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Long-term multicentre randomised controlled study of high frequency chest wall oscillation versus positive expiratory pressure mask in cystic fibrosis
  1. Maggie Patricia McIlwaine1,
  2. Nancy Alarie2,
  3. George F Davidson3,
  4. Larry C Lands4,
  5. Felix Ratjen5,
  6. Ruth Milner6,
  7. Blythe Owen7,
  8. Jennifer L Agnew8
  1. 1Division of Paediatric Respirology and Department of Physiotherapy, Cystic Fibrosis Clinic, BC Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Division of Pediatric Respiratory Medicine, Montreal Children's Hospital, Allied Health Services, Physiotherapy Department, McGill University Health Center Research Institute, Montreal, Quebec, Canada
  3. 3Department of Paediatrics, Cystic Fibrosis, BC Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
  4. 4Division of Pediatric Respiratory Medicine, Montreal Children's Hospital, McGill University Health Center Research Institute, Montreal, Quebec, Canada
  5. 5Division of Respiratory Medicine, Department of Pediatrics, and Program in Physiology and Experimental Medicine, SickKids Research Institute, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada
  6. 6Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
  7. 7Division of Respiratory Medicine, Department of Rehabilitation Services, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada
  8. 8Division of Respiratory Medicine, Department of Rehabilitation Services, SickKids Research Institute, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Maggie Patricia McIlwaine, Division of Paediatric Respirology and Department of Physiotherapy, Cystic Fibrosis Clinic, BC Children's Hospital and University of British Columbia, Room K3-202, BC Children's Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada; mmcilwaine{at}cw.bc.ca

Abstract

Background Positive expiratory pressure (PEP) is the most commonly used method of airway clearance (AC) in Canada for patients with cystic fibrosis (CF) whereas, in some countries, high frequency chest wall oscillation (HFCWO) is the preferred form of AC. There have been no long-term studies comparing the efficacy of HFCWO and PEP in the CF population.

Objectives To determine the long-term efficacy of HFCWO compared with PEP mask therapy in the treatment of CF as measured by the number of pulmonary exacerbations (PEs).

Methods A randomised controlled study was performed in 12 CF centres in Canada. After a 2-month washout period, subjects were randomised to perform either HFCWO or PEP mask therapy for 1 year.

Results 107 subjects were enrolled in the study; 51 were randomised to PEP and 56 to HFCWO. There were 19 dropouts within the study period, of which 16 occurred prior to or at the time of randomisation. There were significant differences between the groups in the mean number of PEs (1.14 for PEP vs 2.0 for HFCWO) and time to first PE (220 days for PEP vs 115 days for HFCWO, p=0.02). There was no significant difference in lung function, health-related quality of life scores or patient satisfaction scores between the two groups. PEP mask therapy required a shorter treatment time.

Conclusions The results of this study favour PEP and do not support the use of HFCWO as the primary form of AC in patients with CF.

Clinical Trial Registration number NCT00817180.

  • Cystic Fibrosis
  • Health Economist

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