Effective Airway Clearance Therapy

Airway clearance therapy is appropriate for any patient with impaired ability to clear pulmonary secretions. Airway clearance therapy is widely prescribed for patients with hundreds of diagnoses and conditions. To meet the growing need for assistive airway clearance therapy, a number of non-invasive techniques and devices have emerged since the 1960s.

Examples Include:

  • Vest therapy, also called high frequency chest wall oscillation (HFCWO) or high frequency chest compression (HFCC), uses air pressure and pulses to create compressions against the chest wall to help remove mucus from breathing passages.
  • Chest physiotherapy (CPT) a broad term for treatments using clapping or percussion techniques to help remove mucus from breathing passages.
  • Positive expiratory pressure (PEP) treatments use a “flutter” or oscillating positive pressure device with PEP masks or breathing devices to help remove mucus.
  • Intrapulmonary percussive ventilation (IPV) is a device designed to recreate percussive therapy techniques used by a respiratory therapist.
  • Cough-assist machines are designed to aid in secretion removal in patients with neuromuscular and other diseases.
  • Hand-held mechanical percussors create vibrations against the chest wall to loosen and help remove mucus from airways.

Technology Progression: From Chest Physiotherapy to Vest Therapy

Chest physiotherapy (CPT) is the pioneer of airway clearance therapies. CPT uses percussion, performed by a caregiver cupping or clapping on various areas of the chest and back to create impact to the chest wall that helps loosen sticky mucus. Strategic positioning of the patient helps drain mucus from smaller to larger airways where it then can be removed by coughing, swallowing or suctioning.

Manual chest physiotherapy requires 30-45 minutes, two to three times daily with a skilled, physically able, available caregiver. Patients must be able to tolerate treatments. Until 1988, manual CPT was the only airway clearance method suitable for young children.

In the early 1990s vest therapy was introduced as a technique-independent therapy that emulates the functions of CPT. Vest therapy consists of a vest garment attached to a machine that creates compressions to the chest that help loosen, thin and mobilize mucus. Vest therapy does not require special positioning techniques or manual percussion like CPT. Since its release, vest therapy efficacy and safety has been documented in a number of studies.

Vest therapy has contributed to improved or sustained long-term pulmonary function scores (PFTs),1,2.3 lower incidence of pneumonias, hospitalizations, intensive care unit (ICU) days,4,5.6 and reduced healthcare expenditures.7,8

In comparison studies, triangle waveform pulse therapy (used in the inCourage® System) improved airway secretion clearance by as much as 20% over sine wave systems – and study participants found it easier to breathe during therapy compared to sine wave systems.9