Symptom Management of Chronic Obstructive Pulmonary Disease Using High Frequency Airway Oscillations.

Introduction

Dyspnoea and sputum retention are common problems in patients with Chronic Obstructive Pulmonary Disease (COPD). A High Frequency Airway Oscillating (HFAO) device offers respiratory muscle training and oscillatory mechanism with the aim of addressing dyspnoea and sputum retention, both common symptoms in COPD. The assessment of sputum clearance is challenging due to lack of reliable outcome measures. This thesis aims to assess the feasibility and clinical effectiveness of using a HFAO device in patients with COPD and assess the feasibility and responsiveness of the Lung Clearance Index as a surrogate measure for sputum clearance.

Methods

Three main study designs were undertaken to assess the above aims.

1. Systematic review to assess the effect of airway clearance devices on sputum clearance, exacerbation frequency and health related quality of life.

2. Single arm feasibility study to assess the use of HFAO device and LCI.

3. A randomised, double blinded, sham controlled trial to determine the clinical effectiveness of the HFAO device and the response of the LCI to an intervention.

Results

The use of the HFAO device is feasible in stable COPD however in a double-blind randomised controlled trial did not demonstrate statistically significant improvements when compared to the sham. There were favourable improvements in the multidimensional dyspnoea profile however this was not significant over the sham. The LCI offers promise in the assessment of sputum clearance, and whilst this worsened following the intervention, there were improvements in peripheral ventilation (measured by the Sacin).

Conclusion

The use of HFAO device does not improve dyspnoea in patients with stable COPD. There was no identified clinical responders’ group however further research should focus on patients with frequent exacerbations. The LCI can be a valuable outcome measure in the assessment of sputum clearance when supplemented by the Sacin.