differences between patients who used any form of ACT with those who did not [7]. Of the patients using ACTs at baseline, more than half of the patients (288/535; 58 %) did not report the use of ACTs at follow-up. In contrast, in the current study, only 27 % of patients did not report use of HFCWO at follow-up. This may be because patients who need more aggressive therapy with HFCWO are less likely to terminate HFCWO. It is also possible that ease of use and not requiring undivided attention may support ongoing use of HFCWO compared to other forms of ACT. Although the reasons for HFCWO discontinuation were not recorded in the registry, in clinical practice, patients may decide to discontinue an ACT for various reasons. Patients may experience an improvement in symptoms and feel therapy is no longer necessary. Other reported reasons for discontinuation include lack of improvement in symptoms, difficulties with adherence to an intensive regimen, and tolerability issues [19]. In general, stopping therapy is often the choice of the patient as most physicians will encourage ongoing treatment unless the patient is experiencing unfavorable side effects.History of past exacerbations and hospitalizations may be a predictor of future exacerbations [20] and may indicate a requirement for ongoing use of aggressive ACT with HFCWO. Additionally, severity of illness is likely associated with both the selection of ACT therapy and the choice to continue more aggressive treatment. Previous research investigating characteristics of patients with BE on HFCWO compared to other ACTs confirms that the cohort using HFCWO is a population of individuals with more severe disease [17]. For patients receiving HFCWO, the disease severity, measured using m-BSI, was 18 % mild, 36 % moderate, and 46 % severe, compared to 26 % mild, 48 % moderate, and 25 % severe in patients receiving other ACTs at baseline [17]. In the current study, in the overall cohort of patients using HFCWO at baseline, the severity of bronchiectasis measured using m-BSI was 16 % mild, 29 % moderate and 55 % severe, consistent with previous results supporting the association of high disease severity with the selection of HFCWO. Additionally, differences in disease severity were observed across history of exacerbations and hospitalizations in the previous registry analysis, both higher for the HFCWO group compared to the group using other forms of ACT [17]. The current study adds to the knowledge base, demonstrating that not only are patients who are prescribed HFCWO a more severe group than the population requiring other ACTs, but that patients who continue to experience exacerbations and hospitalizations may be more likely to require ongoing use of HFCWO therapy.Baxter provided financial support for editorial support of the manuscript and for the Bronchiectasis and NTM Research Registry but did not directly fund this study.The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Ashwin Basavaraj reports writing assistance was provided by LeeAnn Phipps. AB - Consultant and Advisory Board for Baxter, Insmed, Physio-Assist, Dymedso, Zambon. Medical education consulting for Tactile Medical. Principal investigator on clinical trial sponsored by Baxter with funding to institution. Educational grant funding received from Insmed to institution.MM - Grant funding from Insmed and COPD foundation. Consulting fees from Insmed, Boehringer-Ingelheim, and Tactile Medical. Payment/honoraria for presentations/lectures from Insmed. Participation on data safety monitoring/advisory board for AN2, Renovion.TA - Support as medical director of the Bronchiectasis and NTM research registry. Has participated in clinical trials sponsored by Bayer, Aradigm, Zambon. The authors would like to acknowledge the COPD Foundation, a 501(c)(3) nonprofit organization, who manages the Bronchiectasis and NTM Research Registry. The Registry is funded by the Richard H. Scarborough Bronchiectasis Research Fund, the Anna-Maria and Stephen Kellen Foundation, a research grant from Insmed, and the Bronchiectasis and NTM Industry Advisory Committee. It should also be noted that this work would not have been possible without the comprehensive chart reviews and recording of data by the dedicated research coordinators and PIs at each of the participating Registry sites.
| Funders | Funder number |
|---|---|
| HFCWO | |
| LeeAnn Phipps | |
| Richard H. Scarborough Bronchiectasis Research Fund | |
| Baxter International | |
| COPD Foundation | 288/535 |
| Anna-Maria and Stephen Kellen Foundation | |
| Insmed |
Keywords
- Airway clearance therapy
- Bronchiectasis
- HFCWO
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine